Bipolar disorder is often underdiagnosed, mistaken for unipolar depression and treated with antidepressants rather than mood stabilizing agents, reported S. D., senior investigator with the Center on Neuroscience, Medical Progress and Society, George Washington University.
Confronted with the increasingly favorable treatment outcomes associated with cognitive behavioral packages, there are three possible reasons why pharmacological interventions might be considered. First, it could be that pharmacological interventions achieve the same outcomes as the cognitive behavioral therapy packages but at a cheaper cost (financially to the patient or in terms of therapist time), with fewer dropouts, lower relapse rates, and with fewer associated difficulties (such as side-effects). Second, it could be that pharmacological treatments may be useful adjuncts to the cognitive behavioral therapy packages.
Panic disorder and agoraphobia
In 1988, Barlow examined the evidence from around the world and concluded that “with specifically targeted psychological treatments, panic is eliminated in close to 100% of all cases, and these results are maintained at follow-ups of over 1 year. If these results are confirmed by additional research and replication, it will be one of the most important and exciting developments in the history of psychotherapy”. The question facing researchers and clinicians alike is, with the benefit of more than a decade of subsequent research and replication, “Is it possible to concur with Barlow’s statement?”.
A successful treatment for specific phobias should decrease the fear-driven avoidance behavior. Coupled with reducing the avoidance are two related problems.
Pharmacological Treatments of Social Phobia
Several classes of drug have been the subject of research. These are beta blockers, anxiolytics of the benzodiazepine class, and antidepressants.
In vivo exposure has been one of the strongest and most consistently demonstrated treatments for agoraphobic avoidance. In fact, it has often been demonstrated to be superior to placebo interventions as well as other credible psychological treatments – a none too easy achievement in psychological research. Furthermore, when anti-exposure instructions are included in comparison therapies, the strength of exposure becomes even more evident.
The aims of treatment are symptom reduction and improved function. Elimination of all anxiety is unlikely (and unnecessary), and the therapist has a role in helping the patient to set realistic goals for therapy. Psychological and pharmacological treatments are available for social phobia.
Although Obsessive-compulsive disorder has been recognized for centuries, effective treatment for this condition has been available only for the past four decades. The treatments of choice for Obsessive-compulsive disorder are behavior therapy, consisting of exposure and response prevention, and selective serotonin reuptake-inhibiting medications.
Generalized Anxiety Disorder
The goal of the treatment of Generalized anxiety disorder is the reduction of impairment that results from both cognitive and somatic symptoms of anxiety: the worry or anxious expectation, and the accompanying symptoms of tension and overarousal. This chapter aims to summarize the evidence for the effectiveness of psychological and pharmacological treatments for Generalized anxiety disorder. Since the first edition of this book was published, five reviews of the psychological treatment of Generalized anxiety disorder have been published.
Posttraumatic Stress Disorder
Survivors of trauma who do not recover independently, and who go on to develop longer-term problems as a result of their experiences, may require formal treatment. There is also a mounting body of research suggesting that early interventions with high risk survivors may facilitate the recovery process and reduce the prevalence of subsequent Posttraumatic stress disorder.
Psychological Treatments for Social Phobia
The role of social skills training in the treatment of social phobia continues to be debated. Prior to the publication of DSM-III, social skills training had demonstrated clinical utility in heterogeneous populations of psychiatric outpatients with social skills difficulties or anxieties.
Current pharmacotherapeutic interventions are primarily symptomatic attempts to improve or maintain cognition. Table Treatment Options for Cognitive Symptoms in Alzheimer’s Disease may be used as an algorithm for managing cognitive symptoms in Alzheimer’s disease.
Prevention and Early Intervention
Posttraumatic stress disorder, it would seem, is potentially an ideal candidate for early intervention and prevention, since it is possible to accurately identify the precipitating event. In recent years, there has been considerable debate regarding the extent to which it may be possible to modify the course of traumatic stress reactions, and to facilitate recovery, by means of an early intervention.
Pharmacotherapy of Obsessive-Compulsive Disorder
Although a wide variety of medications have been utilized in the treatment of Obsessive-compulsive disorder, there is little doubt as to the consistent efficacy of serotonin reuptake inhibitors, of which clomipramine is the most widely researched. Placebo controlled trials have in general attested to its efficacy and comparison to other antidepressants have also demonstrated its superiority in decreasing obsessional symptoms.
Pharmacological Treatments of Generalized Anxiety Disorder
For many years, benzodiazepines were the preferred pharmacotherapy for Generalized anxiety disorder and considered the treatment of choice. There is ample evidence to conclude that the benzodiazepines are safe and provide effective symptomatic relief for the majority of patients.