in Women's Etifoxina maladaptive Anxiety and
Jaime Urdinola
MD Medical Association Andes CS AK 9116 20 326 Bogotá DC Colombia
Phone 571/215 23 00
e-mail: jaimeurdinolamd@gmail.com - blogger: http: / / www.urdinola.blogspot.com/ www.urdinolamenopausia2.blogspot.com
Symposium / Luncheon on Women's Health and Medical MenopausiaAsociación
Andes Boardroom - Wednesday, July 30, 2008
Anxiety often occurs in any medical consultation. Nor is the exception in the office of women, specifically women 40 to 54 years. According to data INTE (Therapeutic Index of Diseases) in Colombia for June 2007, meaning 14.7% of consultations in this age group.
Adjustment Disorder (or also known as adjustment disorder) and anxiety (TAA), which considered many clinicians and researchers as a marginal diagnostic category, is often seen by psychiatrists, but ignored or unknown in clinical practice general despite its relatively high prevalence. She recently appeared as such in the DSM, the Diagnostic and Statistical Manual of Mental Disorders. Reports from France
consider the prevalence of 9.2% if associated with other psychiatric disorders. Is considered "pure" form of 4.5% to occur in 1% of the general population in primary care clinic. Women represent 2 / 3 of the cases diagnosed, mean age 42 years and most have a professional activity. Major life events are associated with problems at work (23.1%), followed by a family illness (9.0%) or a serious personal illness or accident (7.7%). The average duration is 2.32 months. In 91% of cases are considered necessary psychological or pharmacological treatment, prescribing an anxiolytic (64.9% of cases), followed by an antidepressant (10.8% of cases) or a hypnotic (8.1%) 1. During the past
II International Medical and Mental Health of Women, held in Medellin from 14 to 16 February this year, Dr. Jorge Mario Tamayo, a psychiatrist at the University of Antioquia and pharmacology experts, made the following notations for our country, based on the National Survey of Mental Health, Colombia, 2003 2, which can be found online at the following link: http://www.abacolombia.org. co / bv / clinic / estudio_salud_mental_colombia.pdf
● Prevalence of any psychiatric disorder
- Ever
40.1% - 16.0% Last 12 Months
- 30 days 7.4%
● Prevalence of Anxiety Disorders
- Colombia
19.3% - 21.7% Bogotá
As noted earlier, the reasons for consultation are different and the patient, including women, rarely manifest in a clear and spontaneous that it is anxiety. The doctor well the diagnosis must distinguish between the TAA that carries a real anxiety disorder and anxiety normal adaptation, properly orienting the patient, ensuring the improvement in symptoms and quality of life. TAA is defined as a state of anxiety and emotional disorder that usually interferes with social life and appears as an adjustment to a stressful life change, with the following features to the diagnosis:
- significant anxiety symptoms (anxiety, impatience , irritability),
present within 3 months after the occurrence of one or more identifiable stressors
- Clinical Implications: - Suffering marked and more intense than expected in reaction to the stressor
- social functioning, school or occupational deteriorated
- independent of any other psychiatric disorder or affliction
- TAA remains less than 6 months after removal of the stressor, but may
become chronic (more than 6 months), if the stressors persist
Other symptoms may include marked fatigue, persistent sleep disorders or somatic signs without demonstrable organic etiology (several eruptions, nonspecific pain, etc.).
Other diagnoses that should be discarded: - Depression - Dysthymia (the same number and intense depressive symptoms that persist for at least 2 years without any real interruption) - Generalized Anxiety Disorder (GAD) - Statement of acute stress or chronic post-traumatic - Other anxiety disorders characterized (phobia, panic disorder, obsessive-compulsive disorder) - anxious state induced directly by drug use, drug, alcohol or physical illness. Towards
most serious psychiatric disorders listed above may evolve a patient not treated. Also to a disorder of eating patterns or alcohol or drug addiction.
20 to 50% of cases, according to colleagues Psychiatrists warrant treatment. Psychotherapy is effective, but requires expertise. Pharmacological options may be beneficial, taking into account that reduce the suffering and anxiety that do not affect cognitive functions. Among the most commonly used drugs are mainly anxiolytics, antidepressants, hypnotics, and antihistamines.
Benzodiazepines (BZD) have been the most commonly used for treatment of acute stress and anxiety, as potent positive modulators and active acid neurotransmitter gamma-amino butyric acid (GABA) inhibits the central nervous system (CNS ) by fixation the binding site specific GABAA receptor, or subrecipient of BZD. Another neuromodulator allosteric (compound adjust the three dimensional structure of the receptor, as in this case increasing its activity) of the GABA receptor, especially important in women, is the neurosteroid alopregnenolona, \u200b\u200bwhich is set in another place, another receptor subtype selective. The research has been directed therefore to find new drugs than the previous ones, with more selective effects, in this case on anxiety.
Given the above, Etifoxina (exsist ®) represents a concrete and innovative application in the treatment of anxiety, through a dual mechanism of transmission GABA, stimulating its receptor inhibit transmission by allosteric site different from the BD, close to the chloride channel. It also stimulates the production of neurosteroids have anxiolytic effects as alopregnenolona, \u200b\u200ballowing respect the patient's cognitive abilities like memory, attention and vigilance without inducing habituation or drug or produce amnesia or sedation, such as the BD. Belongs to the class of benzoxazines, which is very different from the BD. Your dosage is one capsule of 50 mg 3-4 times a day for a maximum time recommended 12 weeks. It is not recommended while taking alcohol as it increases its sedative effect. The adverse effects most frequently reported were skin diseases like rashes, few allergic manifestations such as urticaria and Quincke edema. Is mainly eliminated via the urine.
From the clinical point of view there have been several representative studies. In a parallel double-masked, noninferiority study compared the clinical efficacy of Etifoxina 50 mg 3 times a day in front of a BZD, lorazepam at 0.5 - 0.5 - 1 mg daily, in 191 outpatients, 66% female , on day 7 and 28 of treatment using the HAM to anxiety, clinical global impression scale and the scale of social adjustment among other measures. The two drugs were equivalent at day 28. More patients with Etifoxina markedly improved (p = 0.03) and no side effects (p = 0.04). One month after stopping treatment, fewer patients had Etifoxina rebound anxiety compared with lorazepam (p = 0.034) 3.
Another double-masked study in 170 patients over 4 weeks (approx. 73% of women in both groups), comparing Etifoxina (150-200 mg daily) with buspirone (15-20 mg daily) for 4 weeks showed clinical efficacy and safety of both compounds, although not equivalent, being superior Etifoxina. The scale of improvement and global performance index showed significant improvement in the group with Etifoxina from day 7 (Kruskal-Wallis nonparametric 0.01) 4 .
Recently in the year 2008, Encephale magazine publishes a special issue on Etifoxina 5 , which Besnier and Blin 6 review recent clinical studies showing that more effective Etifoxina buspirone and produces a more favorable clinical response to lorazepam.
is concluded that the rapid onset of clinical effect Etifoxina and that its safety profile may be of great interest for the management of TAA as an excellent alternative to conventional anti-anxiety treatments.
Highlights
● The TAA is a very common problem also in Colombian women, the
altering their quality of life and whose diagnosis is unknown and ignored
● Failure to identify and treat the TAA may lead to psychiatric disorders
serious
● The BZD anxiolytics were the most used so far, but create
● Etifoxina drug for rapid clinical effect and safety profile appropriate without
create habituation is an excellent option for the TAA
References
1 - W Semaan, Hergueta T, Bloch J, Charpak Y, Duburcq A, Le Guern ME, AlquierC, Rouillon F. [Cross-sectional study of the Prevalence of Adjustment disorder with anxiety in general practice]. Encephale. 2001, 27: 238-44.
2 - A national picture of health and mental illness in Colombia: PRELIMINARY REPORT. Estudio Nacional de Salud Mental, Colombia, 2003. Ministerio de la Protección Social. República de Colombia.
3- Nguyen N, Fakra E, Pradel V, Jouve E, Alquier C,Le Guern ME, Micallef J, Blin O. Efficacy of etifoxine compared to lorazepam monotherapy in the treatment of patients with adjustment disorders with anxiety: a double-blind controlled study in general practice.Hum Psychopharmacol. 2006; 21:139-49.
4- Servant D, Graziani PL, Moyse D, Parquet PJ. Treatment of adjustment disorder with anxiety: efficacy and tolerance of etifoxine in a double-blind controlled study. Encephale. 1998; 24:569-74.
5- Besnier N, Blin O. Étifoxine: etudes cliniques récentes. Encephale.2008, 34 (S1) :9-14.
6 - Etifoxine: A Regard sur le nouveau et l'anxietas recepteur GABA. Encephale.2008, 34 (S1): 1-43.
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