Anxiolytics: Difference between revisions
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:*[[Traumatic brain injury]] | :*[[Traumatic brain injury]] | ||
*Other sedative-, hypnotic, or anxiolytic-induced disorders | *Other sedative-, hypnotic, or anxiolytic-induced disorders | ||
:*sedative,hypnotic,or anxiolytic-induced anxiety disorder<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | :*sedative, hypnotic, or anxiolytic-induced anxiety disorder<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | ||
===DSM-V Diagnostic Criteria for Sedative, Hypnotic, or Anxiolytic Intoxication<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>=== | ===DSM-V Diagnostic Criteria for Sedative, Hypnotic, or Anxiolytic Intoxication<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>=== | ||
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==Anxiolytic Use Disorder== | ==Anxiolytic Use Disorder== | ||
===Differential Diagnosis=== | ===Differential Diagnosis=== | ||
*[[Alcohol use disorder]] | * [[Alcohol use disorder]] | ||
*Clinically appropriate use of sedative, hypnotic, or anxiolytic medications | *Clinically appropriate use of sedative, hypnotic, or anxiolytic medications | ||
*Other mental disorders | *Other mental disorders | ||
:*[[Generalized anxiety disorder]] | :*[[Generalized anxiety disorder]] | ||
*Medical conditions | * Medical conditions | ||
:*[[Multiple sclerosis]] | :*[[Multiple sclerosis]] | ||
:*[[Subdural hematoma]]<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | :*[[Subdural hematoma]]<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | ||
| Line 143: | Line 143: | ||
*Environmental factors | *Environmental factors | ||
*Early onset of use | *Early onset of use | ||
*Genetic predisposition | *Genetic predisposition | ||
*Peer | *Peer use of the substance<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | ||
===DSM-V Diagnostic Criteria for Sedative, Hypnotic, or Anxiolytic Use Disorder<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>=== | ===DSM-V Diagnostic Criteria for Sedative, Hypnotic, or Anxiolytic Use Disorder<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>=== | ||
Revision as of 15:58, 14 November 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]
Overview
An anxiolytic is a drug prescribed for the treatment of symptoms of anxiety. Some anxiolytics have been shown to be useful in the treatment of anxiety disorders as have antidepressants such as the class of selective serotonin reuptake inhibitors (SSRIs).
Though not anxiolytics, beta-receptor blockers such as propranolol and oxprenolol can be used to combat the somatic symptoms of anxiety.
Types of Anxiolytics
Anxiolytics are generally divided into two groups of medication, benzodiazepines and non-benzodiazepines.
Benzodiazepines
- Main article: Benzodiazepine
Benzodiazepines are prescribed for short-term relief of severe and disabling anxiety. Common medications are lorazepam (Ativan), clonazepam (Klonopin), alprazolam (Xanax), and diazepam (Valium). Benzodiazepines may also be indicated to cover the latent periods associated with the medications prescribed to treat an underlying anxiety disorder. They are used to treat a wide variety of conditions and symptoms and are usually a first choice when short-term CNS sedation is needed. Longer term uses include treatment for severe anxiety and psychosis. There is a risk of withdrawal symptoms and rebound syndrome after continuous usage past two weeks. There is also the added problem of the accumulation of drug metabolites and adverse effects.
Non-Benzodiazepines
Buspirone (Buspar) is a serotonin 1A agonist. It lacks the sedation and the dependence associated with benzodiazepines and causes much less cognitive impairment. It may be less effective than benzodiazepines in patients who have been previously treated with benzodiazepines as the medication does not provide the sedation that these patients may expect or equate with anxiety relief.
Barbiturates
Barbiturates and meprobamate exert an anxiolytic effect linked to the sedation they cause. The risk of abuse and addiction is high. Many experts consider these drugs as obsolete for treating anxiety, although they may be valuable for the short term treatment of severe insomnia.
Herbal Treatments
Certain herbs, such as St. John's wort, kava (kava kava), chamomile, bacopa monniera and Valerian are reputed to have anxiolytic properties. With the exception of kava kava, only limited evidence exists for their efficacy.[1][2]
Use of marijuana as an anxiolytic has seen promising results in regions where its practical study is possible, but its status as a controlled substance in many countries make its study as such difficult.
Alternatives to Medication
Psychotherapy (e.g. cognitive or behavior therapy) is often useful as an adjunct to pharmacotherapy or as an alternative to medication.
Anxiolytic Withdrawal
Differential Diagnosis
- Alcohol withdrawal
- Anxiety disorders
- Essential tremor
- Other medical disorders
- Hypoglycemia
- Diabetic ketoacidosis
- Seizure due to infections,head injury,poisonings
- Other sedative,hypnotic,or anxiolytic induced disorders[3]
DSM-V Diagnostic Criteria for Sedative, Hypnotic, or Anxiolytic Withdrawal[3]
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AND
AND C. The signs or symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. AND D. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance. Specify if:
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Anxiolytic Intoxication
Differential Diagnosis
- Alcohol use disorders
- Alcohol intoxication
- Neurocognitive disorders
- Other sedative-, hypnotic, or anxiolytic-induced disorders
- sedative, hypnotic, or anxiolytic-induced anxiety disorder[3]
DSM-V Diagnostic Criteria for Sedative, Hypnotic, or Anxiolytic Intoxication[3]
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AND
AND
1. Slurred speech. 2. Incoordination. 3. Unsteady gait. 4. Nystagmus. 5. Impairment in cognition (e.g., attention, memory). 6. Stupor or coma. AND
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Anxiolytic Use Disorder
Differential Diagnosis
- Alcohol use disorder
- Clinically appropriate use of sedative, hypnotic, or anxiolytic medications
- Other mental disorders
- Medical conditions
Epidemiology and Demographics of Sedative, Hypnotic, or Anxiolytic Use Disorder
Prevalence
The 12 month prevalence of hypnotic or anxiolytic use disorder is:
- 300 per 100,000 (0.3%) among adults 12-17 years old
- 200 per 100,000 among adults 18 years and older[3]
Risk Factors
- Availability of the substances
- Alcohol use disorder
- Environmental factors
- Early onset of use
- Genetic predisposition
- Peer use of the substance[3]
DSM-V Diagnostic Criteria for Sedative, Hypnotic, or Anxiolytic Use Disorder[3]
| “ |
Note: This criterion is not considered to be met for individuals taking sedatives, hypnotics, or anxiolytics under medical supervision.
Note: This criterion is not considered to be met for individuals taking sedatives, hypnotics, or anxiolytics under medical supervision.
Specify if:
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References
- ↑ http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16428031&query_hl=1&itool=pubmed_DocSum
- ↑ http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17145239&query_hl=3&itool=pubmed_DocSum
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.