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Causes and symptoms
Social and environmental stressors
Symptoms of anxiety
- Repression. The person pushes anxious thoughts or ideas out of conscious awareness.
- Displacement. Anxiety from one source is attached to a different object or event. Phobias are an example of the mechanism of displacement in psychoanalytic theory.
- Rationalization. The person justifies the anxious feelings by saying that any normal person would feel anxious in their situation.
- Somatization. The anxiety emerges in the form of physical complaints and illnesses, such as recurrent headaches, stomach upsets, or muscle and joint pain.
- Delusion formation. The person converts anxious feelings into conspiracy theories or similar ideas without reality testing. Delusion formation can involve groups as well as individuals.
Anxiety may be rational, such as the anxiety about doing well in a new job, about one's own or someone else's illness, about passing an examination, or about moving to a new community. People also feel realistic anxiety about world dangers, such as the possibility of war, and about social and economic changes that may affect their livelihood or way of living. Most persons find healthy ways to deal with their normal quota of anxiety.
Factors that can precipitate an attack of anxiety include any pathophysiological event that interferes with satisfaction of the basic human physiological needs. Situational factors include actual or perceived threat to self-concept, loss of significant others, threat to biological integrity, change in environment, change in socioeconomic status, and transmission of another person's anxiety to the individual. Other etiologic factors are associated with a threat to completion of developmental tasks at various life stages, for example, a threat to an adolescent in the completion of developmental tasks associated with sexual development, peer relationships, and independence.
Interventions. Measures to assist the individuals suffering from anxiety are aimed at helping them recognize their anxiety and their usual means of coping with it, and providing alternate, more healthful coping mechanisms that give a sense of physiological and psychological comfort.
People with anxiety disorders experience both the subjective emotion and various physical manifestations resulting from muscular tension and autonomic nervous system activity. This can produce a variety of symptoms, including sweating, dizziness, shortness of breath, insomnia, loss of appetite, and palpitations. The source of the anxiety lies in unconscious fears, unresolved conflicts, forbidden impulses, or threatening memories. Symptoms are often triggered by an apparently harmless stimulus that the patient unconsciously links with a deeply buried, anxiety-producing experience. Chronic anxiety can lead to various somatic alterations. The onset of anxiety may be gradual or sudden. Some persons experience incapacitating acute anxiety (as in panic disorder) while others manifest their anxiety through avoidant behavior patterns (phobias, obsessive-compulsive disorder). Anxiety disorders include: panic disorder, agoraphobia, social phobia, specific phobia, obsessive-compulsive disorder, posttraumatic stress disorder, acute stress disorder, generalized anxiety disorder, and substance-induced anxiety disorder.
cyclosporine ophthalmic emulsion
Restasis, Sandimmun (UK)CNS: tremor, headache, confusion, paresthesia, insomnia, anxiety, depression, lethargy, weakness
Pharmacologic class: Polypeptide antibiotic
Therapeutic class: Immunosuppressant
Pregnancy risk category C
Respiratory: cough, dyspnea, Pneumocystis jiroveci pneumonia, bronchospasm
FDA Box Warning
• Drug should be prescribed only by physicians experienced in managing systemic immunosuppressive therapy for indicated disease. At doses used for solid-organ transplantation, it should be prescribed only by physicians experienced in immunosuppressive therapy and management of organ transplant recipients. Patient should be managed in facility with adequate laboratory and medical resources. Physician responsible for maintenance therapy should have complete information needed for patient follow-up.
• Neoral may increase susceptibility to infection and neoplasia. In kidney, liver, and heart transplant patients, drug may be given with other immunosuppressants.
• Sandimmune should be given with adrenal corticosteroids but not other immunosuppressants. In transplant patients, increased susceptibility to infection and development of lymphoma and other neoplasms may result from increased immunosuppression.
• Sandimmune and Neoral aren't bioequivalent. Don't use interchangeably without physician supervision.
• In patients receiving Sandimmune soft-gelatin capsules and oral solution, monitor at repeated intervals (due to erratic absorption).
Unclear. Thought to act by specific, reversible inhibition of immunocompetent lymphocytes in G0-G1 phase of cell cycle. Preferentially inhibits T lymphocytes; also inhibits lymphokine production. Ophthalmic action is unknown.
Capsules: 25 mg, 100 mg
Injection: 50 mg/ml
Oral solution: 100 mg/ml
Solution (ophthalmic): 0.05% (0.4 ml in 0.9 ml single-use vial)
⊘Indications and dosages
Adults:Neoral only-1.25 mg/kg P.O. b.i.d. for 4 weeks. Based on patient response, may increase by 0.5 mg/kg/day once q 2 weeks, to a maximum dosage of 4 mg/kg/day.
➣ Severe active rheumatoid arthritis
Adults:Neoral only-1.25 mg/kg P.O. b.i.d. May adjust dosage by 0.5 to 0.75 mg/kg/day after 8 weeks and again after 12 weeks, to a maximum dosage of 4 mg/kg/day. If no response occurs after 16 weeks, discontinue therapy. Gengraf only-2.5 mg/kg P.O. daily given in two divided doses; after 8 weeks, may increase to a maximum dosage of 4 mg/kg/day.
➣ To prevent organ rejection in kidney, liver, or heart transplantation
Adults and children:Sandimmune only-Initially, 15 mg/kg P.O. 4 to 12 hours before transplantation, then daily for 1 to 2 weeks postoperatively. Reduce dosage by 5% weekly to a maintenance level of 5 to 10 mg/kg/day. Or 5 to 6 mg/kg I.V. as a continuous infusion 4 to 12 hours before transplantation.
➣ To increase tear production in patients whose tear production is presumed to be suppressed due to ocular inflammation associated with keratoconjunctivitis sicca
Adults: 1 drop in each eye b.i.d. given 12 hours apart
• Aplastic anemia
• Atopic dermatitis
• Hypersensitivity to drug and any ophthalmic components
• Rheumatoid arthritis, psoriasis in patients with abnormal renal function, uncontrolled hypertension, cancer (Gengraf, Neoral)
• Active ocular infections (ophthalmic use)
Use cautiously in:
• hepatic impairment, renal dysfunction, active infection, hypertension
• herpes keratitis (ophthalmic use)
• pregnant or breastfeeding patients
• children younger than age 16 (safety and efficacy not established for ophthalmic use).
• For I.V. infusion, dilute as ordered with dextrose 5% in water or 0.9% normal saline solution. Administer over 2 to 6 hours.
• Mix Neoral solution with orange juice or apple juice to improve its taste.
• Dilute Sandimmune oral solution with milk, chocolate milk, or orange juice. Be aware that grapefruit and grapefruit juice affect drug metabolism.
• In postoperative patients, switch to P.O. dosage as tolerance allows.
• Be aware that Sandimmune and Neoral aren't bioequivalent. Don't use interchangeably.
• Before administering eyedrops, invert unit-dose vial a few times to obtain a uniform, white, opaque emulsion.
• Know that eyedrops can be used concomitantly with artificial tears, allowing a 15-minute interval between products.
CV: hypertension, chest pain, myocardial infarction
EENT: visual disturbances, hearing loss, tinnitus, rhinitis; (with ophthalmic use) ocular burning, conjunctival hyperemia, discharge, epiphora, eye pain, foreign body sensation, itching, stinging, blurring
GI: nausea, vomiting, diarrhea, constipation, abdominal discomfort, gastritis, peptic ulcer, mouth sores, difficulty swallowing, anorexia, upper GI bleeding, pancreatitis
GU: gynecomastia, hematuria, nephrotoxicity, renal dysfunction, glomerular capillary thrombosis Hematologic: anemia, leukopenia, thrombocytopenia
Metabolic: hyperglycemia, hypomagnesemia, hyperuricemia, hyperkalemia, metabolic acidosis
Musculoskeletal: muscle and joint pain
Respiratory: cough, dyspnea, Pneumocystis jiroveci pneumonia, bronchospasm
Skin: acne, hirsutism, brittle fingernails, hair breakage, night sweats
Other: gum hyperplasia, flulike symptoms, edema, fever, weight loss, hiccups, anaphylaxis
The following interactions pertain to oral and I.V. routes only.
Drug-drug.Acyclovir, aminoglycosides, amphotericin B, cimetidine, diclofenac, gentamicin, ketoconazole, melphalan, naproxen, ranitidine, sulindac, sulfamethoxazole, tacrolimus, tobramycin, trimethoprim, vancomycin: increased risk of nephrotoxicity
Allopurinol, amiodarone, bromocriptine, clarithromycin, colchicine, danazol, diltiazem, erythromycin, fluconazole, imipenem and cilastatin, itraconazole, ketoconazole, methylprednisolone, nicardipine, prednisolone, quinupristin/dalfopristin, verapamil: increased cyclosporine blood level
Azathioprine, corticosteroids, cyclophosphamide: increased immunosuppression Carbamazepine, isoniazid, nafcillin, octreotide, orlistat, phenobarbital, phenytoin, rifabutin, rifampin, ticlopidine: decreased cyclosporine blood level
Digoxin: decreased digoxin clearance
Live-virus vaccines: decreased antibody response to vaccine
Lovastatin: decreased lovastatin clearance, increased risk of myopathy and rhabdomyolysis
Potassium-sparing diuretics: increased risk of hyperkalemia
Drug-diagnostic tests.Alanine aminotransferase, aspartate aminotransferase, bilirubin, blood urea nitrogen, creatinine, glucose, low-density lipoproteins: increased levels
Hemoglobin, platelets, white blood cells: decreased values
Drug-food.Grapefruit, grapefruit juice: decreased cyclosporine metabolism, increased cyclosporine blood level
High-fat diet: decreased drug absorption (Neoral)
Drug-herbs.Alfalfa sprouts, astragalus, echinacea, licorice: interference with immunosuppressant action St. John's wort: reduced cyclosporine blood level, possibly leading to organ rejection
• Observe patient for first 30 to 60 minutes of infusion. Monitor frequently thereafter.
• Monitor cyclosporine blood level, electrolyte levels, and liver and kidney function test results.
• Assess for signs and symptoms of hyperkalemia in patients receiving concurrent potassium-sparing diuretic.
• Advise patient to dilute Neoral oral solution with orange or apple juice (preferably at room temperature) to improve its flavor.
• Instruct patient to use glass container when taking oral solution. Tell him not to let solution stand before drinking, to stir solution well and then drink all at once, and to rinse glass with same liquid and then drink again to ensure that he takes entire dose.
• Tell patient taking Neoral to avoid high-fat meals, grapefruit, and grapefruit juice.
• Advise patient to dilute Sandimmune oral solution with milk, chocolate milk, or orange juice to improve its flavor.
• Instruct patient to invert vial a few times to obtain a uniform, white, opaque emulsion before using eyedrops and to discard vial immediately after use.
• Inform patient that eyedrops can be used with artificial tears but to allow 15-minute interval between products.
• Caution patient not to wear contact lenses because of decreased tear production; however, if contact lenses are used, advise patient to remove them before administering eyedrops and to reinsert 15 minutes after administration.
• Inform patient that he's at increased risk for infection. Caution him to avoid crowds and exposure to illness.
• Instruct patient not to take potassium supplements, herbal products, or dietary supplements without consulting prescriber.
• Tell patient he'll need to undergo repeated laboratory testing during therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, and herbs mentioned above.
anxiety/an·xi·e·ty/ (ang-zi´ĕ-te) a feeling of apprehension, uncertainty, and fear without apparent stimulus, associated with physiological changes (tachycardia, sweating, tremor, etc.).
anxietyA mood disorder characterised by somatic, emotional, cognitive and behavioral components encompassing chronic fear, dread, worry and panic attacks.
Insomnia, recurring negative thoughts are common, as well as nausea, palpitations, dizziness and dyspnoea.
Anxiolytics (benzodiazepines), serotonin-selective reuptake inhibitors (SSRIs), 5-HT1A receptor agonists (azapirones), barbiturates; somatic symptoms of anxiety may respond to beta-receptor blockers, e.g., propranolol.
anxietyPsychology The emotional component of biological responses to imagined danger, linked to intrapsychic conflict Clinical-physical Tachycardia, dyspnea, trembling, cognitive difficulties, hypersensitivity, dizziness, weakness, dysrhythmia, sweating, fatigue Clinical-mental Sense of impending doom, powerlessness, apprehension, tension Types External stress–exogenous anxiety, internal stress–endogenous anxiety; it is pathological when it interferes with effectiveness in living, achieving of goals or satisfaction, or reasonable emotional comfort. See Anxiety disorder, Anticipatory anxiety, Castration anxiety, Free-floating anxiety, Monitor anxiety, Performance anxiety, Separation anxiety, Signal anxiety.
anxietyThe natural response to threat or danger, real or perceived and characterized, in its extreme form, by a rapid heart rate, tremulousness, a dry mouth, a feeling of tightness in the chest, sweaty palms, weakness, nausea, bowel hurry with diarrhoea, insomnia, fatigue, headache, and loss of appetite. Anxiety is a response to stress and is a concomitant of a wide spectrum of diseases. But it is also a vital motivating factor causing us to respond constructively to dangers of all kinds and to make greater efforts in all kinds of situations. Anxiety disorders include PANIC DISORDERS, OBSESSIVE-COMPULSIVE DISORDERS, PHOBIAS, POST-TRAUMATIC STRESS DISORDER and GENERALIZED ANXIETY DISORDER.
anxietya subjective experience of fear, apprehension or dread; cognitive anxiety the cognitive elements of anxiety including worrying thoughts, fear of failure and negative expectations about performance, also known as cognitive stress; competitive sport anxiety the anxiety response to competitive sporting situations or to sport competition in general; somatic anxiety the physiological and affective elements of anxiety including unpleasant perceptions of arousal, nervousness and tension; state anxiety the anxiety response to a threatening situation; trait anxiety a general disposition to respond to situations with a high level of state anxiety.
Patient discussion about anxiety
Q. Social Anxiety I have found myself wondering more and more about social anxiety. My partner seemed to develop social anxiety around the same time she was diagnosed bipolar. i am wondering how many of you also suffer from soical anxiety and if you feel it is a result of bipolar disorder (perhaps personal knowledge of the possible behaviours associated with the illness) or if it is a seperate and unrelated symptom?
social anxiety disorder is best defeated by groups like
the Toastmasters International or the dale carnegie course.
The nwork without drugs
Q. what about opiod use in anxiety and depression? vicodin, anxiety, depression
Q. what are anxiety symptoms for a teen? before i get to school my heart beats really fast when i talk to someone i somtimes get hot or start to sweat. i dont feel like myself i also don't talk to some people anymore because i'm scared its going to be akward..