Summary case 4 biology

Case 4 Biology

1. What medication exists to treat anxiety
- Benzodiazepines use, abuse and dependence
o They have a direct effect on the anxiety you feel right now.
o 2 abuse patterns
 Deliberate abuse by people who use drugs for their euphoriant effects
(mostly to get high)
 Unintentional abuse by patients who begin using benzodiazepines to
treat anxiety disorders and end up using them inappropriately. (taking
higher doses then the doctor prescribed or taking it longer than
prescribed)
 People who abuse benzodiazepines might get dependent on them
 2 types of dependence
 Physical or pharma logical dependence
 Addiction
o Pharmalogic dependence vs. addiction
 Addicted people are usually physical dependent (however not a
required criteria for addiction) but physical dependent people are not
necessarily addicted.
 Addiction requires evidence of compulsive drug seeking behaviour and
loss of control.
 Physical dependence can result from long term regular use
 Addiction: tolerance of the drug and need for increasing amounts to
achieve intoxication or the desired effect
o Deliberate abuse of benzodiazepines
 Often begins as prescription misuse and is usual recreational and thrill
seeking behaviour.
 Sometimes used in conjunction with other substances to improve the
desired effect.
o Variables effecting the abusers choice of benzodiazepine
 Drug effect: a lot of variation in the half time of the benzodiazepines,
abusers choose more often for a type with a quick onset, a rapid offset
increases abuse potential, the age of the individual has a big effect on
the half time of the drug (in older persons a longer half time because it
takes longer to break the drug down)
 Tolerance: tolerance does develop and over time higher doses are
necessary to get the desired effect.
 Relative high
 Street value
 Use again value
o Dependence on benzodiazepines without intentional abuse
 Most unintentional abusers are unaware of their dependence until they
abruptly try to discontinue using the drugs
 The withdrawal symptoms are usually short in duration and should be
differentiated from a relapse of anxiety.
o Long term use of benzodiazepines
 Previous they thought they did not work in the long term because of the
tolerance but this is not true

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,o Withdrawal from benzodiazepines
 Occur when a decline in blood or tissue concentration
 Symptoms are time limited, mostly 1 or 2 weeks
 The symptoms are often the opposite of the acute effect of the drug
 3 factors that influence the intensity and duration of the withdrawal
 Amount of time spent in treatment
 Dose of the medication
 Half time/life of the benzodiazepine
o Withdrawal vs. relapse of anxiety
 2 specific differences
 Length of time between discontinuation of treatment and
appearance of symptoms, tendency of the symptoms to improve
or worsen
o Withdrawal: symptoms after 1 or 2 days after stopping
drug use, over time the symptoms improve/lessen
o Relapse: more than a week after stopping drug use,
symptoms get worse over time
 The symptoms itself
o Withdrawal also shows other symptoms that have
nothing to do with the disorder
 Pseudowithdrawal: a psychological or subjective withdrawal that
occurs as a result of a patients apprehension about discontinuing
medication. It consists of anxious symptoms without the other true
withdrawal symptoms.
o Clinical options for discontinuing benzodiazepine treatment
 Gradual taper: a quarter of the daily dose is generally the maximum
amount of medication that should be reduced in one week. Therefore
the minimum time for tapering is 4 weeks. The patient may still
experience some withdrawal symptoms for as long as the tapering
continues
 Substitution with a long-acting benzodiazepine or phenobarbital:
switching to a long acting instead of short acting may prevent or lessen
withdrawal symptoms. They also have a longer half time. Phenobarbital
less effective than long acting benzodiazepine successfully tapering
sedative hypnotics but equally or more effective when used to counter
recurrent or rebound anxiety.
 Treating the symptoms of withdrawal: medication to treat symptoms as
tremor, anxiety and seizure
 Continued treatment with benzodiazepines: continue treatment in a low
dose.




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, o
- Alternatives to tranquillizers
o Beta receptor blockers
 With beta-blockers, i.e., substances which occupy a subgroup of
adrenergic (NE receptors) receptors and protect them against the action
of released cathecholamines, the vegetative arousal is reduced, so that a
state of excitement can lose much of its severity. It reduces sumpathic
activity (physical fear response). antagonists
 While te vegatative symptoms of stress can be eliminated with beta
blockers, mental clarity or artistic performance are not adversely
affected.
 Beta blockers are usually well tolerated, but contraindications include
asthma, bronchospasm and certain cardiac arythmias, blood pressure
etc.
 Not effective for GAD because GAD mainly consists of cognitive
symptoms.
o Alprazolam and antidepressants
 Alprazolam is a benzodiazepine derivative with a rather short half-life
which is used as an anxiolytic and in larger doses for the treatment of
panic attacks.
 As alternatives for tranquillizers antidepressants have recently been
recommended for the treatment of panic attacks and OCD. SSRI’s are
particularly suitable for the treatment of panic disorder . they mainly
reduce the number of panic attacks but have little effect ont the severity
of the remaining anxiety effects.
 OCD that is not treatable with psychotherapy is today treated with
serotoninergic antidepressants.
o Psychotherapy and/or drug therapy
 Combined behavioural and tranquillizers therapy showed better results
with behaviour therapy alone.
 Psychotherapy can have the same effect size as pharmaceuticals.
- Drugs for treating anxiety
o Called anxiolytics. Many belong to the class of sedative-hypnotics, which is
part of a larger category called CNS depressants. CNS depressants reduce
neuron excitability.


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