Anxiety Disorder : DEFINITION
Anxiety can be described as an uncomfortable feeling of vague fear or apprehension accompanied by characteristic physical sensations. It is a normal and often beneficial response to situations that humans perceive as threatening, frightful, or otherwise disturbing.
PATHOPHYSIOLOGY
A neurocircuit arising from the output pathways of the central nucleus of the amygdala is thought to mediate fear and anxiety responses in humans.Dysregulated or exaggerated output through various amygdala-related circuits may be a common element underlying the different anxiety disorders, but the specific type of dysfunction probably differs among the various disorders. Several neurotransmitter systems have been linked to the neurobiology of anxiety: the inhibitory amino acid, ?-aminobutyric acid (GABA); the monoamine neurotransmitters, serotonin and norepinephrine; the excitatory amino acid, glutamate; and the neuropeptides, cholecystokinin (CCK), corticotrophin-releasing factor (CRF), neuropeptide Y (NPY), and substance P.2,3 Much of the evidence for these biologic processes has come from research on drugs that are used either to treat anxiety or to induce anxiety. Discovery of the anxiolytic effects of benzodiazepines in the early 1960s marked the beginning of this era of research. However, the anxiety-reducing properties of alcohol and barbiturates were recognized long before that time.
Insomnia : Insomnia, or sleeplessness, is a sleep disorder in which there is an inability to fall asleep or to stay asleep as long as desired
Non pharmacological strategies provide long lasting improvements to insomnia and are recommended as a first line and long term strategy of management. The strategies include attention to sleep hygiene, stimulus control, behavioral interventions, sleep-restriction therapy, paradoxical intention, patient education and relaxation therapy
Medicatons
Antihistamines
The antihistamine diphenhydramine is widely used in nonprescription sleep aids. The antihistamine doxylamine is used in nonprescription sleep aids
Benzodiazepine
The most commonly used class of hypnotics prescribed for insomnia are the benzodiazepines. Hypnotic benzodiazepines include drugs such as temazepam, flunitrazepam, triazolam, flurazepam, midazolam, nitrazepam, and quazepam. Non-benzodiazepines
Nonbenzodiazepine sedative-hypnotic drugs, such as zolpidem, zaleplon, zopiclone, and eszopiclone, are a class hypnotic medications indicated for mild to moderate insomnia. Antidepressants
Some antidepressants such as amitriptyline, doxepin, mirtazapine, and trazodone can have a sedative effect, and are prescribed to treat insomnia
Other
Opioid medications such as hydrocodone, oxycodone, and morphine are used for insomnia that is associated with pain due to their analgesic properties and hypnotic effects