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» Home » CAD » Psychiatry » Psychiatry Disorder » Anxiety
Background
Fear is an innate neurophysiological condition of alarm marked by a fight-or-flight reaction to a perception of a threat that is either immediate or present. Fear is related to anxiety, which appears as a future-focused emotional state that involves a sophisticated affective, cognitive, behavioral, and physiological alert system geared at preparing for impending events or situations that are viewed as threatening.
When there is an exaggerated perception of threat or an incorrect assessment of the danger in a scenario, pathologic anxiety is set off, leading to inappropriate and excessive behaviors. One of the more prevalent psychiatric diseases is anxiety, although the exact incidence is unknown because many sufferers don’t seek treatment or doctors don’t correctly diagnose them.
Epidemiology
In the general public, anxiety is among the most prevalent psychiatric diseases. With prevalence estimates of 12.1 percent over a 12-month period, specific phobia ranks as the most prevalent. The second most prevalent condition is social phobia disorder, with a twelve-month incidence of 7.4 percent.
With a prevalence estimate of 2.5 percent during a twelve-month period, agoraphobia is the least prevalent anxiety illness. An average 2:1 proportion favors females with anxiety illness over males.
Anatomy
Pathophysiology
Norepinephrine, GABA (gamma-aminobutyric acid), dopamine, and serotonin are regarded to be the major regulators of anxiety in the CNS. The majority of symptoms are mediated by the autonomic system, particularly the sympathetic system. The amygdala is crucial in regulating anxiety and fear.
An elevated amygdala reaction to anxiety stimuli has been observed in patients who suffer from anxiety. Prefrontal-limbic activity imbalances may be corrected with psychological and medication therapies since the amygdala & limbic network structures are related to certain prefrontal cortical areas.
Etiology
There is evidence that a combination of biopsychosocial variables contributes to anxiety illness. Traumatic or stressful circumstances interact with genetic susceptibility to create clinically severe disorders.
The following conditions can contribute to anxiety:
Trauma
Medications
Panic disorders
Herbal supplements
Early life experiences
Abusing drugs
Genetics
Prognostic Factors
Substance addiction, alcoholism, & serious depression all have very significant morbidity rates when it comes to anxiety illness. Constant anxiousness also raises the possibility of unfavorable cardiovascular problems.
Others experience a worsening of their life quality or a reduction in social interaction due to anxiety. High suicide rates have also been connected to extreme anxiety.
Clinical History
Physical Examination
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
by Stage
by Modality
Chemotherapy
Radiation Therapy
Surgical Interventions
Hormone Therapy
Immunotherapy
Hyperthermia
Photodynamic Therapy
Stem Cell Transplant
Targeted Therapy
Palliative Care
Medication
30
mg
Tablet
Orally
once a day
Adjust dose in the range of 15-60 mg/kg
2 - 10
mg
Orally
every 6 hrs
Indicated for Post-traumatic stress disorder :
0.5 - 8
mg/day
Orally
Dose Adjustments
Hepatic impairment
The recommended starting dose for patients with mild to moderate liver impairment is 0.5 mg once daily, gradually increasing to a maximum of 2-3 mg daily. For patients with severe liver impairment, the starting dose is typically 0.25 mg once daily, gradually increasing to a maximum of 1-2 mg daily
It's important to note that the pharmacokinetics of risperidone may be affected in patients with liver impairment, and there may be an increased risk of adverse reactions. Therefore, a healthcare provider should closely monitor patients with liver impairment
Renal impairment
It is eliminated primarily by the liver, with a small portion eliminated by the kidneys. Therefore, modifications to the dosing may not typically be necessary for patients with renal impairment
1200 to 1600mg/day orally divided a day thrice. Do not exceed 2.4g/day
Dose Adjustments
Renal Impairment
CrCl 10–50 mL/min: Modify the administration schedule every 9 to 12 hours
CrCl 10 mL/min: Adjust delivery frequency to 12–18 hours
A dose of 0.25-0.5 mg orally every 6 to 8 hours is indicated for 3 to 4 days
Do not outreach the drug dose to more than 4 mg/day
Initially 2-3 mg orally every 8 to 12 hours as and when required
Do not exceed more than 10 mg/day
Maintain the dose at 2-6 mg per day orally every 8-12 hours
Short term treatment of insomnia-
2-4 mg of a tablet orally as and when required
10 mg orally each day
Increase the dose to 20 mg/day after a week
Maintain the lowest effective dose
Assess the need for extended therapy if required
levomepromazine (methotrimeprazine)
Initially, 6-25 mg/day orally in divided doses with food
Increase the dose based on tolerability and response
Indicated for anxiety or agitation associated with depression, severe agitation with chronic pathophysiology
Initially, 25 mg/2 mg or 25 mg/4 mg orally 3-4 times daily
or
50 mg/4 mg orally twice daily
Flexibility can be increased by adjustment of maintenance dose through 10 mg/2 mg & 10 mg/4 mg
Do not exceed the daily dose of more than 200 mg/16 mg
Take a dose of 250 mg orally after meals every 8 hours and daily dose not more than 2 g
Dosing modification
Renal Impairment
Not recommended
Hepatic Impairment
Not recommended
Administration
When the patient has been consistently taking high doses of the medication for extended periods of time
It is recommended to gradually reduce the dosage over a period of two weeks before completely discontinuing
Indicated for anxiety and stress
60 mg extract orally 2-3 times daily
600 mg dried leaves orally 3 times daily
1 cup of tea orally 3 times daily, 600 mg dried leaves in 150 ml of water
70% of standardized extract: Administer 100mg orally thrice a day
Root tea: Administer one cup orally thrice a day; use 2 to 4 g of root in 150 ml water
Kava lactones-Administer 60 to 120 mg/day orally
Put 1 drop via sublingual route daily
Dosing modification
Renal Impairment
Drug modification not required
Hepatic Impairment
Drug modification not required
The starting oral dose is 20 mg Thrice daily
The Maximum dose is 160 mg
Indicated for Anxiety, Hyperthyroidism, Nervousness, breast pain, PMS
0.2 gm-2 gm of whole herb orally every day
Or
Two tablets (i.e., 40 mg) orally every day
Administer 15 to 60mg as a single dose or divided doses orally at bedtime
Administer 15 to 60mg as a single dose or divided doses orally at bedtime.
Indicated for Anxiety disorders
The recommended dose is 5-20 mg/day orally
Dosage regimens are individualized, starting with lower initial doses and incrementally elevating them until they reach the ideal level
Regular dose outpatient
The suggested dose is 1.5 to 3 mg orally up to every 8 hours a day
Serious hospitalized
The suggested dose is 6 to 12 mg orally up to every 8-12 hours a day
The maximum suggested dose is 60 mg orally in a day
Duration of Treatment
The duration should be minimized, ideally within eight to twelve weeks encompassing a gradual reduction phase
The suggested dose is 50 mg three times a day orally
Initially, administer 15 to 30 mg daily in two divided dosages. Administer the larger doses at bedtime
Short course treatment:
Take 10 to 30 mg orally a day with divided doses
In severity of the condition, dosage can be elevated to a maximum of 60 mg in a day
<6 years old: Not recommended
6 to 12 years old: 100 to 200mg orally twice a day
>12 years old:
1200 to 1600mg/day orally divided a day thrice. Do not exceed 2.4g/day
Take 25 to 50 mg/kg daily orally divided every 6 to 8 hours and dose not more than 500 mg
2 - 2.5
mg
Orally
every 12 hrs
200mg orally twice a day
A lower dose of 1-2 mg orally is indicated every 8 to 12 hours
The starting oral dose is 20 mg two times daily
The maximum suggested dose is 3 mg orally every day to be taken in divided doses
Debilitated patients
The maximum suggested dose is 3 mg orally every day to be taken in divided doses
Initially, administer 5 to 10 mg per day in the divided dosages. Administer the larger doses at night. Maintenance dose: 15mg/day
Future Trends
References
https://www.ncbi.nlm.nih.gov/books/NBK470361/
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» Home » CAD » Psychiatry » Psychiatry Disorder » Anxiety
Fear is an innate neurophysiological condition of alarm marked by a fight-or-flight reaction to a perception of a threat that is either immediate or present. Fear is related to anxiety, which appears as a future-focused emotional state that involves a sophisticated affective, cognitive, behavioral, and physiological alert system geared at preparing for impending events or situations that are viewed as threatening.
When there is an exaggerated perception of threat or an incorrect assessment of the danger in a scenario, pathologic anxiety is set off, leading to inappropriate and excessive behaviors. One of the more prevalent psychiatric diseases is anxiety, although the exact incidence is unknown because many sufferers don’t seek treatment or doctors don’t correctly diagnose them.
In the general public, anxiety is among the most prevalent psychiatric diseases. With prevalence estimates of 12.1 percent over a 12-month period, specific phobia ranks as the most prevalent. The second most prevalent condition is social phobia disorder, with a twelve-month incidence of 7.4 percent.
With a prevalence estimate of 2.5 percent during a twelve-month period, agoraphobia is the least prevalent anxiety illness. An average 2:1 proportion favors females with anxiety illness over males.
Norepinephrine, GABA (gamma-aminobutyric acid), dopamine, and serotonin are regarded to be the major regulators of anxiety in the CNS. The majority of symptoms are mediated by the autonomic system, particularly the sympathetic system. The amygdala is crucial in regulating anxiety and fear.
An elevated amygdala reaction to anxiety stimuli has been observed in patients who suffer from anxiety. Prefrontal-limbic activity imbalances may be corrected with psychological and medication therapies since the amygdala & limbic network structures are related to certain prefrontal cortical areas.
There is evidence that a combination of biopsychosocial variables contributes to anxiety illness. Traumatic or stressful circumstances interact with genetic susceptibility to create clinically severe disorders.
The following conditions can contribute to anxiety:
Trauma
Medications
Panic disorders
Herbal supplements
Early life experiences
Abusing drugs
Substance addiction, alcoholism, & serious depression all have very significant morbidity rates when it comes to anxiety illness. Constant anxiousness also raises the possibility of unfavorable cardiovascular problems.
Others experience a worsening of their life quality or a reduction in social interaction due to anxiety. High suicide rates have also been connected to extreme anxiety.
30
mg
Tablet
Orally
once a day
Adjust dose in the range of 15-60 mg/kg
2 - 10
mg
Orally
every 6 hrs
Indicated for Post-traumatic stress disorder :
0.5 - 8
mg/day
Orally
Dose Adjustments
Hepatic impairment
The recommended starting dose for patients with mild to moderate liver impairment is 0.5 mg once daily, gradually increasing to a maximum of 2-3 mg daily. For patients with severe liver impairment, the starting dose is typically 0.25 mg once daily, gradually increasing to a maximum of 1-2 mg daily
It's important to note that the pharmacokinetics of risperidone may be affected in patients with liver impairment, and there may be an increased risk of adverse reactions. Therefore, a healthcare provider should closely monitor patients with liver impairment
Renal impairment
It is eliminated primarily by the liver, with a small portion eliminated by the kidneys. Therefore, modifications to the dosing may not typically be necessary for patients with renal impairment
1200 to 1600mg/day orally divided a day thrice. Do not exceed 2.4g/day
Dose Adjustments
Renal Impairment
CrCl 10–50 mL/min: Modify the administration schedule every 9 to 12 hours
CrCl 10 mL/min: Adjust delivery frequency to 12–18 hours
A dose of 0.25-0.5 mg orally every 6 to 8 hours is indicated for 3 to 4 days
Do not outreach the drug dose to more than 4 mg/day
Initially 2-3 mg orally every 8 to 12 hours as and when required
Do not exceed more than 10 mg/day
Maintain the dose at 2-6 mg per day orally every 8-12 hours
Short term treatment of insomnia-
2-4 mg of a tablet orally as and when required
10 mg orally each day
Increase the dose to 20 mg/day after a week
Maintain the lowest effective dose
Assess the need for extended therapy if required
levomepromazine (methotrimeprazine)
Initially, 6-25 mg/day orally in divided doses with food
Increase the dose based on tolerability and response
Indicated for anxiety or agitation associated with depression, severe agitation with chronic pathophysiology
Initially, 25 mg/2 mg or 25 mg/4 mg orally 3-4 times daily
or
50 mg/4 mg orally twice daily
Flexibility can be increased by adjustment of maintenance dose through 10 mg/2 mg & 10 mg/4 mg
Do not exceed the daily dose of more than 200 mg/16 mg
Take a dose of 250 mg orally after meals every 8 hours and daily dose not more than 2 g
Dosing modification
Renal Impairment
Not recommended
Hepatic Impairment
Not recommended
Administration
When the patient has been consistently taking high doses of the medication for extended periods of time
It is recommended to gradually reduce the dosage over a period of two weeks before completely discontinuing
Indicated for anxiety and stress
60 mg extract orally 2-3 times daily
600 mg dried leaves orally 3 times daily
1 cup of tea orally 3 times daily, 600 mg dried leaves in 150 ml of water
70% of standardized extract: Administer 100mg orally thrice a day
Root tea: Administer one cup orally thrice a day; use 2 to 4 g of root in 150 ml water
Kava lactones-Administer 60 to 120 mg/day orally
Put 1 drop via sublingual route daily
Dosing modification
Renal Impairment
Drug modification not required
Hepatic Impairment
Drug modification not required
The starting oral dose is 20 mg Thrice daily
The Maximum dose is 160 mg
Indicated for Anxiety, Hyperthyroidism, Nervousness, breast pain, PMS
0.2 gm-2 gm of whole herb orally every day
Or
Two tablets (i.e., 40 mg) orally every day
Administer 15 to 60mg as a single dose or divided doses orally at bedtime
Administer 15 to 60mg as a single dose or divided doses orally at bedtime.
Indicated for Anxiety disorders
The recommended dose is 5-20 mg/day orally
Dosage regimens are individualized, starting with lower initial doses and incrementally elevating them until they reach the ideal level
Regular dose outpatient
The suggested dose is 1.5 to 3 mg orally up to every 8 hours a day
Serious hospitalized
The suggested dose is 6 to 12 mg orally up to every 8-12 hours a day
The maximum suggested dose is 60 mg orally in a day
Duration of Treatment
The duration should be minimized, ideally within eight to twelve weeks encompassing a gradual reduction phase
The suggested dose is 50 mg three times a day orally
Initially, administer 15 to 30 mg daily in two divided dosages. Administer the larger doses at bedtime
Short course treatment:
Take 10 to 30 mg orally a day with divided doses
In severity of the condition, dosage can be elevated to a maximum of 60 mg in a day
<6 years old: Not recommended
6 to 12 years old: 100 to 200mg orally twice a day
>12 years old:
1200 to 1600mg/day orally divided a day thrice. Do not exceed 2.4g/day
Take 25 to 50 mg/kg daily orally divided every 6 to 8 hours and dose not more than 500 mg
2 - 2.5
mg
Orally
every 12 hrs
200mg orally twice a day
A lower dose of 1-2 mg orally is indicated every 8 to 12 hours
The starting oral dose is 20 mg two times daily
The maximum suggested dose is 3 mg orally every day to be taken in divided doses
Debilitated patients
The maximum suggested dose is 3 mg orally every day to be taken in divided doses
Initially, administer 5 to 10 mg per day in the divided dosages. Administer the larger doses at night. Maintenance dose: 15mg/day
https://www.ncbi.nlm.nih.gov/books/NBK470361/
Fear is an innate neurophysiological condition of alarm marked by a fight-or-flight reaction to a perception of a threat that is either immediate or present. Fear is related to anxiety, which appears as a future-focused emotional state that involves a sophisticated affective, cognitive, behavioral, and physiological alert system geared at preparing for impending events or situations that are viewed as threatening.
When there is an exaggerated perception of threat or an incorrect assessment of the danger in a scenario, pathologic anxiety is set off, leading to inappropriate and excessive behaviors. One of the more prevalent psychiatric diseases is anxiety, although the exact incidence is unknown because many sufferers don’t seek treatment or doctors don’t correctly diagnose them.
In the general public, anxiety is among the most prevalent psychiatric diseases. With prevalence estimates of 12.1 percent over a 12-month period, specific phobia ranks as the most prevalent. The second most prevalent condition is social phobia disorder, with a twelve-month incidence of 7.4 percent.
With a prevalence estimate of 2.5 percent during a twelve-month period, agoraphobia is the least prevalent anxiety illness. An average 2:1 proportion favors females with anxiety illness over males.
Norepinephrine, GABA (gamma-aminobutyric acid), dopamine, and serotonin are regarded to be the major regulators of anxiety in the CNS. The majority of symptoms are mediated by the autonomic system, particularly the sympathetic system. The amygdala is crucial in regulating anxiety and fear.
An elevated amygdala reaction to anxiety stimuli has been observed in patients who suffer from anxiety. Prefrontal-limbic activity imbalances may be corrected with psychological and medication therapies since the amygdala & limbic network structures are related to certain prefrontal cortical areas.
There is evidence that a combination of biopsychosocial variables contributes to anxiety illness. Traumatic or stressful circumstances interact with genetic susceptibility to create clinically severe disorders.
The following conditions can contribute to anxiety:
Trauma
Medications
Panic disorders
Herbal supplements
Early life experiences
Abusing drugs
Substance addiction, alcoholism, & serious depression all have very significant morbidity rates when it comes to anxiety illness. Constant anxiousness also raises the possibility of unfavorable cardiovascular problems.
Others experience a worsening of their life quality or a reduction in social interaction due to anxiety. High suicide rates have also been connected to extreme anxiety.
https://www.ncbi.nlm.nih.gov/books/NBK470361/
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