U

Barbiturate site

Ethanol

Barbiturates

Chlormethiazole Chloral

Fig. 19.4 Schematic representation of the GABAa-benzodiazepine (B2D) receptor complex. Note that drugs that bind to the benzodiazepine (B2D) receptor site do not open the chloride channel directly but rather augment the capacity of GABA to do so. Conversely agents such as the barbiturates at lower doses enhance GABA action but at higher doses act directly to open the chloride channel.

Classification of anxiety disorders

The diagnostic criteria of DSM-IV (Diagnostic and Statistical Manual) or ICD 10 (International Classification of Disease) are generally used. Both divide anxiety into a series of sub-syndromes with clear operational criteria to assist in distinguishing them. At any one time many patients may have symptoms of more than one syndrome but making the primary diagnosis is important as this markedly influences the choice of treatment.

The key features of each anxiety disorder are given below, with a practical description of the preferred choice of medication, its dose and duration.

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