Psychosomatic masks of anxiety

Khaustоva O.O.

Main
Publications
Psychosomatic masks of anxiety

August 9, 2019

1020

Neurology and Psychiatry

Keywords :

Specialities :

Neurology and Psychiatry

Resume

Anxiety disorders (AD) often interfere with somatic diseases. Physical manifestations of anxiety can mask the presence of physical illness, which makes it difficult for early diagnosis. Clinical signs of somatic disorders can be similar to somatic symptoms of anxiety, masking already severe disorders, worsening the overall course of the morbid condition and quality of life of the patient. For the purpose of clinical verification of healthy anxiety, anxiety and AD, appropriate classification criteria ICD-10, DSM-5 and specific testing algorithm should be used: Self-assessment scale of anxiety; The Four-Dimensional Symptom Questionnaire for the assessment of distress, depression, anxiety and somatization; Hospital anxiety and depression scale; Hamilton anxiety scale so etc. The therapy of AD following international standards is a combination of pharmacotherapy and psychotherapy, and psychotherapy of even low intensity is considered the first line of treatment. The leading methods of psychotherapy are cognitive-behavioral therapy and progressive relaxation, but many other psychotherapeutic approaches are practical. The standards of evidence-based medicine recommended selective serotonin reuptake inhibitors (SSRI), serotonin and norepinephrine reuptake inhibitors (SNRI) and pregabalin as the first line for psychopharmacotherapy for AD. Use pregabalin as first-line therapy in patients with intellectual disabilities, as well as in therapeutic resistance to SSRI, SNRI. Given the positive effects on sleep, somatic components of anxiety and pain syndromes pregabalin should be recommended for widespread use in patients with anxiety in general medicine. Patients with AD should not be prescribed benzodiazepines or neuroleptics if there are no specific clinical causes.

Published: 09.08.2019

References:

American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (https://www.psychiatry.org/psychiatrists/practice/dsm).
Asanova A., Khaustova O. (2018) Типові складні ситуації у взаємодії лікар-пацієнт у залежності від особистісних особливостей і психічного стану реагування пацієнта. Psychosom. Med. Gen. Pract., 3(3): e0303125.
Baldwin D.S., Ajel K. (2007) The role of pregabalin in the treatment of generalized anxiety disorder. Neuropsychiat. Dis. Treat., 3(2): 185–191.
Baldwin D.S., Ajel K., Masdrakis V. (2013) Pregabalin for the treatment of generalized anxiety disorder: update. Neuropsychiatr. Dis. Treat., 9: 883–892.
Baldwin D.S., Schweizer E., Xu Y., Lyndon G. (2012) Does early improvement predict endpoint response in patients with generalized anxiety disorder (GAD) treated with pregabalin or venlafaxine XR? Eur. Neuropsychopharmacol., 22(2): 137–142.
Bandelow B., Wedekind D., Leon T. (2007) Pregabalin for the treatment of generalized anxiety disorder: a novel pharmacologic intervention. Expert. Rev. Neurother., 7(7): 769–781.
Bech P. (2007) Dose-response relationship of pregabalin in patients with generalized anxiety disorder. A pooled analysis of four placebo-controlled trials. Pharmacopsychiat., 404: 163–168.
Chaban O.S., Khaustova O.O. (2015) Psychosomatic comorbidity and quality of life in elderly patients. Tavr. zhurn. psikhiatr., 19(3): 13–21.
Clark D.M. (2011) Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: the IAPT experience. Int. Rev. Psychiatr., 23(4): 318–327.
Cramer P. (2000) Defense mechanisms in psychology today: Further processes for adaptation. Am. Psychol., 55: 637.
Derogatis L.R. (1979) Psychological coping mechanisms and survival time in metastatic breast cancer. JAMA, 242: 1504–1508.
De Salas-Cansado M., Olivares J.M., Alvarez E. et al. (2012) Pregabalin versus SSRIs and SNRIs in benzodiazepine-refractory outpatients with generalized anxiety disorder: a post hoc cost-effectiveness analysis in usual medical practice in Spain. Clinicoecon. Outcomes. Res., 4: 157–168.
Di Nicola M., Martinotti G., Tedeschi D. et al. (2010) Pregabalin in outpatient detoxification of subjects with mild-to-moderate alcohol withdrawal syndrome. Hum. Psychopharmacol., 25(3): 268–275.
Fava G.A., Cosci F., Sonino N. (2017) Current Psychosomatic Practice. Psychother. Psychosom., 86: 13–30.
Feltner D.E., Crockatt J.G., Dubovsky S.J. et al. (2003) A randomized, doubleblind, placebo-controlled, fixed-dose, multicenter study of pregabalin in patients with generalized anxiety disorder. J. Clin. Psychopharmacol., 23: 240–249.
Feltner D., Wittchen H., Kavoussi R. et al. (2008) Long-term efficacy of pregabalin in generalized anxiety disorder. Int. Clin. Psychopharmacol., 23: 18–28.
Gaebel W., Becker T., Janssen B. et al.; European Psychiatric Association (2012) EPA guidance on the quality of mental health services. Eur. Psychiatry, 27(2): 87–113.
Guglielmo R., Martinotti G., Clerici M., Janiri L. (2012) Pregabalin for alcohol dependence: a critical review of the literature. Adv. Ther., 29(11): 947–957.
Hadley S.J., Mandel F.S., Schweizer E. (2012) Switching from long-term benzodiazepine therapy to pregabalin in patients with generalized anxiety disorder: a double-blind, placebo-controlled trial. J. Psychopharmacol., 26(4): 461–470.
Kasper S., Herman B., Nivoli G. et al. (2009) Efficacy of pregabalin and venlafaxine-XR in generalized anxiety disorder: results of a double-blind, placebo-controlled 8-week trial. Int. Clin. Psychopharmacol., 24: 87–96.
Lydiard R.B., Rickels K., Herman B., Feltner D.E. (2010) Comparative efficacy of pregabalin and benzodiazepines in treating the psychic and somatic symptoms of generalized anxiety disorder. Int. J. Neuropsychopharmacol., 13(2): 229–241.
Maier W., Buller R., Philipp M., Heuser I. (1988) The Hamilton Anxiety Scale: reliability, validity and sensitivity to change in anxiety and depressive disorders. J. Affect. Disord.,14(1): 61–68.
Montgomery S., Chatamra K., Pauer L. et al. (2008) Efficacy and safety of pregabalin in elderly people with generalised anxiety disorder. Br. J. Psychiat., 193: 389–394.
Montgomery S.A., Tobias K., Zornberg G.L. et al. (2006) Efficacy and safety of pregabalin in the treatment of generalized anxiety disorder: a 6 week, multicenter, randomized, double-blind, placebo-controlled comparison of pregabalin and venlafaxine. J. Clin. Psychiat., 67: 771–782.
NICE (2014) Anxiety disorders (https://www.nice.org.uk/guidance/qs53/chapter/Quality-statement-2-Psychological-interventions).
Ogawa S., Satoh J., Arakawa A. et al. (2012) Pregabalin treatment for peripheral neuropathic pain: a review of safety data from randomized controlled trials conducted in Japan and in the west. Drug Saf., 35(10): 793–806.
Oulis P., Konstantakopoulos G. (2012) Efficacy and safety of pregabalin in the treatment of alcohol and benzodiazepine dependence. Exp. Opin. Invest. Drugs., 21(7): 1019–1029.
Oulis P., Masdrakis V.G., Karakatsanis N.A. et al. (2008) Pregabalin in the discontinuation of long-term benzodiazepine use: a case-series. Int. Clin. Psychopharm., 23(2): 110–112.
Pande A.C., Crockatt J.G., Feltner D.E. et al. (2003) Pregabalin in generalized anxiety disorder: a placebo-controlled trial. Am. J. Psychiat., 160: 533–540.
Pohl R.B., Feltner D.E., Fieve R.R., Pande A.C. (2005) Efficacy of pregabalin in the treatment of generalized anxiety disorder: double-blind placebocontrolled comparison of BID vs. TID dosing. J. Clin. Psychopharmacol., 25: 151–158.
Rickels K., Pollack M.H., Feltner D.E. et al. (2005) Pregabalin for treatment of generalized anxiety disorder: a 4-week, multicenter, double-blind, placebo-controlled trial of pregabalin and alprazolam. Arch. Gen. Psychiat., 62: 1022–1030.
Snowdon D.A., Friesen W.V. (2001) Positive emotions in early life and longevity: findings from the nun study. J. Personal. Soc. Psychol., 80: 804.
Sjoberg G., Feychting K. (2010) Pregabalin overdose in adults and adolescents — experience in Sweden. Clin. Toxicol., 48(3): 282.
Stein D.J., Baldwin D.S., Baldinetti F., Mandel F. (2008) Efficacy of pregabalin in depressive symptoms associated with generalized anxiety disorder: a pooled analysis of 6 studies. Eur. Neuropsychopharmacol., 18(6): 422–430.
Tassone D.M., Boyce E., Guyer J., Nuzum D. (2007) Pregabalin: a novel gaminobutyric acid analogue in the treatment of neuropathic pain, partial-onset seizures, and anxiety disorders. Clin. Ther., 29(1): 26–48.
Terluin B., van Marwijk H.W.J., Adèr H.J. et al. (2006) The Four-Dimensional Symptom Questionnaire (4DSQ): a validation study of a multidimensional self-report questionnaire to assess distress, depression, anxiety and somatization. BMC Psychiatry, 6: 34.
Wells J., Principal Pharmacist MH & LD Divisions (2017) Anxiety treatment guidelines for people over the age of 18 years. Version 4, 8 р.
Wensel T., Powe K. (2012) Pregabalin for the treatment of generalized Anxiety Disorder. Ann. Pharmacother., 46: 424–429.
World Health Organization (1992) The ICD-10 classification of mental and behavioural disorders. Clinical descriptions and diagnostic guidelines (https://www.who.int/publications/i/item/9241544228).
Zigmond A.S., Snaith R.P. (1983) The hospital anxiety and depression scale. Acta Psych. Scandinav., 67(6): 361–370.
DZ «Tsentr medychnoi statystyky MOZ Ukrainy» (2014) Dynamika stanu psykhichnoho zdorovia naselennia ta orhanizatsii psykhiatrychnoi i narkolohichnoi dopomohy v Ukraini (analitychno-statystychnyi dovidnyk za 2009–2013 roky u hrafikakh i tablytsiakh). Kyiv, UkrNDI SSPN MOZ Ukrainy, 664 s.
Kleban K.I. (2015) Khronobiolohichni osoblyvosti nepsykhotychnykh psykhichnykh rozladiv u patsiientiv z metabolichnym syndromom. Avtoref. dys. … kand. med. nauk. Kyiv, NDI sots. i sudovoi psykhiatrii ta narkolohii, 18 s.
Kornatskyi V.M., Tretiak I.V., Chaplynska N.V. (2011) Osoblyvosti emotsiinoho stanu patsiientiv z arterialnoiu hipertenziieiu. Ukr. kardiol. zhurn., 3: 55–59.
Sapon D.M. (2016) Tryvozhno-depresyvni rozlady pry KhBS i fibromialhii. Avtoref. dys. … kand. med. nauk. Kyiv, MOZU UNDI sotsialnoi i sudovoi psykhiatrii ta narkolohii, 22 s.
Haustova E.A., Bezsheyko V.G. (2012) Sovremennyie predstavleniya o diagnostike i terapii trevozhnyih rasstroystv. Mezhdunar. nevrol. zhurn., 2(48) (http://www.mif-ua.com/archive/article/27309).
Khaustova O.O. (2009) Metabolichnyi syndrom Kh (psykhosomatychnyi aspekt). Medknyha, Kyiv, 126 s.
Haustova O.O. (2012) Trevozhnyie rasstroystva: prichinyi, simptomyi, diagnostika, lechenie. Ukr. nevrol. zhurn., 3(24): 79–87.
Tsymbal I.V., Zhovtun A.A., Limanska O.L. (2015) Svit VUCA yak suchasnyi kontekst informatsiinykh i suspilno-politychnykh zmin. Naukovyi chasopys NPU imeni M.P. Drahomanova. Seriia 22: Politychni nauky ta metodyka vykladannia sotsialno-politychnykh dystsyplin, 17: 43–47.
Chaban O.S. (2014) Depresyvni rozlady u patsiientiv pokhyloho viku: problemy diahnostyky i terapii. NeiroNews, 2/1: 14–20.
Chaban O.S., Khaustova O.O. (2004) Psykhosomatychna medytsyna (aspekty diahnostyky ta likuvannia). DSH Ltd, Kyiv, 96 s., il.
Chaban O.S., Khaustova O.O., Asanova A.E. ta in. (2018) Praktychna psykhosomatyka: diahnostychni shkaly. Kyiv, Medknyha, 107 s.