PubMed · 12053350
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Finnish Medical Society Duodecim and The Finnish Academy. 2000. [Panic disorder].. https://pubmed.ncbi.nlm.nih.gov/12053350/
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This review covers the effect of drugs affecting anxiety using four psychological procedures for inducing experimental anxiety applied to healthy volunteers and patients with anxiety disorders. The first is aversive conditioning of the skin conductance responses to tones. The second is simulated public speaking, which consists of speaking in front of a video camera, with anxiety being measured with psychometric scales. The third is the Stroop Color-Word test, in which words naming colors are painted in the same or in a different shade, the incongruence generating a cognitive conflict. The last test is a human version of a thoroughly studied animal model of anxiety, fear-potentiated startle, in which the eye-blink reflex to a loud noise is recorded. The evidence reviewed led to the conclusion that the aversive conditioning and potentiated startle tests are based on classical conditioning of anticipatory anxiety. Their sensitivity to benzodiazepine anxiolytics suggests that these models generate an emotional state related to generalized anxiety disorder. On the other hand, the increase in anxiety determined by simulated public speaking is resistant to benzodiazepines and sensitive to drugs affecting serotonergic neurotransmission. This pharmacological profile, together with epidemiological evidence indicating its widespread prevalence, suggests that the emotional state generated by public speaking represents a species-specific response that may be related to social phobia and panic disorder. Because of scant pharmacological data, the status of the Stroop Color-Word test remains uncertain. In spite of ethical and economic constraints, human experimental anxiety constitutes a valuable tool for the study of the pathophysiology of anxiety disorders.
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Over 50 percent of the general population are exposed to a traumatic event at least once in their lives. Some but not all trauma survivors go on to develop posttraumatic stress disorder (PTSD). The diagnostic criteria of acute stress reaction, posttraumatic stress disorder, and enduring personality change after catastrophic experience are presented. PTSD should primarily be treated by means of psychotherapy. Cognitive-behavioral approaches, exposure therapy in particular, currently show the best evidence as effective treatments for PTSD. In addition to psychotherapy, psychopharmacological treatment may be indicated. Selective serotonin-reuptake inhibitors are the first-line psychoactive drugs for PTSD. Due to an increased risk of substance use disorders, benzodiazepines should only be used with caution. Finally, a number of predictors are reported that may help the clinician to identify patients at risk of developing PTSD.