B. Bandelow

A 2010 Evidence-Based Algorithm for the Pharmacotherapy of Social Anxiety Disorder

A growing evidence base on the management of social anxiety disorder has yielded many meta-analyses and guidelines on the pharmacotherapy of this clinically important condition. We aimed to update a pharmacotherapy algorithm for the treatment of social anxiety disorder that was developed to be concise and user friendly and that was addressed to the primary care practitioner in particular. The updated algorithm attempts to summarize succinctly the recent literature in this area, as well as to include the views of an international panel of experts with diverse experience. The algorithm comprises eight sequential steps, beginning with those focused on diagnosis and initiating treatment and ending with the management of the treatment-refractory patient.

Pharmacological Treatment of Panic Disorder

A comprehensive database has developed and precise recommendations can be provided for treating patients with panic disorder. Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are standard treatments for panic disorder. Tricyclic antidepressants are as effective as modern antidepressants, but less well tolerated. For short-term treatment and in non-responsive cases, benzodiazepines such as alprazolam may be used when the patient does not have a history of dependency and tolerance. Combining drug treatment with cognitive behaviour therapy is the most successful treatment strategy for panic disorder. This chapter also includes treatment recommendations for pregnant or lactating women, children, adolescents, elderly patients, and patients who are non-responsive to standard treatments.

Improvement of quality of life in panic disorder with escitalopram versus citalopram, and placebo

Depressive symptoms are frequently found in schizophrenic patients during the longitudinal course of illness. The DSM-IV and the ICD-10 have operationalized postschizophrenic depression, which can follow after remission of a psychotic episode. However, a rational approach for treating depression in schizophrenia is to rule out other causes for depression-like symptoms: a number of organic factors and substance/medication-induced depressive syndromes have to be excluded. Furthermore, side effects of neuroleptic treatment such as extrapyramidal symptoms (i.e. akinesia and akathisia) and neuroleptic-induced dysphoria have to be distinguished from depressive features. Negative symptoms of schizophrenia may be particularly difficult to differentiate from postpsychotic depression. At last, prodromes of a psychotic relapse can resemble a depression-like state and have to be recognized by the clinician. Besides increased surveillance and unspecific support, optimization of antipsychotic treatment (switch from typical neuroleptic to atypical antipsychotic, dose adjustment, treatment of side effects) is the first step after the development of depression-like symptoms. Despite the limited literature on this topic, schizophrenic patients with persistent depression may respond to adjunctive antidepressant medication [1]. However, psychosocial strategies, such as stress reduction, social skills training and minimizing high expressed emotions, may also be beneficial and should be integrated in a holistic treatment approach [2].