RESUMEN
OBJECTIVES: Health costs, which are increasing at a yearly rate of 4 %, represent 11% and thus a large share of Austria's gross domestic product (GDP). High expenditures derive frommental health care costs, including medication. In this article we investigate whether the costs and usage of psychopharmaceutic products in Austria are rising. METHOD: We did a descriptive analysis of the sales figures and number for packaging units of pharmaceutical products of ATC-classes N05 and N06 in all Austrian hospitals, pharmacies and medicine chests for the years 2006-2013. All data were provided free of charge by IMSHealth. RESULTS: The sales volume and number of prescribed packaging units of pharmaceuticals of ATC-classes N05 and N06 increased over the time period in question. In 2013, about 25% more packaging units were being sold than in 2006. Among the two ATC-classes, however, the indication subgroups developed differently. Expenditures increased a total of about 31%within the period of consideration. CONCLUSIONS: The increase in psycho-pharmaceutical sales exceeds the expansion rates of other health expenditures (17.8 %). During the 9 years of observation, 25% more psychopharmaceutical products were sold. This may result from increased prevalence of mental disorders, higher usage or an increment in prescriptions.
Asunto(s)
Costos de los Medicamentos/tendencias , Costos de la Atención en Salud/tendencias , Trastornos Mentales/tratamiento farmacológico , Trastornos Mentales/economía , Programas Nacionales de Salud/economía , Programas Nacionales de Salud/tendencias , Psicotrópicos/economía , Psicotrópicos/uso terapéutico , Ansiolíticos/clasificación , Ansiolíticos/economía , Ansiolíticos/uso terapéutico , Antidepresivos/clasificación , Antidepresivos/economía , Antidepresivos/uso terapéutico , Antipsicóticos/clasificación , Antipsicóticos/economía , Antipsicóticos/uso terapéutico , Austria , Estimulantes del Sistema Nervioso Central/clasificación , Estimulantes del Sistema Nervioso Central/economía , Estimulantes del Sistema Nervioso Central/uso terapéutico , Estudios Transversales , Utilización de Medicamentos/tendencias , Predicción , Hipnóticos y Sedantes/clasificación , Hipnóticos y Sedantes/economía , Hipnóticos y Sedantes/uso terapéutico , Trastornos Mentales/epidemiología , Psicotrópicos/clasificaciónRESUMEN
INTRODUCTION: Current classifications of psychotropic drugs, developed in the 1960s, are based on beliefs about clinical effectiveness. This article evaluates the scientific validity of current drug terms and possible alternative classifications. METHODS: A historical, conceptual, and empirical review of the psychopharmacology literature is provided. Consistency of classification is examined by 3 major categories: chemical structure, pharmacodynamic mechanism, and clinical efficacy. RESULTS: Current drug terms based on clinical effectiveness are not valid scientifically, either claiming efficacy which is disproven or ignoring other areas of clinical efficacy. Hence, clinical efficacy is not a consistent and scientifically valid way of classifying psychotropic drugs. Chemical structures are also heterogeneous for drugs with similar clinical efficacy. The most consistent way to define drug classes is pharmacodynamic mechanism. Specific drug groups identified are: monoamine agonists ("antidepressants" and "stimulants"), dopamine blockers ("antipsychotics"), second messenger modifiers ("mood stabilizers), and gabaergic agonists ("anxiolytics" or "hypnotics"). CONCLUSIONS: Consistent with a recent proposal of psychopharmacology organizations, this article proposes a new nomenclature based mainly on biological pharmacodynamic mechanisms. Specific terms that are scientifically valid and clinically practical are suggested. It is hoped that this new language would allow for more meaningful and accurate communication between clinicians and patients.
Asunto(s)
Psicofarmacología/clasificación , Psicotrópicos/clasificación , Ansiolíticos/clasificación , Ansiolíticos/uso terapéutico , Antidepresivos/clasificación , Antidepresivos/uso terapéutico , Antipsicóticos/clasificación , Antipsicóticos/uso terapéutico , Estimulantes del Sistema Nervioso Central/clasificación , Estimulantes del Sistema Nervioso Central/uso terapéutico , Humanos , Trastornos Mentales/tratamiento farmacológico , Psicofarmacología/tendencias , Psicotrópicos/uso terapéuticoRESUMEN
BACKGROUND: Complex medical conditions are frequent among seniors, and their medical treatment represents a challenge. Older patients have a high rate of consumption of prescription drugs, greater risks of medication interactions, and a higher likelihood of side effects. Many common drugs used by the elderly also have addictive potential. Prescription patterns involving general practitioners (GPs) are not sufficiently known. OBJECTIVE: Our objective was to examine the regular GP role in the prescription of addictive and non-addictive drugs to home-dwelling older people in Norway. DESIGN: The study was designed as a panel data study. SETTING: Data on all prescription drugs dispensed at pharmacies to patients 70 years and older from the Norwegian Prescription Database were merged with data on GPs and GPs' patient lists from the Regular General Practitioner Database. The dataset included 624,308 patients and 4,520 GPs in the period from 2004 to 2007. OUTCOME MEASURES: Outcome measures included quantities of addictive and non-addictive drugs prescribed and dispensed per patient by the regular GP, other GPs, non-GP specialists, and hospital doctors; the number of prescribers per patient; and time trend over the observation period. RESULTS: On average, 319 defined daily doses of medication were prescribed per quarter to an older patient, 6 % of which were classified as possibly addictive medications. Of all drugs, 72 % were prescribed by the patients' regular GP, 77 % of addictives and 71 % of non-addictives. Drug quantities prescribed increased with multiple prescribers and did so to a greater extent for addictives than for non-addictives. Time trends show an increasing number of prescribers and increasing drug quantities over the observation period. CONCLUSION: The regular GP prescribes the major portion of non-addictive and, especially, addictive medications to older patients and thus holds a key role in the coordination of prescriptions to this group. Focusing on the role of the GP is important in view of the increasing time trends.
Asunto(s)
Analgésicos Opioides/uso terapéutico , Anestésicos/uso terapéutico , Ansiolíticos/uso terapéutico , Anticonvulsivantes/uso terapéutico , Prescripciones de Medicamentos/estadística & datos numéricos , Pautas de la Práctica en Medicina/normas , Anciano , Anciano de 80 o más Años , Analgésicos Opioides/clasificación , Anestésicos/clasificación , Ansiolíticos/clasificación , Anticonvulsivantes/clasificación , Bases de Datos Factuales , Utilización de Medicamentos/estadística & datos numéricos , Utilización de Medicamentos/tendencias , Médicos Generales/normas , Médicos Generales/estadística & datos numéricos , Servicios de Salud para Ancianos/estadística & datos numéricos , Humanos , Noruega , Pautas de la Práctica en Medicina/estadística & datos numéricosRESUMEN
BACKGROUND: Tolerance towards the effects of benzodiazepines is observed in various animal and human studies. Therefore, it is assumed that patients who use benzodiazepines for a longer period of time need to increase their dose over time to experience the same effect. OBJECTIVE: To observe whether long-term benzodiazepine users increase their dose over time. METHODS: From the Dutch National Information Network of Family Practices, a group of long-term benzodiazepine users was identified. This group was divided into an incident long-term benzodiazepine users group (N = 113) and a prevalent long-term benzodiazepine users group (N = 992). Long-term use of benzodiazepines was defined as usage for at least 6 months. The main outcome was a change in prescribed dose from baseline until 24 months after baseline. Linear regression analysis was performed to evaluate dose change. RESULTS: Neither incident long-term benzodiazepine users nor prevalent long-term benzodiazepine users were prescribed increasing dosages during follow-up. CONCLUSION: There is no increase in prescribed dose among long-term users, as might be expected due to the development of tolerance to the effects of benzodiazepines.
Asunto(s)
Trastornos de Ansiedad/tratamiento farmacológico , Benzodiazepinas , Pautas de la Práctica en Medicina/estadística & datos numéricos , Atención Primaria de Salud , Trastornos del Sueño-Vigilia/tratamiento farmacológico , Trastornos Relacionados con Sustancias/etiología , Adulto , Ansiolíticos/clasificación , Ansiolíticos/farmacología , Benzodiazepinas/clasificación , Benzodiazepinas/farmacología , Relación Dosis-Respuesta a Droga , Tolerancia a Medicamentos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Atención Primaria de Salud/métodos , Atención Primaria de Salud/estadística & datos numéricos , Trastornos Relacionados con Sustancias/epidemiología , TiempoRESUMEN
OBJECTIVE: To quantify the rates of clinical outcomes of Canadian Psychiatric Association (CPA) guideline-recommended pharmacotherapies for generalized anxiety disorder (GAD) by drug classification within each treatment line. METHODS: Evidence from original research cited by the CPA was included. Pooled analyses, duplicates, and studies with nonextractable data were excluded. Response, remission, and baseline-endpoint or mean reductions scores of the Hamilton Anxiety Rating Scale (HARS) were extracted. The Cochrane Collaboration's computer program, Review Manager, version 5, with a random effects model, was used to pool results. RESULTS: A total of 50 articles were cited as evidence for managing GAD by the CPA. There was sufficient evidence of remission with first- or third-line agents to pool reported rates, and with agents from all 3 treatment lines to pool response rates and reduction in HARS scores. The mean range of effect size varied considerably from study to study within each treatment line. Comparison of pooled remission rates between first- and second-line agents was not possible. While the range of values by drug and drug class overlapped, the summary results for the probability of response and reduction in HARS scores was greater for first-line, compared with second-line, treatments. Drug components for third-line treatments were heterogeneous and produced mixed results. CONCLUSION: Despite the abundance of evidence in its totality presented in the CPA guidelines, there is inadequate evidence to formulate recommendations based on the pooled results from this study alone. However, such analysis provides an additional resource for clinicians to make more effective treatment decisions for individual patients with GAD.
Asunto(s)
Ansiolíticos/uso terapéutico , Trastornos de Ansiedad/tratamiento farmacológico , Medicina Basada en la Evidencia , Adhesión a Directriz , Ansiolíticos/efectos adversos , Ansiolíticos/clasificación , Anticonvulsivantes/efectos adversos , Anticonvulsivantes/uso terapéutico , Antidepresivos/efectos adversos , Antidepresivos/uso terapéutico , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/psicología , Benzodiazepinas/efectos adversos , Benzodiazepinas/uso terapéutico , Quimioterapia Combinada , Humanos , Inventario de Personalidad , Inhibidores Selectivos de la Recaptación de Serotonina/efectos adversos , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéutico , Resultado del TratamientoRESUMEN
BACKGROUND: Benzodiazepines misuse, abuse, and dependence is becoming a new problem in medicine used in Thailand. OBJECTIVE: Study the prevalence of benzodiazepines use, misuse, abuse, and dependence in Ubon Ratchathani province Thailand. MATERIAL AND METHOD: A cross-sectional household survey was conducted between October 2008 and June 2009. The target population were the people age 15 and above. A sample size of 2280 was selected from three stage stratified random sampling. Benzodiazepines were identified with generic name and drug characteristics. The DSM-IV questionnaires were used to define misuse, abuse, and dependence. Dependence was interpreted with judgment of a psychiatric nurse. For statistical analyses, prevalence was estimated with weight adjustment, variances estimated by Teylor Series Linearization method, and interpreted with 95% CI. RESULTS: There were 46,805 current users [3.9% (95% CI: 2.2-6.4)], 26,404 misuser [2.2% (95% CI: 1.6-6.2)], 7203 abuser [0.6% (95% CI: 0.1-4.1)] and 2402 dependent [0.2% (95% CI: O. 1-9.2)]. When considering the group of current user, the results showed that 57.2% of this group misused, 16.6% abused and 5.9% were dependent. CONCLUSION: Prevalence of use was higher than previously reported in Thailand while more than half of the current users misused Surveillance ofmisuse should be done in the group of current user Medical professional should give recommendations to patients, focusing on harm of misuse. Furthermore, they should limit the amount of medicine when it is necessary to dispense.
Asunto(s)
Ansiolíticos/uso terapéutico , Benzodiazepinas/uso terapéutico , Utilización de Medicamentos/estadística & datos numéricos , Farmacoepidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Ansiolíticos/clasificación , Benzodiazepinas/clasificación , Estudios Transversales , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/etiología , Encuestas y Cuestionarios , Tailandia/epidemiología , Adulto JovenRESUMEN
Anxiety disorders are persistent impairing diseases, with often chronic course and suffering from symptoms throughout a life-span. The medication with the most evidence of efficacy is the benzodiazepines having a low incidence of side effects but may cause physical dependence, withdrawal and sedation. The use of these drugs should be limited to the acute treatments during the first several weeks in combination with an SSRI or and SNRI for the treatment of the acute phase. After three to four weeks, when antidepressants become effective, benzodiazepine dose should be tapered over a one week period. Among the antidepressants, the SSRI and the SNRI are considered a first-line therapy because of their favourable side effect spectrum compared to tricyclic antidepressants. However, the association with side effects such as nausea, sweating, sexual dysfunction and gastrointestinal problems and insomnia may be intolerable for a number of patients. Combining antidepressants and benzodiazepine therapy or medication treatment and psychotherapy may lead to an increase in improvement in patients not responding to one treatment approach alone. The most effective treatment for managing the recurrent symptoms of this chronic disorder are still unknown and other studies and approaches are in need as remission rates are still only about 40%.
Asunto(s)
Ansiolíticos/uso terapéutico , Trastornos de Ansiedad/tratamiento farmacológico , Enfermedad Aguda , Ansiolíticos/efectos adversos , Ansiolíticos/clasificación , Antidepresivos/efectos adversos , Antidepresivos/uso terapéutico , Trastornos de Ansiedad/clasificación , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/psicología , Nivel de Alerta/efectos de los fármacos , Benzodiazepinas/efectos adversos , Benzodiazepinas/clasificación , Benzodiazepinas/uso terapéutico , Quimioterapia Combinada , Medicina Basada en la Evidencia , Humanos , Trastornos Relacionados con Sustancias/etiología , Trastornos Relacionados con Sustancias/prevención & controlRESUMEN
Compared to adults, the use of psychopharmacological substances in childhood and adolescence is significantly more controversial. Often sensation-seeking media reports on the negative effects of psychopharmacological treatments of children and adolescents intensify this controversy on a regular basis. In addition, even pharmacologically trained experts--though frequently without expertise in Child and Adolescent Psychiatry--question the seriousness and thus the demands for treatment of psychiatric disorders in childhood and adolescence. Considering this background evidence based treatment decisions in pediatric psychopharmacology are of utmost importance. Effective psychopharmacotherapy needs to be distinguished from ineffective treatments. The pros and cons of such evidence based treatment approaches ought to be weighted out carefully together with the patients and their families. The aim of this article is to provide a rational and concise foundation for the use of psychopharmacotherapy for clinicians treating children and adolescents as well as to point out the currently best evidence for psychopharmacological treatments of selected disorders in child and adolescent psychiatry.
Asunto(s)
Trastornos Mentales/tratamiento farmacológico , Psicotrópicos/uso terapéutico , Adolescente , Ansiolíticos/efectos adversos , Ansiolíticos/clasificación , Ansiolíticos/uso terapéutico , Antidepresivos de Segunda Generación/efectos adversos , Antidepresivos de Segunda Generación/clasificación , Antidepresivos de Segunda Generación/uso terapéutico , Antidepresivos Tricíclicos/efectos adversos , Antidepresivos Tricíclicos/clasificación , Antidepresivos Tricíclicos/uso terapéutico , Antipsicóticos/efectos adversos , Antipsicóticos/clasificación , Antipsicóticos/uso terapéutico , Trastornos de Ansiedad/clasificación , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/tratamiento farmacológico , Trastornos de Ansiedad/psicología , Trastorno por Déficit de Atención con Hiperactividad/clasificación , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Estimulantes del Sistema Nervioso Central/efectos adversos , Estimulantes del Sistema Nervioso Central/clasificación , Estimulantes del Sistema Nervioso Central/uso terapéutico , Niño , Trastorno Depresivo/clasificación , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/tratamiento farmacológico , Trastorno Depresivo/psicología , Relación Dosis-Respuesta a Droga , Aprobación de Drogas , Medicina Basada en la Evidencia , Humanos , Trastornos Mentales/clasificación , Trastornos Mentales/diagnóstico , Trastornos Mentales/psicología , Educación del Paciente como Asunto , Psicotrópicos/efectos adversos , Psicotrópicos/clasificación , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Inhibidores Selectivos de la Recaptación de Serotonina/efectos adversos , Inhibidores Selectivos de la Recaptación de Serotonina/clasificación , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéuticoAsunto(s)
Trastornos de Ansiedad/prevención & control , Trastorno Depresivo/prevención & control , Ansiolíticos/clasificación , Ansiolíticos/farmacología , Ansiolíticos/uso terapéutico , Antidepresivos/clasificación , Antidepresivos/farmacología , Antidepresivos/uso terapéutico , Trastornos de Ansiedad/etiología , Trastornos de Ansiedad/psicología , Causalidad , Terapia Cognitivo-Conductual , Trastorno Depresivo/etiología , Trastorno Depresivo/psicología , Desensibilización Psicológica , Terapia por Estimulación Eléctrica , Terapia Electroconvulsiva , Humanos , Neurotransmisores/fisiología , Rol de la Enfermera , Educación del Paciente como Asunto , Psicoterapia , Terapia por Relajación , Estimulación Magnética TranscranealRESUMEN
Pregabalin is a new anxiolytic that has been recently licensed for the treatment of generalised anxiety disorder (GAD) in Europe. Short-term efficacy is based on six positive placebo-controlled studies, all of which showed a significant early separation from placebo in all of the doses used (150-600 mg) at the first week, and the efficacy at the end of the treatment was comparable with the comparators used in four of these studies. Pregabalin was effective in more or less severe GAD, on psychic and somatic symptoms of GAD, and in treating the subsyndromal depressive symptoms of GAD. Efficacy in the elderly was shown in a separate placebo-controlled study. The effect on cognitive function was minimal and notably less than that observed with benzodiazepines. The discontinuation symptoms following abrupt treatment cessation were similar to the rates with serotonin-noradrenaline re-uptake inhibitors and lower than with benzodiazepines with no signals of tolerance or dependence.
Asunto(s)
Ansiolíticos/uso terapéutico , Trastornos de Ansiedad/tratamiento farmacológico , Ácido gamma-Aminobutírico/análogos & derivados , Ansiolíticos/clasificación , Ansiolíticos/farmacocinética , Humanos , Pregabalina , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento , Ácido gamma-Aminobutírico/efectos adversos , Ácido gamma-Aminobutírico/farmacocinética , Ácido gamma-Aminobutírico/uso terapéuticoAsunto(s)
Ansiolíticos/uso terapéutico , Hipnóticos y Sedantes/uso terapéutico , Trastornos del Inicio y del Mantenimiento del Sueño/tratamiento farmacológico , Ansiolíticos/efectos adversos , Ansiolíticos/clasificación , Ensayos Clínicos como Asunto , Trastornos del Conocimiento/tratamiento farmacológico , Humanos , Hipnóticos y Sedantes/efectos adversos , Hipnóticos y Sedantes/clasificación , Medicamentos sin Prescripción/efectos adversos , Medicamentos sin Prescripción/uso terapéutico , Guías de Práctica Clínica como AsuntoRESUMEN
Pharmacogenetics as a field of research is increasing the basis of knowledge on the use of psychotropics in different ethnic patient populations. This chapter summarizes current knowledge on the metabolism of anxiolytic agents with emphasis on pharmacogenetics and ethnic variations in drug responses.
Asunto(s)
Ansiolíticos/uso terapéutico , Etnicidad , Farmacogenética , Ansiolíticos/clasificación , Ansiolíticos/farmacocinética , Sistema Enzimático del Citocromo P-450/genética , Sistema Enzimático del Citocromo P-450/metabolismo , HumanosRESUMEN
The pharmacological treatment of anxiety has a long and chequered history, and recent years have seen a rich development in the options available to prescribers. Most of the currently used anxiolytic agents act via monoaminergic (chiefly serotonin) or amino acid (GABA or glutamate) neurotransmitters, and this chapter describes the pharmacology of the major drug groups. Clinical applications are discussed with respect to the five major anxiety disorders, as well as simple phobia and depression with concomitant anxiety. Prospective future developments in the field are considered.
Asunto(s)
Ansiolíticos/uso terapéutico , Ansiedad/tratamiento farmacológico , Ansiolíticos/clasificación , Ansiedad/clasificación , Ansiedad/diagnóstico , HumanosRESUMEN
New developments in the pharmacological treatment of anxiety disorders will have distinct backgrounds: characterization of pathophysiological processes including evolving techniques of genomics and proteomics will generate new drug targets. Drug development design will generate new pharmacological substances with specific action at specific neurotransmitter and neuropeptide receptors or affecting their reuptake and metabolism. New anxiolytic drugs may target receptor systems that only recently have been linked to anxiety-related behavior. This includes the N-methyl-D-aspartate (NMDA), S-alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA), and the cannabinoid receptors. In addition, signal transduction pathways, neurotrophic factors, and gases such as nitric oxide or carbon monoxide may be new drug targets. Combining psychopharmacological and psychotherapeutical interventions is a further field where benefits for the treatment of anxiety disorders could be achieved. Although the road of drug development is arduous, improvements in the pharmacological treatment of anxiety disorders are expected for the near future.
Asunto(s)
Ansiolíticos/uso terapéutico , Trastornos de Ansiedad/tratamiento farmacológico , Ansiolíticos/clasificación , Humanos , Neuropéptidos/fisiología , Neurotransmisores/fisiologíaAsunto(s)
Ansiolíticos/envenenamiento , Ansiedad/tratamiento farmacológico , Servicios Médicos de Urgencia/métodos , Adulto , Ansiolíticos/clasificación , Ansiolíticos/farmacología , Antídotos/uso terapéutico , Niño , Sobredosis de Droga/tratamiento farmacológico , Sobredosis de Droga/terapia , Educación Continua , Femenino , Humanos , Masculino , Intento de Suicidio , Estados UnidosRESUMEN
Antecedentes: el tratamiento odontológico de los pacientes sistémicamente comprometidos tiene cada vez más importancia en el campo de la salud bucal. El sistema general de seguridad social actual en Colombia crea la necesidad de establecer protocolos para el diagnóstico y tratamiento de las diferentes patologías, con evidencia científica para el mejoramiento en la calidad de la atención de los usuarios. La mayoría de los protocolos que existen actualmente para el manejo del paciente con compromiso sistémico y diangóstico de patología bucal, se presentan como revisiones teóricas con poca aplicabilidad clínica o con una inapropiada sustentación científica; de igual forma, se encuentra diversidad de procedimientos terapéuticos para abordar una mismma patología, generando serias dificultades para unificar criterios de planes de tratamiento en este grupo de pacientes. Objetivo: diseñar guías de práctica clínica bassadas en la evidencia para el manejo del paciente sistémicamente comprometido que requiera tratamiento. En este artículo se presenta una revisión que concierne a la condición sistémica del embarazo. Métodos: revisión sistemática de la literatura y desarrollo de guías de práctica clínica con metodología de medicina basada en la evidencia. Resultados: desarrollo de la guía de práctica clínica basada en la evidencia para el manejo de la paciente embarazada que requiera tratamiento endodóntico. Conclusiones: la realización de esta guía ofrece una ilustración práctica de los puntos críticos de la toma de decisiones para el tratamiento endodóntico de la paciente embarazada (uso de anestésicos, analgésicos, antibióticos y toma de radiografías) y garantiza que éstas sean tan realizables y éticas como sea posible
Asunto(s)
Humanos , Femenino , Embarazo , Protocolos Clínicos , Medicina Basada en la Evidencia , Embarazo , Tratamiento del Conducto Radicular , Analgésicos/farmacología , Anestésicos Locales/farmacología , Anestésicos Locales/química , Ansiedad al Tratamiento Odontológico/terapia , Ansiolíticos/clasificación , Ansiolíticos/farmacología , Antibacterianos/clasificación , Antibacterianos/farmacología , Enfermedades Cardiovasculares , Enfermedades de la Pulpa Dental , Evaluación Preclínica de Medicamentos/normas , Hipertensión/etiología , Revisión , Metaanálisis , Enfermedades de la Boca , Mucosa Bucal , Obturación del Conducto Radicular/normas , Embarazo , Complicaciones del Embarazo , Odontología Preventiva , Procedimientos Quirúrgicos Orales/normas , Exposición a la Radiación , Radiografía Dental/normas , Medición de Riesgo , Teratógenos/análisis , Teratógenos/clasificaciónRESUMEN
A selection of articles that focus on psychosocial treatments, pharmacotherapy, and psychosurgery of anxiety disorders are reviewed. While some medications look clearly beneficial or potentially effective in the treatment of anxiety disorders, other compounds seem less promising or not effective. A combination of proven pharmacotherapies and psychotherapies may be the most clinically prudent approach to the treatment of anxiety disorders. Thermocapsulotomy may be an "extreme" option in selected cases of severe nonobsessive anxiety but may carry a significant risk of adverse effects indicative of frontal lobe functioning impairment. In spite of all the research and progress in studying relatively well-defined therapies, many patients suffering from anxiety and depression still use complementary and alternative therapies. The use of alternative and complementary is likely to increase as insurance coverage expands.