8 - Anxiety disorders

Summary

Overview

Introduction

The pharmacologic treatment of child and adolescent anxiety disorders has evolved considerably in the past decade. Changes in the diagnostic system have brought childhood anxiety disorders into line with adult disorders, and this trend has been accompanied by a further extension of adult psychopharmacologic approaches to children. The importance of constitutional and persistent anxiety diathesis has been confirmed in genetic and longitudinal studies. Anxiety disorders of childhood are now recognized as chronic, disabling conditions requiring early and effective interventions. Extension of effective pharmacologic treatments from adult psychiatry has continued to guide child and adolescent psychopharmacologists, as systematic studies are still lacking in childhood anxiety disorders. At present, recommendations regarding pharmacotherapy in children are based on the accumulated best evidence from adult studies, a few controlled studies in children and adolescents, open trials, case studies, and clinical experience.

There are recent practical developments in the psychopharmacologic treatment of anxiety disorders. Panic disorder is now known to respond to a number of pharmacologic interventions. It has also been shown that the chronic, disabling disorders of generalized anxiety and social phobia are responsive to the newer serotonergic agents. Since anxiety disorders tend to be chronic and relapsing, long-term or intermittent pharmacotherapy is often required.