The role of anticonvulsants in treatment-resistant anxiety disorders

Antidepressants are the first-line pharmacological treatment approach for the anxiety disorders. Other pharmacotherapy options for anxiety disorders include benzodiazepines, atypical antipsychotics, and anticonvulsants. Evidence provided by double-blind, placebo-controlled trials demonstrates the effectiveness of pregabalin and valproic acid for generalized anxiety disorder, pregabalin and gabapentin for social anxiety disorder, valproic acid for panic disorder, and lamotrigine for posttraumatic stress disorder. Further research is needed to determine the efficacy of anticonvulsants for the treatment-resistant anxiety disorder patients

The Efficacy and Role of Anticonvulsants as a Treatment Option in Anxiety Disorders

Treatment options for anxiety disorders include pharmacotherapy and cognitive-behavioral therapy. Selective serotonin reuptake inhibitors and serotonin noradrenalin reuptake inhibitors are the first-line pharmacological treatment approach for most of the anxiety disorders. The efficacy of anticonvulsants in anxiety disorders, including carbamazepine, lamotrigine, topiramate and gabapentin has been shown in some clinical studies. The strongest evidence has been provided for pregabalin and valproic acid in generalized anxiety disorder, pregabalin and gabapentin in social anxiety disorder, and lamotrigine in posttraumatic stress disorder. Further research is needed to determine the efficacy of anticonvulsants as an alternative therapeutic option for the patients resistant to conventional treatment. (Archives of Neuropsychiatry 2009; 46: 19-23

Development of social anxiety disorder secondary to attention deficit/hyperactivity disorder (the developmental hypothesis)

Social anxiety disorder (SAD) may develop secondary to childhood attention deficit/hyperactivity (ADHD) in a subgroup of the patients with SAD. Patients pass through a number of identifiable stages of developmental pathways to SAD as they grow up. Patients with ADHD have maladaptive behaviours in social settings due to the symptoms of ADHD. These behaviours are criticized by their parents and social circle; they receive insults, humiliation and bullying. After each aversive incident, the individual feels shame and guilt. A vicious cycle emerges. The patients then develop social fears and a cognitive inhibition that occurs in social situations. The inhibition increases gradually as the fear persists and the individual becomes withdrawn. Patients start to monitor themselves and to focus on others' feedback. Finally, performative social situations become extremely stimulating for them and may trigger anxiety/panic attacks. If this hypothesis is proven, treatment of patients with SAD secondary to ADHD' should focus on the primary disease

A comparison of comorbidity in body dysmorphic disorder and obsessive-compulsive disorder

BACKROUND: The aim of this study is to compare 3 groups of patients with body dysmorphic disorder (BDD), obsessive-compulsive disorder (OCD), and comorbid BDD and OCD with respect to clinical characteristics and to study their similarities and differences

Psychiatry Written Board Examination: Experience of Turkey 2006-2009

Objective: This paper aims to provide information about process and results of Psychiatry Written Board Examinations 2006-2009 of Psychiatric Association of Turkey

The Features of Comorbidity of Childhood ADHD in Patients With Obsessive Compulsive Disorder

Objective: Our aim is to investigate the impact of childhood ADHD comorbidity on the clinical features of obsessive compulsive disorder (OCD). Method: Ninety-five adult outpatients with a diagnosis of OCD were assessed by using the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version, ADHD module, and the Yale-Brown Obsessive Compulsive Scale. Patients with or without childhood ADHD were compared in terms of the sociodemographic and clinical features, psychiatric comorbidities, and rating scales. Results: The rate of episodic course of OCD (p < .001), religious and sexual obsessions (p = .009, p = .020, respectively), lifetime comorbidity of bipolar disorder (BD), social anxiety disorder (SAD; p = .001, p = .009, respectively), and tic disorder (TD) comorbidity (p < .001) were higher in the OCD + ADHD group than in the OCD without ADHD group. Conclusion: Childhood ADHD may be associated with higher rates of BD, SAD, and TD comorbidity and episodic course of OCD as well as higher frequency of certain types of obsessions

Obsessive compulsive symptoms are related to lower quality of life in patients with Schizophrenia

Background. The aim of this study is to investigate the effects of obsessive-compulsive symptoms (OCS) on quality of life (QoL) and to identify the OCS with a particular effect on QoL, and whether there are any such symptoms for patients with schizophrenia. Methods. We studied three groups of patients with schizophrenia. One group of patients (n = 45) without OCS or obsessive-compulsive disorder (OCD), one group with OCS, not fulfilling the diagnostic criteria for OCD (n = 31), and one group with OCD as a comorbid condition (n = 24). Severity of clinical symptoms was evaluated with the Positive and Negative Symptom Scale and OCS was examined using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) Symptom Checklist. We also administered the Y-BOCS. The patients' QoL was assessed using the Quality of Life Scale (QLS). Results. QLS interpersonal relationships subscale scores of those with OCS were lower than those without OCS. There was no difference among OCS, non-OCS, and OCD groups in terms of QoL. There was no relationship between QLS scores and symmetry, contamination and causing harm obsessions, but those with cleaning and repeating compulsions had lower QoL. Conclusions. Questioning of comorbid OCS and treatment with specific medication in schizophrenia patients may increase QoL

Is there a prodrom period in patients with social anxiety disorder? A discussion on the hypothesis of social anxiety disorder development secondary to attention-deficit/hyperactivity disorder

The association between social anxiety disorder (SAD) and attention-deficit/hyperactivity disorder (ADHD) is poorly established. In fact, increasing and converging evidences suggest that there is a close relationship between the two disorders. High comorbidity rate between these two disorders, follow-up studies showing high rates of later development of SAD in ADHD and treatment studies in which ADHD medications have been helpful for both conditions all indicate this relationship. Recently, we have published a hypothesis regarding the development of SAD secondary to ADHD. In this hypothesis, we recognized that patients with SAD seem to go through a prodromal period that we labeled as "pre-social anxiety." Detecting patients in this period before meeting full-blown SAD criteria provides early intervention and prevention of SAD. New, comprehensive follow-up studies which will investigate whether ADHD causes later SAD secondarily are needed. In the current review, taken into account our developmental hypothesis, we will discuss whether high comorbidity of SAD and ADHD is a chance finding (i.e., the two disorders are found in cases with no causal relationship between them) or can SAD develop secondarily due to childhood ADHD. Is there a prodrom period in patients with SAD as in cancer or psychosis patients? We are going to summarize the overlapping features of SAD and ADHD in terms of child/parents interaction and family issues, aversive childhood experiences, social skill deficits, and development of cognitive distortions

Proton Magnetic Resonance Spectroscopy in Social Anxiety Disorder

In the present study, 24 nonmedicated patients with social anxiety disorder (SAD) were compared with 24 healthy control subjects to assess metabolite levels in the anterior cingulate, insula, caudate, and putamen using proton magnetic resonance spectroscopy. The ratio of N-acetylaspartate (NAA)/creatine (Cr) was significantly higher in patients with SAD than in healthy control subjects in the anterior cingulate and insula. NAA/Cr ratios in the insula correlated positively with the Liebowitz Social Anxiety Scale total scores in patients with SAD. Our results support the significance and biochemical involvement of the anterior cingulate and insula in the pathophysiology of SAD