A 45 year old male sought consultation in our neurology clinic with the complaint of persistent genital uncomfortable sensations and pain. After extensive investigations, there was no underlying urological or neurological disease demonstrable. He was diagnosed to have restless genital syndrome and was given pramipexole and gabapentin with significant improvement of his symptoms. Our patient suggests that pramipexol and gabapentin may be useful as treatment for restless genital syndrome.
Anxiety Disorders ; Anti-Anxiety Agents

BACKGROUND AND PURPOSE: Anxiety is the most important precipitating factor of migraine attacks, and more than half of migraineurs have coexisting anxiety disorders. Paroxetine, an antidepressant, is one of the selective serotonin reuptake inhibitors (SSRIs) that has an anxiolytic effect, and is also known to be effective for migraine prophylaxis. The aim of this study was to determine the role of the anxiolytic effect of paroxetine on the prevention of migraine. METHODS: This study investigated migraineurs with a general anxiety disorder who visited the neurological clinic. The following efficacy variables were assessed at baseline and after taking paroxetine (20 for 12 weeks: headache frequency, Hamilton Anxiety Rating Scale (HAM-A), Headache Management Self-Efficacy Scale (HMSE), and Headache Disability Inventory (HDI). The correlation between the headache responsiveness to paroxetine and improvement in anxiety levels was analyzed. RESULTS: Twenty-four patients (aged 54.96+/-12.09 years, mean+/-SD) were included in this study. Paroxetine reduced headache frequency by 49.1% within 12 weeks (p<0.05 vs baseline). HAM-A and HMSE scores also showed an improvement, whereas there was no significant change in HDI score. The baseline HAM-A scores did not differ between paroxetine responders and nonresponders. In addition, the improvement in HAM-A score was not correlated with the reduction in headache frequency. CONCLUSIONS: Paroxetine decreased the headache frequency and reduced anxiety levels. However, the anxiolytic effect of paroxetine was not correlated with the migraine prevention effect. These observation indicate that the anxiolytic effect of paroxetine does not contribute strongly to its prophylactic effect on migraine frequency in migraineurs with anxiety disorder.
Anti-Anxiety Agents* ; Anxiety ; Anxiety Disorders ; Headache ; Humans ; Migraine Disorders* ; Paroxetine* ; Precipitating Factors ; Serotonin Uptake Inhibitors

OBJECTIVES: Cancer patients experience various types of anxiety, from normal fears to pathological anxiety, through the entire process of the illness. This anxiety requires attention, because it may interfere with their cancer treatment and result in a negative impact on quality of life. The present paper aimed to provide an overview of current pharmacotherapy for anxiety in the oncology setting, by systematically reviewing the related literature. METHODS: We searched both international and Korean domestic databases with the search terms "cancer", "anxiety", and "pharmacological treatment", targeting between 1980 and 2008, and graded the evidence levels according to the Scottish Intercollegiate Guideline Network (SIGN). RESULTS: Of 215 studies searched, we selected only 22 pharmacological clinical studies. There was no meta-analysis or systematic review of psychopharmacotherapy for anxiety disorders among cancer patients. Also, we reviewed a few expert opinions and available clinical trials on anxiety in general. CONCLUSION: Based on the limited evidence, the present review provides an understanding and some recommendations for treating anxiety in cancer patients. Further investigation of psychopharmacotherapy for anxiety in cancer patients is warranted, to develop evidence-based guidelines for comprehensive cancer care.
Anti-Anxiety Agents ; Anxiety ; Anxiety Disorders ; Expert Testimony ; Humans ; Quality of Life ; Serotonin Uptake Inhibitors

OBJECTIVE: In applying Electro-Convulsive Therapy(ECT) to patients, initial electric stimuli have been often determined without the adequate guidelines. This study was designed to determine adequate numerical value of parameters for initial electric stimuli inducing seizure successfully in ECT. We prepared Asan Medical Center(AMC) guidelines for 4 parameters based on our clinical experiences and MECTA(Monitored Electro-Convulsive Therapy Apparatus, MECTA Crop(R)) instruction manual, and investigated the success rate in the first session of ECT following AMC guidelines for parameters. METHOD: Twenty-two patients(male 10, female 12) treated with ECT using MECTA SR-1 model in Asan Medical Center between september 1996 and october 1998 were included in this study. We carried out bilateral ECT under anesthesia according to AMC guidelines. Seizure that persisted longer than 20 seconds was considered successful. RESULTS: 18 of 22 patients showed successful seizures in the first session (82%). Four patients failed to show successful seizures. One out of the foiled patients received inadequate stimuli due to premature release of switch burton and two patients were taking continuously anticonvulsants and anxiolytics, respectively prior to ECT. But all foiled patients except one, who was thought to have unusually high seizure threshold, demonstrated successful seizures in the second session with the same initial parameters. CONCLUSIONS: The bilateral ECT according to AMC guidelines resulted in the adequate seizures in all patients except one patient who had unusually high seizure threshold. These data show that AMC guidelines can be successfully applied in ECT using MECTA device.
Anesthesia ; Anti-Anxiety Agents ; Anticonvulsants ; Chungcheongnam-do ; Female ; Humans ; Seizures

OBJECTIVE: This study compared the efficacy and tolerability of clonazepam with other benzodiazepines in patients with anxiety disorders. METHODS: Inclusion criteria were as follows: age >20 years, diagnosis of anxiety disorder according to the Diagnostic and Statistical Manual of Mental Disorders 4th edition, text revision (DSM-IV-TR) criteria, taking only one type of antidepressant, and prescribed one of three oral benzodiazepines (alprazolam, clonazepam, or lorazepam). At baseline and week 6, clinical benefit was evaluated using the Clinical Global Impression-Severity Scale (CGI-S), Clinical Global Impression-Anxiety Scale (CGI-anxiety), and Clinical Global Impression-Sleep Scale (CGI-sleep). RESULTS: Among 180 patients, no differences in demographic characteristics among the three benzodiazepine groups were noted. After six weeks of treatment, all benzodiazepine groups showed significant improvements in CGI-S, CGI-anxiety, and CGI-sleep scores (p<0.001). There were no differences in mean changes in CGI-S, CGI-anxiety and CGI-sleep among the three benzodiazepine groups. The incidence of side effects was significantly lower in the clonazepam group than with the other benzodiazepines. The incidences of adverse events for the clonazepam, alprazolam, and lorazepam groups were 26.7% (n=20), 48.4% (n=31), and 43.9% (n=18), respectively. CONCLUSION: The present study suggests that clonazepam is as efficacious as other benzodiazepines for the treatment of various anxiety disorders. Furthermore, the safety profile of clonazepam was superior to the other benzodiazepines in this study.
Alprazolam ; Anti-Anxiety Agents ; Antidepressive Agents* ; Anxiety Disorders* ; Anxiety* ; Benzodiazepines ; Clonazepam* ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Incidence ; Lorazepam

BACKGROUND AND OBJECTIVES: According to the neurophysiologic model of tinnitus, emotion and autonomic nervous systems are closely related to generation of tinnitus. We performed this study to evaluate the treatment response of modified tinnitus retraining therapy (TRT) with medication in the patients with sensorineural tinnitus. SUBJECTS AND METHOD: Forty-three tinnitus patients who were diagnosed as sensorineural tinnitus through audiologic evaluation and have normal hearing in speech frequency were included in this study. Tinnitus and psychological status were measured by tinnitus questionnaire, Korean version of Brief Encounter Psychosocial Instrument (BEPSI) scale, Beck Depression Inventory (BDI), Spielberger State Trait Anxiety Inventory (STAI). Patients treated with anxiolytics and microcirculation enhancer were Group 1 and those treated with modified TRT and medications were Group 2. Short-term therapeutic response was analyzed and compared between two groups. RESULTS: Loudness, awareness, annoyance and effect on life of tinnitus and tinnitus handicap score were significantly decreased in Group 2. Relief of tinnitus in more than 2 of 4 subjective parameters was achieved in 4 patients (30.7%) in Group 1 and 15 patients (75%) in Group 2. Stress score was also decreased significantly after treatment in Group 2. CONCLUSION: Tinnitus patients in Group 2 treated with medication and modified TRT showed the higher compliance and the response rate of treatment than the patients in Group 1 treated with medication alone. Modified TRT, in addition to medical therapy, should be considered to increase the therapeutic response in patients with sensorineural tinnitus.
Anti-Anxiety Agents ; Anxiety ; Autonomic Nervous System ; Compliance ; Depression ; Hearing ; Humans ; Microcirculation ; Surveys and Questionnaires ; Tinnitus

The anxiety disorders make up one of the most common groups of psychiatric disorders. Anxiety is an alerting signal ; it warns of impending danger and enables a person to take measures to deal with a threat. Three major schools of psychological theory-psychoanalytic, behavioral, and existential-have contributed theories about the causes of anxiety. Many drugs are effective in managing distressing signs and symptoms associated with anxiety disorders. As the symptoms are controlled by medication, patients are reassured and develop confidence that they will not be incapacitated by the disorder. Benzodiazepines are useful in panic disorder, phobias, and agitation. In general, benzodiazepines act as hypnotics at high doses and as anxiolytics or sedatives at low doses. The benzodiazepines have become the sedative-hypnotic drugs of first choice because they have a higher therapeutic index and significantly less abuse potential than do many of other sedative-hypnotics. The most common adverse effect of benzodiazepines is drowsiness. Some patients also experience dizziness and ataxia. The most serious adverse effects of benzodiazepines occur when other sedative substances are taken concurrently. When benzodiazepines are used for long periods, they usually cause significant tolerance, dependence, or withdrawal effects. Overdoses with benzodiazepines alone have a predictably favorable outcome. The benzodiazepines should be started at a low dosage, and the patient should be informed about the drug’s sedative properties and abuse potential. Serotonin-specific reuptake inhibitors (SSRIs) have a much more favorable profile of adverse effects and have significantly broadened the horizon for pharmacological treatment of anxiety disorder. Three fourths of patients experience no adverse effects at low starting doses, and doses may be increased relatively rapidly in these patients. In the remaining one fourth of patients, most of the SSRIs’ adverse effects appear within the first 1 to 2 weeks, and they generally subside or resolve spontaneously if the drugs are continued at the same dose.
Anti-Anxiety Agents ; Anxiety ; Anxiety Disorders ; Ataxia ; Benzodiazepines ; Dihydroergotamine ; Dizziness ; Humans ; Hypnotics and Sedatives ; Panic Disorder ; Phobic Disorders ; Sleep Stages

OBJECTIVE: Benzodiazepines are from the most common drugs which are used for treatment of anxiety disorders. There are other drugs with antianxiety properties including antihistamines such as hydroxyzine, too. Body of evidence show that co-administration of two drugs which act through different mechanisms, makes the dose of each drug to be reduced, while preserving the desired effect with less adverse drug reactions. The aim of this study was to see whether co-administration of subeffective antianxiety doses of diazepam and hydroxyzine has any antianxiety effect in elevated zero-maze (EZM) in mice. METHODS: To find the highest subeffective dose of each drug, different doses of hydroxyzine from 1.5 to 24 mg/kg and diazepam in doses of 0.25, 0.5 and 1 mg/kg were injected to male mice. Thirty minutes later, the animals were placed on EZM and various parameters of anxiety were recorded by a camera to assess later. After determination of subeffective antianxiety dose of the drugs, co-administration of hydroxyzine and diazepam was done and the anxiety parameters were measured. RESULTS: In co-administration of 0.25 mg/kg of diazepam and 12 mg/kg hydroxyzine, as subeffective antianxiety doses of either drug, there were not any significant differences in main anxiety parameters, i.e., time spent in open areas and open area entries compared to control group. Hence, no anxiolytic effect was seen. CONCLUSION: It seems that subeffective doses of diazepam and hydroxyzine may not have any facilitating or synergistic effect on each other in antianxiety responses in mice.
Animals ; Anti-Anxiety Agents ; Anxiety ; Anxiety Disorders ; Benzodiazepines ; Diazepam ; Drug Toxicity ; Histamine Antagonists ; Humans ; Hydroxyzine ; Male ; Mice

BACKGROUND: Migraine is commonly associated with anxiety disorder. However, whether anxiolytic medicine or changes in anxiety levels affect the migraine attack is unclear. Buspirone, the agonist for 5-HT1A receptor, is effective in treating generalized anxiety disorder. In this study, we attempted to test the efficacy of buspirone for migraine combined with anxiety disorder. METHODS: 111 outpatients aged 20 to 70 years (mean, 46.4; SD, 12.8), were analyzed. The diagnosis of migraine was made according to the HIS (International Headache Society) criteria, and the level of anxiety was rated by the Hamiton Anxiety Rating Scale (HAM-A). The migraineurs were randomly assigned to treatment with either buspirone (15 mg/day) or placebo for 6 weeks. The efficacy variables included changes in headache frequency, headache intensity, Headache Index, Headache Management Self-Efficacy Scale (HMSE), Headache Disability Inventory (HDI), and the Hamilton Anxiety Rating Scale (HAM-A). The correlation between headache improvement and the anxiolytic effect were analyzed. RESULTS: Headache frequency showed a 43.3% reduction (from 6.7/2 weeks to 3.8/2 weeks) in the buspirone-treated group, whereas a 10.3% reduction (from 6.8 to 6.1/2 weeks) in the placebo group. The Headache Index, HDI, and HAM-A were also significantly lowered in buspirone-treated patients than in placebo-treated patients. However, the headache intensity or the HMSE score were not changed. Correlation analysis between the change of Headache Index and that of HAM-A revealed no significant association. CONCLUSIONS: Buspirone is an effective prophylactic agent in migraine combined with anxiety disorder. This prophylactic effect is not secondary to the anxiolytic effect. This suggests that the agonistic action for 5-HT1A is primarily effective in migraine prophylaxis.
Anti-Anxiety Agents ; Anxiety Disorders ; Anxiety* ; Buspirone* ; Diagnosis ; Headache ; Humans ; Migraine Disorders ; Outpatients ; Receptor, Serotonin, 5-HT1A

Deep vein thrombosis (DVT) is a rare but potentially serious complication of coronary angiography (CAG) affecting just under 5 in 10000 patients. Most of the cases regarding DVT after CAG reported in the literature were associated with procedure-related vascular complications or with risk factors for venous thromboembolism (VTE). Here, we describe the case of a 50-year-old woman during treatment for anxiety disorder, who developed significant DVT after CAG without a history of VTE and with no significant risk factors for VTE, which was treated with an anticoagulant. This case reminds us that clinicians should consider the possible occurrence of VTE after diagnostic CAG even in patients without significant risk factors.
Anti-Anxiety Agents ; Antidepressive Agents ; Anxiety Disorders ; Coronary Angiography ; Female ; Humans ; Risk Factors ; Venous Thromboembolism ; Venous Thrombosis