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11. Mental/psychical disorders in adults
Anxiety
A p a tie nt s uffe r ing fr om a nxie ty ha s :
– p s yc hic a l s ym p tom s : p e r v a s iv e w or r ie s , e .g. fe a r of ha v ing a s e r ious
illne s s , fe a r w ith
no c le a r ly-d e fine d obje c t or p hobia s ;
– be ha v iour a l c ha nge s : ne r v ous ne s s , a v oid a nc e be ha v iour ;
– p h ys ic a l s ym p tom s : e .g., d r y m outh, “lum p in the thr oa t,” n ons p e c ific
c om p la in ts
(e .g. fe e ling of m a la is e , hot fla s he s or c hills , d iffus e p a in).
A nxie ty is a c om m on fe a tur e in d e p r e s s ion (p a ge 2 9 7 ), p os t-tr a um a tic s tr e s s
d is or d e r
(p a ge 2 9 5 ) a nd p s yc hos is (p a ge 3 0 0 ). I t c a n a ls o oc c ur in is ola tion, not
a s s oc ia te d w ith
a ny othe r m e nta l d is or d e r s . A nxie ty d is or d e r s ofte n oc c ur im m e d ia te ly a fte r
a d iffic ult
life e v e nt.
s im p le r e la xa tion te c hniq ue s to a lle v ia te the s ym p tom s .
Management
dTiarzyeptoamd: e5 tetor1m0inme gthPe Os ouorrc1e0ofmthge IMa n,xtioebtye arnedp er eaatesds uarfetetrh oenpe ahtoieurnti.f Irfe q uir e d .
ne c e s s a r y, us e
Se v e r e a nxie ty m a y jus tify a s hor t c our s e (on1e to tw o w e e ks m a x.) of diazepam P
If s ym p tom s a r e e xa c e r ba te d (e .g., ta c hyc a r d ia , fe e ling of s uffoc a tion, fe a r of
d ying or
H“gaoloinpgercidroal PzyO,” aagtitva etiorny,lorwc odnovseer saendly, fpor oas str haotirotnp),eitrmioda oyfbteimnee c(1e ms sga/ rdyatoy in 2 d iv
a d m inis te r
2
1 0 m g/ d a y in 2 d iv id e d d os e s ; r e d uc in g t h e d os e by h a lf in t h e la s t fe w
d a ys of
tr e a tm e nt.
If s ym p tom s r e c ur a fte r tr e a tm e nt d is c ontinua tion, d o not r e s um e d ia ze p a m .
for m a xim um 2 to 4 w e e ks ) m a y be us e d for its a nxiolytic p r op e r tie s if a
tr e a tm e nt is
s t ill n e e d e d . H ow e v e r , be for e p r e s c r ibin g h a lop e r id ol, r e - e v a lua t e for
p os s ible
d e p r e s s ion or p os t-tr a um a tic s tr e s s d is or d e r (s e e p a ge s 2 9 5 a nd 2 9 7 ).
F or ge n e r a lis e d a n xie t y, a n a n t id e p r e s s a n t w it h a n xiolyt ic p r op e r t ie s is
p r e fe r r e d
(paroxetine P O : 1 0 to 2 0 m g m a xim um onc e d a ily a t be d tim e ), to be c ontinue d for
2 to
3 m onths a fte r s ym p tom s r e s olv e the n, s top gr a d ua lly ov e r 2 w e e ks .
F or r e c ur r ing a tta c ks (p a nic d is or d e r ), clomipramine P O m a y be p r e s c r ibe d to
p r e v e nt
r e c ur r e nc e s : 2 5 m g onc e d a ily, to be gr a d ua lly inc r e a s e d to 7 5 m g onc e d a ily.
C ontinue
for 2 to 3 m onths a fte r s ym p tom s r e s olv e the n, s top gr a d ua lly (ov e r 3 to 4
w e e ks ) w hile
m onitor ing the p a tie nt for r e c ur r e nc e of s ym p tom s .
Anxiety
A p a tie nt s uffe r ing fr om a nxie ty ha s :
– p s yc hic a l s ym p tom s : p e r v a s iv e w or r ie s , e .g. fe a r of ha v ing a s e r ious
illne s s , fe a r w ith
no c le a r ly-d e fine d obje c t or p hobia s ;
– be ha v iour a l c ha nge s : ne r v ous ne s s , a v oid a nc e be ha v iour ;
– p h ys ic a l s ym p tom s : e .g., d r y m outh, “lum p in the thr oa t,” n ons p e c ific
c om p la in ts
(e .g. fe e ling of m a la is e , hot fla s he s or c hills , d iffus e p a in).
A nxie ty is a c om m on fe a tur e in d e p r e s s ion (p a ge 2 9 7 ), p os t-tr a um a tic s tr e s s
d is or d e r
(p a ge 2 9 5 ) a nd p s yc hos is (p a ge 3 0 0 ). I t c a n a ls o oc c ur in is ola tion, not
a s s oc ia te d w ith
a ny othe r m e nta l d is or d e r s . A nxie ty d is or d e r s ofte n oc c ur im m e d ia te ly a fte r
a d iffic ult
life e v e nt.
s im p le r e la xa tion te c hniq ue s to a lle v ia te the s ym p tom s .
Management
dTiarzyeptoamd: e5 tetor1m0inme gthPe Os ouorrc1e0ofmthge IMa n,xtioebtye arnedp er eaatesds uarfetetrh oenpe ahtoieurnti.f Irfe q uir e d .
ne c e s s a r y, us e
Se v e r e a nxie ty m a y jus tify a s hor t c our s e (on1e to tw o w e e ks m a x.) of diazepam P
If s ym p tom s a r e e xa c e r ba te d (e .g., ta c hyc a r d ia , fe e ling of s uffoc a tion, fe a r of
d ying or
H“gaoloinpgercidroal PzyO,” aagtitva etiorny,lorwc odnovseer saendly, fpor oas str haotirotnp),eitrmioda oyfbteimnee c(1e ms sga/ rdyatoy in 2 d iv
a d m inis te r
2
1 0 m g/ d a y in 2 d iv id e d d os e s ; r e d uc in g t h e d os e by h a lf in t h e la s t fe w
d a ys of
tr e a tm e nt.
If s ym p tom s r e c ur a fte r tr e a tm e nt d is c ontinua tion, d o not r e s um e d ia ze p a m .
for m a xim um 2 to 4 w e e ks ) m a y be us e d for its a nxiolytic p r op e r tie s if a
tr e a tm e nt is
s t ill n e e d e d . H ow e v e r , be for e p r e s c r ibin g h a lop e r id ol, r e - e v a lua t e for
p os s ible
d e p r e s s ion or p os t-tr a um a tic s tr e s s d is or d e r (s e e p a ge s 2 9 5 a nd 2 9 7 ).
F or ge n e r a lis e d a n xie t y, a n a n t id e p r e s s a n t w it h a n xiolyt ic p r op e r t ie s is
p r e fe r r e d
(paroxetine P O : 1 0 to 2 0 m g m a xim um onc e d a ily a t be d tim e ), to be c ontinue d for
2 to
3 m onths a fte r s ym p tom s r e s olv e the n, s top gr a d ua lly ov e r 2 w e e ks .
F or r e c ur r ing a tta c ks (p a nic d is or d e r ), clomipramine P O m a y be p r e s c r ibe d to
p r e v e nt
r e c ur r e nc e s : 2 5 m g onc e d a ily, to be gr a d ua lly inc r e a s e d to 7 5 m g onc e d a ily.
C ontinue
for 2 to 3 m onths a fte r s ym p tom s r e s olv e the n, s top gr a d ua lly (ov e r 3 to 4
w e e ks ) w hile
m onitor ing the p a tie nt for r e c ur r e nc e of s ym p tom s .
