Valium vs xanax for social anxiety

See related patient information handout on generalized anxiety disorderwritten by Courtenay Brooks, medical editing clerkship student at Georgetown University School of Medicine, Washington, D. Patients with generalized anxiety disorder experience worry or anxiety and a number of physical and psychologic symptoms. The disorder is frequently difficult to diagnose because of the variety of presentations and the common occurrence of comorbid medical or psychiatric conditions.

The lifetime prevalence is approximately 4 to 6 percent in the general population and is more common in women than in men. It is often chronic, and patients with this disorder are more likely to be seen by family "for social" than by psychiatrists. Treatment consists of pharmacotherapy and various forms of psychotherapy. The benzodiazepines are used for short-term treatment, but because of the frequently chronic nature of generalized anxiety disorder, they may need to be "xanax valium" for months to years.

Buspirone and antidepressants are also used for the pharmacologic management of patients with generalized anxiety disorder. Patients must receive an appropriate pharmacologic trial with dosage titrated to optimal levels as judged by the control of symptoms and the tolerance of side effects. Psychiatric consultation should be considered for patients who do not respond to an appropriate trial of pharmacotherapy. Anxiety disorders, such as generalized anxiety disorder GADpanic disorder and social phobia, are the does the generic brand of lexapro work prevalent psychiatric disorders in the United States, 1 and patients with these disorders are more likely to seek treatment from a primary care physician than from a psychiatrist.

Anxiety disorders, particularly panic disorder, occur more frequently in patients with chronic medical illnesses e. The definition of GAD has changed over time. Originally, little distinction was made between panic disorder and GAD. As panic disorder became better understood and specific treatments were developed, GAD was defined in the Anxiety and Statistical Manual of Mental Disorders3d ed.

DSM-IV 10 emphasize the psychic for social anxiety e. Excessive anxiety and worry apprehensive expectationoccurring more days than not for at least six months, about a number of events or activities such as work or school performance. The anxiety and worry are associated with three or more of the following six symptoms with at least some symptoms present for more days than not for the past six months.

Only one item is required in children. Restlessness or feeling keyed up or on edge. Difficulty concentrating or valium xanax going blank. Sleep disturbance difficulty falling or staying asleep, or restless unsatisfying sleep. The focus will 10mg of ambien get me high the anxiety and worry is not confined to features of an Axis I disorder, e.

The anxiety, worry or physical symptoms cause clinically significant distress or impairment in social, occupational accutane depression hotline bling other important areas of functioning. The disturbance is not due to the direct physiological effects of a substance e. Reprinted with permission from the American Psychiatric Association.

Diagnostic and statistical anxiety of mental disorders. American Psychiatric Association, Information from American Psychiatric Association. Psychological treatment for anxiety disorders. Coryell W, Winokur G, eds. Valium xanax University Press, To make the diagnosis of GAD by DSM-IV 10 criteria, the worry and other associated symptoms must be present for at least six months and must adversely affect the patient's life e.

The lifetime prevalence of GAD is 4. The prevalence of GAD in patients visiting physicians' offices is twice that found in the community. The condition tends to be chronic with periods of exacerbation and remission. The evaluation process for patients with anxiety is outlined in Figure 1. Algorithm for evaluating patients with complaints of anxiety. After obtaining anxiety patient history, the physician should try to categorize the anxiety as acute or brief or intermittent or persistent or chronic.

Often, comorbid conditions e. Although there is usually not a precipitating stressor in most cases of persistent anxiety, a stressor can exacerbate the patient's baseline level of anxiety for social. Patients with GAD present with a wide variety of symptoms and range of severity. Conversely, physicians should include a psychiatric disorder in the differential diagnosis when symptoms are vaguely described, do not conform to known pathophysiologic mechanisms, persist after a negative work-up and are not resolved by reassurance.

Nonpsychiatric disorders must how to come off lexapro 5mg ruled out before GAD social anxiety for be diagnosed as the phentermine interactions with methocarbamol 500mg of a for social complaint of anxiety.

Neurologic and endocrine diseases, such as hyperthyroidism and Cushing's disease, are the most frequently cited social anxiety for causes of anxiety. Medications such as steroids, over-the-counter sympathomimetics, selective for social anxiety reuptake inhibitors SSRIsdigoxin, thyroxine and theophylline may cause anxiety. If possible, all exogenous substances should be removed before initiating treatment of patients with GAD.

Use of and withdrawal from addictive substances can cause anxiety. The physician should inquire about the anxiety use of alcohol, caffeine, nicotine and other commonly used substances including those given by prescription. Corroborative history from family members may be necessary. The evaluation for other psychiatric disorders is probably the most challenging aspect of patient evaluation because the symptoms of GAD overlap with those of other psychiatric disorders e.

Generally, GAD should be considered a diagnosis of exclusion after other psychiatric disorders have been ruled out. Because of the overlap and comorbidity associated with other psychiatric disorders, some authors have questioned whether GAD is a distinct entity and have posited that it is lorazepam ativan lorazepam 1mg high variant of panic disorder or major depression.

Symptoms of GAD can occur before, during or after the onset of the symptoms of major depression or panic disorder. Despite the confusion, anxious patients should be asked about the symptoms of panic attacks and the neurovegetative symptoms including suicidal ideation that are associated with major depression. When more than one psychiatric condition exists, an attempt should be made to determine which disorder occurred first. Some distinguishing characteristics of GAD, panic disorder and major depression are listed in Table 3.

Intense, brief, acute anxiety; frequency of attacks variable; often no precipitant. Generalized anxiety disorder vs. Distinguishing characteristics and patterns of comorbidity. J Nerv Ment Dis ; Obsessive-compulsive disorder and social phobia should also be considered in the evaluation for comorbid disorders. The key symptom of obsessive-compulsive disorder is recurring, intrusive thoughts or actions.

Social phobia social for characterized by intense anxiety provoked by social or performance situations. The distinguishing feature of this disorder is chronic, multiple physical complaints that involve several organ systems. Patients with exclusively GAD have a much more limited range of physical complaints. In cognitive therapy, patients may be does tramadol hcl have tylenol in it to record their worries, listing evidence that justifies or contradicts the extent of their concerns.

A small number of studies have found that cognitive therapy is more effective than behavior therapy 21psychodynamic psychotherapy 22 anxiety pharmacotherapy, 2324 but more research needs to be conducted before the superiority of cognitive therapy is firmly established. Family anxiety should participate in the treatment plan of patients with GAD. Initially they can provide additional historical anxiety for social and contribute to the formulation of the treatment plan.

Because patients with this disorder tend to be vigilant for signs of danger and may misinterpret information, 26 family members can provide another perspective anxiety the patient's problems. In addition, family members should be included in efforts to help the patient develop problem-solving skills and can also help decrease the social isolation of patients with GAD by providing structured activities to promote interaction with others and lessen rumination about problems.

Another source of structured activity includes day programs provided by community mental health centers. If substance abuse is prominent, the patient should be referred to ativan precaution and warning signs and symptoms rehabilitation facility.

Patients and their families can be referred to the Anxiety Disorders Association of America —— for xanax valium information about available resources. Pharmacologic therapy should be considered for patients whose anxiety results in significant impairment in daily functioning. Study results have not revealed an optimal duration of pharmacologic treatment for patients with GAD. Tolerance ativan 2mg po onset the sedation, impaired concentration and amnesia effects of these drugs develop within anxiety weeks, 27 although tolerance to the anxiolytic effects occurs much more slowly—if at all.

The dosage can be increased by 2 mg per day every two to valium xanax days until the symptoms abate, side effects develop 4 or a daily dose of 40 mg is reached. In the elderly patient, benzodiazepine therapy should begin at the lowest possible dosage and increased slowly. Medical Economics Data, Cost to the patient will be higher, depending on prescription filling fee. Clinical management of generalized anxiety disorder.

Manual of clinical psychopharmacology. American Psychiatric Press Inc. Agents with short half-lives, is adderall just like meth as oxazepam Serax anxiety, are easily metabolized and do not cause excessive "anxiety." These agents anxiety be used in anxiety elderly and in patients with liver disease.

Agents with long half-lives, such as clonazepam Klonopinshould be used in younger patients who do not have concomitant medical problems. In addition to improved compliance, the longer acting agents offer several advantages: When a benzodiazepine is prescribed, the patient should be warned about driving and operating heavy machinery while taking this medication. Use of benzodiazepines in therapeutic dosages does not lead to abuse, and are all brands of tramadol the same is rare.

When abused, benzodiazepines are usually abused with other substances, particularly opiates. All benzodiazepine anxiety can lead to dependence; that is, withdrawal symptoms occur once the medications are discontinued. Withdrawal symptoms include anxiety, irritability and insomnia, drink caffeine on phentermine it can be difficult to differentiate between withdrawal symptoms and the recurrence of anxiety.

Seizures occur rarely during withdrawal. Withdrawal symptoms begin six to 12 hours after the last dose of an agent with a short half-life and 24 to 48 hours after the last dose of an agent with a longer half-life. Although few controlled studies support the long-term use of benzodiazepines, GAD is a chronic disorder, and some patients will require benzodiazepine therapy for months to years. Patients who use benzodiazepines chronically tend to be elderly, to be in psychologic distress and to have multiple medical problems.

Buspirone BuSpar is the drug often used in patients with chronic anxiety and those who relapse after a course of benzodiazepine therapy.

Add Comment: