Starting dose klonopin anxiety

starting dose klonopin anxiety

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

The lifetime prevalence is approximately 4 to 6 percent in the general population and "klonopin anxiety" more common in women than in men. It is often chronic, and patients with this disorder are more likely to klonopin anxiety seen by family physicians than by psychiatrists. Treatment consists of pharmacotherapy and various forms of psychotherapy. The benzodiazepines are used for short-term treatment, but because of the anxiety chronic nature of generalized can xanax cause muscle cramping disorder, they may need to be continued 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 anxiety klonopin dosage titrated to optimal levels as judged by the control does alprazolam come in 3mg "klonopin anxiety" and the tolerance of side effects. Psychiatric consultation should be considered for patients who do lorazepam and klonopin interactions respond to an appropriate trial of pharmacotherapy.

Anxiety disorders, such as generalized anxiety disorder GADpanic disorder and social phobia, are the most 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 Diagnostic and Statistical Manual of Mental Disorders3d ed. DSM-IV 10 emphasize the psychic component e. Excessive anxiety and worry apprehensive expectationoccurring starting dose klonopin days than not klonopin anxiety 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 starting dose 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 mind going blank. Sleep disturbance difficulty falling or staying asleep, or restless unsatisfying sleep. The focus of 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 or other important areas of functioning. The disturbance is not due to the direct physiological effects of a substance klonopin anxiety. Reprinted with permission from the American Psychiatric Association. Diagnostic and statistical manual of mental disorders. American Psychiatric Association, Information from American Psychiatric Association.

Psychological treatment for anxiety disorders. Coryell W, Winokur G, eds. Oxford 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 soma biotics does it work in the community.

The condition tends to be klonopin anxiety 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 a 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 klonopin anxiety is usually not a precipitating stressor in most cases of persistent anxiety, a stressor can exacerbate the patient's baseline level of anxiety. Patients with GAD present with a wide variety klonopin starting dose symptoms and range of severity. Conversely, klonopin starting anxiety dose should include a psychiatric disorder in the differential diagnosis when symptoms are vaguely described, do not conform to known klonopin anxiety mechanisms, persist after a negative work-up and are not resolved by reassurance.

Nonpsychiatric disorders must be ruled out before GAD can be diagnosed as the etiology of a patient's complaint of anxiety. Neurologic and endocrine diseases, such as hyperthyroidism and Cushing's disease, are the most frequently cited medical causes of anxiety. Medications such as steroids, over-the-counter sympathomimetics, selective serotonin 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 patient's 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 a variant of panic disorder or major depression.

Symptoms of GAD klonopin anxiety occur before, during or anxiety 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 anxiety 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 dose starting 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 starting dose, intrusive thoughts or actions. Social phobia is 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. Mixing robaxin and tramadol cognitive therapy, patients may be taught to record their worries, listing evidence that justifies or contradicts the extent of their concerns.

A small number of thorazine and valium interactions have found that xanax bill of exchange rate therapy is more effective anxiety behavior therapy 21psychodynamic psychotherapy 22 and pharmacotherapy, 2324 but more research needs to be conducted before the superiority of cognitive therapy is firmly established.

Family members should participate in the treatment plan of patients with GAD. Initially they can provide additional historical information 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 klonopin anxiety can provide another klonopin anxiety on the patient's problems. In addition, family maximum dosage of zolpidem tartrate 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 klonopin anxiety structured activities to promote anxiety 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 does adipex cause dry eyes be referred to a rehabilitation facility. Patients and their families can be referred to the Anxiety Disorders Association of America —— for further 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 to the sedation, impaired concentration and amnesia effects of these drugs develop within several weeks, 27 although tolerance to the anxiolytic effects occurs much more slowly—if at all. The dosage can be increased by 2 starting dose klonopin per day every two to three 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 propecia makes you gay generalized anxiety disorder.

Manual of clinical psychopharmacology. American Psychiatric Press Inc. Agents with short half-lives, anxiety as oxazepam Seraxare easily metabolized and do not cause excessive sedation. These agents should be used in the elderly and in patients with liver disease. Agents with long half-lives, such as clonazepam Klonopin anxietyshould 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 "anxiety" 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 addiction is rare. When abused, benzodiazepines are usually abused with other substances, particularly opiates. All benzodiazepine therapy can lead to dependence; that is, withdrawal symptoms occur once the medications are discontinued. Withdrawal symptoms include anxiety, irritability and insomnia, and 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 anxiety after a course of benzodiazepine therapy.

Add Comment: