Obsessive-Compulsive Disorder
- Repeated intrusive thoughts, impulses, or images,
recognized as irrational
- Compulsive ritualistic behaviors such as cleaning or
checking
- May present with skin excoriation or excessive picking
and scratching
- Diagnosed when obsessions, compulsions, or both are
present for ≥ 1 hr/day or are present at a level that interferes with
functioning
Specific Phobias
- Fear and avoidance of a specific place, activity, or
situation
- Medically relevant phobias
- Blood and injection phobias
- Vasovagal reactions common (unlike other
anxiety/phobic reactions)
- Dental phobias
- Phobia of childbirth
Best
Therapy
Drug Therapy
Selective Serotonin Reuptake Inhibitors
(SSRIs)
- Any SSRI can be used to treat any anxiety disorder
- Selection based on side effect profile (e.g., activating
versus sedating), potential for interactions with other drugs the patient is
taking, and cost
- Patients who do not respond to one SSRI may respond to
another
- Elevated risk of increased suicidal ideation or behavior
during the initial period after starting SSRIs
- Patients should be seen more frequently during the
first 3 months of SSRI use
- Patients and family members should be advised to
immediately report any suicidal symptoms
- Citalopram
- Relatively more sedating
- Dose: 20 mg q.d. (starting dose); 20–60 mg q.d.
(target dose)
- Cost/mo: $120
- Escitalopram
- Relatively more sedating
- Dose: 10 mg q.d. (starting dose); 10–20 mg q.d.
(target dose)
- Cost/mo: $76
- Fluoxetine
- Relatively more activating
- Dose: 5-10 mg q.d. (starting dose); 20–80 mg q.d.
(target dose)
- Cost/mo: $83
- Fluvoxamine
- Relatively more sedating
- Dose: 50 mg h.s. (starting dose); 100–300 mg in two
divided doses (target dose)
- Cost/mo: $234
- Paroxetine
- Relatively more sedating
- Dose: 10 mg q.d. (starting dose); 10–60 mg q.d.
(target dose)
- Cost/mo: $74
- Sertraline
- Relatively more activating
- Dose: 25–50 mg q.d. (starting dose); 50–200 mg q.d.
(target dose)
- Cost/mo: $152
Drug Treatment for Panic Disorder
- Imipramine
- Dose: 10–25 mg q.d. (starting dose); 150–200 mg q.d.
(target dose)
- Cost/mo: $47
- SSRI
- Alprazolam
- Dose: 0.25–0.50 mg b.i.d. or t.i.d. (starting dose);
0.5–2.0 mg b.i.d. or t.i.d. (target dose)
- Cost/mo: $18
Drug Treatment for PTSD
Drug Treatment
for Generalized Anxiety Disorder
- SSRI
- Venlafaxine
- Dose: 75 mg q.d. in two or three divided doses
(starting dose); 150-300 mg q.d. in two or three divided doses (target
dose)
- Cost/mo: $170
Drug Treatment for Social Anxiety Disorder
Drug Treatment
for Obsessive-Compulsive Disorder
- Clomipramine
- Dose: 25–50 mg q.d. (starting dose); 150–300 mg q.d.
(target dose)
- Cost/mo: $78
Psychological Treatment for Anxiety Disorders
- Cognitive-behavioral psychotherapy
- As effective as medication in treating panic
disorder
- Highly effective in some cases of rape-related
PTSD
- May prevent PTSD in some patients with ASD
- Effective in treatment of social phobias
- Highly effective in treatment of obsessive-compulsive
disorder
- Beneficial in treatment of specific phobias
The author has received grants for
clinical research from Pfizer, Inc., and Forest Pharmaceuticals, Inc., and has
served as a consultant for and member of the speakers' bureaus of Pfizer, Inc.,
and GlaxoSmithKline.
Best References
Ballenger JC: Biol Psychiatry 46:1579, 1999 [PMID
10599485]
Hidalgo RB, et al: Med Clin North Am 85:691, 2001 [PMID
11349480]
Stein MB, et al: J Fam Pract 48:514, 1999 [PMID
10428248]
Zaubler TS, et al: J Psychosom Res 44:25, 1998 [PMID
9483462]
November
2006
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