「anxiety X & W」の編集履歴（バックアップ）一覧に戻る
anxiety X & W - (2006/11/02 (木) 23:01:20) のソース
<div class="Section1" style="LAYOUT-GRID: 14.6pt none">
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">1.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
発作が見られるようになったのはいつからか</span><span lang=
"EN-US" style="FONT-SIZE: 9pt"><font face="Century">.</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">発作の時間帯は</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
発作時に痛みを伴うか</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
痛みがあるならその性状と部位は</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
食事</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
サプリメント</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
薬などが関係していないか</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
誘引となりうる物質やイベントはないか</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">2.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
心疾患</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
呼吸器</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
内分泌</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
薬剤</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
代謝</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
神経</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
精神</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><b><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">FacultyComments<br></font></span></b></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">The differential diagnosis list
foranxiety should include the following broad categories:<br></font></span></p>
<ul style="MARGIN-TOP: 0mm" type="disc">
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l1 level1 lfo1">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">medicalillness<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l1 level1 lfo1">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face="Century">medication
use(including prescription, over-the-counter and
herbalsupplements)<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l1 level1 lfo1">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">medicationabuse<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l1 level1 lfo1">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face="Century">substance
use(including alcohol, nicotine, caffeine and
illegalsubstances)<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l1 level1 lfo1">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">substanceabuse<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l1 level1 lfo1">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">primarypsychiatric<br></font></span></li>
</ul>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">3.
<b>FacultyComments<br></b></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 39pt; TEXT-INDENT: -21pt; tab-stops: list 39.0pt; mso-list: l14 level1 lfo2">
<span lang="EN-US" style=
"FONT-SIZE: 9pt; mso-fareast-font-family: Century; mso-bidi-font-family: Century">
<span style="mso-list: Ignore"><font face="Century">1.</font><span style=
"FONT: 7pt "Times New Roman""> </span></span></span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">review thepatients <b>problem
list</b> could any of the patients medical diagnoses eitherprecipitate or
exaggerate symptoms of anxiety?<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 39pt; TEXT-INDENT: -21pt; tab-stops: list 39.0pt; mso-list: l14 level1 lfo2">
<span lang="EN-US" style=
"FONT-SIZE: 9pt; mso-fareast-font-family: Century; mso-bidi-font-family: Century">
<span style="mso-list: Ignore"><font face="Century">2.</font><span style=
"FONT: 7pt "Times New Roman""> </span></span></span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">review thepatients <b>family
history</b> are there any patterns of medical conditionsthat could induce
anxious feelings?<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 39pt; TEXT-INDENT: -21pt; tab-stops: list 39.0pt; mso-list: l14 level1 lfo2">
<span lang="EN-US" style=
"FONT-SIZE: 9pt; mso-fareast-font-family: Century; mso-bidi-font-family: Century">
<span style="mso-list: Ignore"><font face="Century">3.</font><span style=
"FONT: 7pt "Times New Roman""> </span></span></span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">review thepatients list of
<b>medications</b> including prescription, over-the-counterand herbal
supplements - could any of these drugs either precipitate or worsensymptoms of
anxiety?<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 39pt; TEXT-INDENT: -21pt; tab-stops: list 39.0pt; mso-list: l14 level1 lfo2">
<span lang="EN-US" style=
"FONT-SIZE: 9pt; mso-fareast-font-family: Century; mso-bidi-font-family: Century">
<span style="mso-list: Ignore"><font face="Century">4.</font><span style=
"FONT: 7pt "Times New Roman""> </span></span></span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">assess the useand/or abuse of
<b>substances</b><br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 39pt; TEXT-INDENT: -21pt; tab-stops: list 39.0pt; mso-list: l14 level1 lfo2">
<span lang="EN-US" style=
"FONT-SIZE: 9pt; mso-fareast-font-family: Century; mso-bidi-font-family: Century">
<span style="mso-list: Ignore"><font face="Century">5.</font><span style=
"FONT: 7pt "Times New Roman""> </span></span></span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">determine if thepatient meets the
criteria for one of the primary <b>psychiatric</b> anxietydisorders - is there
a family history of psychiatricdiagnoses?<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">4.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
甲状腺ホルモンと</span><span lang="EN-US" style=
"FONT-SIZE: 9pt; FONT-FAMILY: Symbol">b</span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">刺激薬</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><br></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><b><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">FacultyComments<br></font></span></b></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">Included in the differential for
Dr.Johnson are:<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 18pt; TEXT-INDENT: 0mm; tab-stops: list 26.5pt; mso-list: l8 level1 lfo3">
<span lang="EN-US" style=
"FONT-SIZE: 9pt; FONT-FAMILY: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol">
<span style="mso-list: Ignore">�<span style=
"FONT: 7pt "Times New Roman""> </span></span></span> <span lang=
"EN-US" style="FONT-SIZE: 9pt"><font face="Century">unnecessarily high dose
ofSynthroid causing an iatrogenic hyperthyroidism<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 18pt; TEXT-INDENT: 0mm; tab-stops: list 26.5pt; mso-list: l8 level1 lfo3">
<span lang="EN-US" style=
"FONT-SIZE: 9pt; FONT-FAMILY: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol">
<span style="mso-list: Ignore">�<span style=
"FONT: 7pt "Times New Roman""> </span></span></span> <u><span lang=
"EN-US" style="FONT-SIZE: 9pt"><font face="Century">onset of asthma attack
withassociated apprehension<br></font></span></u></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 18pt; TEXT-INDENT: 0mm; tab-stops: list 26.5pt; mso-list: l8 level1 lfo3">
<span lang="EN-US" style=
"FONT-SIZE: 9pt; FONT-FAMILY: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol">
<span style="mso-list: Ignore">�<span style=
"FONT: 7pt "Times New Roman""> </span></span></span> <span lang=
"EN-US" style="FONT-SIZE: 9pt"><font face="Century">overuse of
albuterolinducing restless, nervousness or anxiety<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 18pt; TEXT-INDENT: 0mm; tab-stops: list 26.5pt; mso-list: l8 level1 lfo3">
<span lang="EN-US" style=
"FONT-SIZE: 9pt; FONT-FAMILY: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol">
<span style="mso-list: Ignore">�<span style=
"FONT: 7pt "Times New Roman""> </span></span></span> <u><span lang=
"EN-US" style="FONT-SIZE: 9pt"><font face="Century">onset of menopause
withassociated fluctuations in body temperature and
mood<br></font></span></u></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">5.<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 21pt; TEXT-INDENT: -21pt; tab-stops: list 21.0pt; mso-list: l8 level2 lfo3">
<span lang="EN-US" style=
"FONT-SIZE: 9pt; mso-fareast-font-family: Century; mso-bidi-font-family: Century">
<span style="mso-list: Ignore"><font face="Century">A)</font><span style=
"FONT: 7pt "Times New Roman""> </span></span></span><span style="FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">上記の診察で見つからない器質性疾患</span>
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">(</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">可能性は低いが</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
異型狭心症や喘息など</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
が実在し不安の原因となる</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 21pt; TEXT-INDENT: -21pt; tab-stops: list 21.0pt; mso-list: l8 level2 lfo3">
<span lang="EN-US" style=
"FONT-SIZE: 9pt; mso-fareast-font-family: Century; mso-bidi-font-family: Century">
<span style="mso-list: Ignore"><font face="Century">B)</font><span style=
"FONT: 7pt "Times New Roman""> </span></span></span><span style="FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">パニック障害</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><b><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">FacultyComments<br></font></span></b></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><font face=
"Century"><b><u><span lang="EN-US" style=
"FONT-SIZE: 9pt">Endocrine</span></u></b><span lang="EN-US" style=
"FONT-SIZE: 9pt"><br></span></font></p>
<ul style="MARGIN-TOP: 0mm" type="disc">
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l0 level1 lfo4">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">thyroiddysfunction (note that 2/3 of patients with Graves Disease
meet the criteriafor Generalized Anxiety Disorder)<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l0 level1 lfo4">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">adrenaldysfunction such as Cushings disease<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l0 level1 lfo4">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">pituitarydysfunction<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l0 level1 lfo4">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">parathyroiddysfunction<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l0 level1 lfo4">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">pheochromocytoma<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l0 level1 lfo4">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">menopause<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l0 level1 lfo4">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">acuteintermittent porphyria<br></font></span></li>
</ul>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><font face=
"Century"><b><span lang="EN-US" style=
"FONT-SIZE: 9pt">Cardiovascular</span></b> <span lang="EN-US" style=
"FONT-SIZE: 9pt"><br></span></font></p>
<ul style="MARGIN-TOP: 0mm" type="disc">
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l4 level1 lfo5">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">angina/myocardial infarction<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l4 level1 lfo5">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">cardiacarrhythmias<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l4 level1 lfo5">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face="Century">mitral
valveprolapse<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l4 level1 lfo5">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">cardiomyopathy(increased noradrenergic tone may be the
precipitatingfactor)<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l4 level1 lfo5">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">anemia<br></font></span></li>
</ul>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><font face=
"Century"><b><span lang="EN-US" style=
"FONT-SIZE: 9pt">Respiratory</span></b><span lang="EN-US" style=
"FONT-SIZE: 9pt"><br></span></font></p>
<ul style="MARGIN-TOP: 0mm" type="disc">
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l5 level1 lfo6">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">hypoxia<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l5 level1 lfo6">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">asthma<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l5 level1 lfo6">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">COPD<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l5 level1 lfo6">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">pneumothorax<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l5 level1 lfo6">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">pulmonaryembolism<br></font></span></li>
</ul>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><font face=
"Century"><b><span lang="EN-US" style=
"FONT-SIZE: 9pt">Immunologic</span></b><span lang="EN-US" style=
"FONT-SIZE: 9pt"><br></span></font></p>
<ul style="MARGIN-TOP: 0mm" type="disc">
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l16 level1 lfo7">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">lupuserythematosus<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l16 level1 lfo7">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">rheumatoidarthritis<br></font></span></li>
</ul>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><font face=
"Century"><b><span lang="EN-US" style=
"FONT-SIZE: 9pt">Metabolic</span></b><span lang="EN-US" style=
"FONT-SIZE: 9pt"><br></span></font></p>
<ul style="MARGIN-TOP: 0mm" type="disc">
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l11 level1 lfo8">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">hypoglycemia<br></font></span></li>
</ul>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><font face=
"Century"><b><span lang="EN-US" style=
"FONT-SIZE: 9pt">Neurologic</span></b><span lang="EN-US" style=
"FONT-SIZE: 9pt"><br></span></font></p>
<ul style="MARGIN-TOP: 0mm" type="disc">
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l9 level1 lfo9">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">epilepsy<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l9 level1 lfo9">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">migraine<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l9 level1 lfo9">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">CVA<br></font></span></li>
</ul>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><font face=
"Century"><b><span lang="EN-US" style=
"FONT-SIZE: 9pt">InfectiousDisease</span></b> <span lang="EN-US" style=
"FONT-SIZE: 9pt"><br></span></font></p>
<ul style="MARGIN-TOP: 0mm" type="disc">
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l10 level1 lfo10">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">HIV<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l10 level1 lfo10">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">cerebralsyphilis<br></font></span></li>
</ul>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><font face=
"Century"><b><u><span lang="EN-US" style=
"FONT-SIZE: 9pt">Dietary</span></u></b><span lang="EN-US" style=
"FONT-SIZE: 9pt"><br></span></font></p>
<ul style="MARGIN-TOP: 0mm" type="disc">
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l13 level1 lfo11">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face="Century">vitamin
B12deficiency<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l13 level1 lfo11">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">monosodiumglutamate excess<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l13 level1 lfo11">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">pellagra<br></font></span></li>
</ul>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">6.
<b>FacultyComments<br></b></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">The following medications include
anxietyas a side effect:<br></font></span></p>
<ul style="MARGIN-TOP: 0mm" type="disc">
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l2 level1 lfo12">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">anticholinergics<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l2 level1 lfo12">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">chemotherapyagents<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l2 level1 lfo12">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">decongestants<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l2 level1 lfo12">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">dietpills<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l2 level1 lfo12">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">digitalis<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l2 level1 lfo12">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">neurolepticsproducing the extrapyramidal side effect of akathesia, or
motorrestless<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l2 level1 lfo12">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">SSRIs<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l2 level1 lfo12">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">steroids<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l2 level1 lfo12">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">sympathomimetics<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l2 level1 lfo12">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">theophylline<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l2 level1 lfo12">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">thyroidsupplements, such as thyroxine<br></font></span></li>
</ul>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">7. Intoxication with the
followingsubstances and illicit drugs often produces feelings
ofanxiousness:<br></font></span></p>
<ul style="MARGIN-TOP: 0mm" type="disc">
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l12 level1 lfo13">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">caffeine<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l12 level1 lfo13">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">cocaine<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l12 level1 lfo13">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">hallucinogens<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l12 level1 lfo13">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">tobacco<br></font></span></li>
</ul>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">8. Withdrawal of alcohol, narcotics
andsedative-hypnotics such as benzodiazepines and barbituates often
inducesanxiety in a patient.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">9.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
神経症性障害</span> <span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">---</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
パニック障害など</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><br></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
気分障害</span> <span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">---</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
うつ病</span><span lang="EN-US" style="FONT-SIZE: 9pt"><br></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><b><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">FacultyComments<br></font></span></b></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt 9pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">The primary psychiatric anxiety
disordersinclude:<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 9pt; TEXT-INDENT: 0mm; tab-stops: list 17.5pt; mso-list: l7 level1 lfo14">
<span lang="EN-US" style=
"FONT-SIZE: 9pt; FONT-FAMILY: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol">
<span style="mso-list: Ignore">�<span style=
"FONT: 7pt "Times New Roman""> </span></span></span> <font face=
"Century"><b><span lang="EN-US" style="FONT-SIZE: 9pt">PanicDisorder</span></b>
<span lang="EN-US" style="FONT-SIZE: 9pt">characterized byrecurrent panic
attacks<br></span></font></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 9pt; TEXT-INDENT: 0mm; tab-stops: list 17.5pt; mso-list: l7 level1 lfo14">
<span lang="EN-US" style=
"FONT-SIZE: 9pt; FONT-FAMILY: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol">
<span style="mso-list: Ignore">�<span style=
"FONT: 7pt "Times New Roman""> </span></span></span> <font face=
"Century"><b><span lang="EN-US" style=
"FONT-SIZE: 9pt">Phobias</span></b><span lang="EN-US" style="FONT-SIZE: 9pt">an
intense fear of specific objectsor situations<br></span></font></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 9pt; TEXT-INDENT: 0mm; tab-stops: list 17.5pt; mso-list: l7 level1 lfo14">
<span lang="EN-US" style=
"FONT-SIZE: 9pt; FONT-FAMILY: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol">
<span style="mso-list: Ignore">�<span style=
"FONT: 7pt "Times New Roman""> </span></span></span> <font face=
"Century"><b><span lang="EN-US" style="FONT-SIZE: 9pt">Generalized
AnxietyDisorder (GAD)</span></b> <span lang="EN-US" style="FONT-SIZE: 9pt">a
six-month(or longer) history of anxious symptoms without
panicattacks<br></span></font></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 9pt; TEXT-INDENT: 0mm; tab-stops: list 17.5pt; mso-list: l7 level1 lfo14">
<span lang="EN-US" style=
"FONT-SIZE: 9pt; FONT-FAMILY: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol">
<span style="mso-list: Ignore">�<span style=
"FONT: 7pt "Times New Roman""> </span></span></span> <font face=
"Century"><b><span lang="EN-US" style="FONT-SIZE: 9pt">Posttraumatic
StressDisorder (PTSD)</span></b> <span lang="EN-US" style=
"FONT-SIZE: 9pt">follows atraumatic, often life-threatening
event<br></span></font></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 9pt; TEXT-INDENT: 0mm; tab-stops: list 17.5pt; mso-list: l7 level1 lfo14">
<span lang="EN-US" style=
"FONT-SIZE: 9pt; FONT-FAMILY: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol">
<span style="mso-list: Ignore">�<span style=
"FONT: 7pt "Times New Roman""> </span></span></span> <font face=
"Century"><b><span lang="EN-US" style="FONT-SIZE: 9pt">Obsessive
CompulsiveDisorder (OCD)</span></b> <span lang="EN-US" style=
"FONT-SIZE: 9pt">recurrentintrusive unwanted thoughts and compulsive
behaviors<br></span></font></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 9pt; TEXT-INDENT: 0mm; tab-stops: list 17.5pt; mso-list: l7 level1 lfo14">
<span lang="EN-US" style=
"FONT-SIZE: 9pt; FONT-FAMILY: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol">
<span style="mso-list: Ignore">�<span style=
"FONT: 7pt "Times New Roman""> </span></span></span> <font face=
"Century"><b><span lang="EN-US" style="FONT-SIZE: 9pt">Adjustment Disorder
withAnxious Mood</span></b> <span lang="EN-US" style=
"FONT-SIZE: 9pt">pooradaptation to a new situation manifested as
anxiety<br></span></font></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">10.
<b>FacultyComments<br></b></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">Anxiety is manifested in a number
ofareas. Patients experience <b>physical symptoms</b> of autonomic
arousal,including anorexia, chest tightness, diaphoresis, diarrhea, dizziness,
drymouth, dyspnea, headache, muscle tension, nausea, palpitations,
paresthesia,shortness of breath, and tremulousness. Patients also experience a
change in<b>affect,</b> ranging from edginess to panic. Anxiety also
manifests<b>cognitively</b> as worry and apprehension and <b>behaviorally</b>
asavoidance of the perceived stressor.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">11.
<b>FacultyComments<br></b></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">The following neurotransmitters
areassociated with anxiety:<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">-<b>norepinephrine</b> cell bodies of
thenoradrenergic system are located in the locus ceruleus of the rostral pons
andaxons project to cerebral cortex, limbic system, brain stem and
spinalcord<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">-<b>serotonin</b>- cell bodies arelocated
in the raphe nuclei of the rostral brainstem and project to thecerebral cortex,
limbic system and hypothalamus<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">-<b>G-aminobutyric acid (GABA)</b>
therole of GABA is supported by the beneficial effect seen with
benzodiazepineuse, which enhances the avtivity of GABA<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">12.
<b>FacultyComments<br></b></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; TEXT-INDENT: 0mm; tab-stops: list 8.5pt; mso-list: l6 level1 lfo15">
<span lang="EN-US" style=
"FONT-SIZE: 9pt; FONT-FAMILY: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol">
<span style="mso-list: Ignore">�<span style=
"FONT: 7pt "Times New Roman""> </span></span></span> <span lang=
"EN-US" style="FONT-SIZE: 9pt"><font face="Century">These brain structures
areinvolved in the production of anxiety:<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 42pt; TEXT-INDENT: -21pt; tab-stops: list 42.0pt; mso-list: l6 level2 lfo15">
<span lang="EN-US" style=
"FONT-SIZE: 9pt; FONT-FAMILY: Wingdings; mso-fareast-font-family: Wingdings; mso-bidi-font-family: Wingdings">
<span style="mso-list: Ignore">�<span style=
"FONT: 7pt "Times New Roman""> </span></span></span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">the <b>locusceruleus</b> in the
rostral pons, the primary source of the brainsnorepinephrine
(NE):<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 42pt; TEXT-INDENT: -21pt; tab-stops: list 42.0pt; mso-list: l6 level2 lfo15">
<span lang="EN-US" style=
"FONT-SIZE: 9pt; FONT-FAMILY: Wingdings; mso-fareast-font-family: Wingdings; mso-bidi-font-family: Wingdings">
<span style="mso-list: Ignore">�<span style=
"FONT: 7pt "Times New Roman""> </span></span></span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">when stimulatedin monkeys, an acute
fear response is produced<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 42pt; TEXT-INDENT: -21pt; tab-stops: list 42.0pt; mso-list: l6 level2 lfo15">
<span lang="EN-US" style=
"FONT-SIZE: 9pt; FONT-FAMILY: Wingdings; mso-fareast-font-family: Wingdings; mso-bidi-font-family: Wingdings">
<span style="mso-list: Ignore">�<span style=
"FONT: 7pt "Times New Roman""> </span></span></span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">when destroyedin monkeys, abnormal
complacency in the face of danger isexhibited<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; TEXT-INDENT: 0mm; tab-stops: list 8.5pt; mso-list: l6 level1 lfo15">
<span lang="EN-US" style=
"FONT-SIZE: 9pt; FONT-FAMILY: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol">
<span style="mso-list: Ignore">�<span style=
"FONT: 7pt "Times New Roman""> </span></span></span> <span lang=
"EN-US" style="FONT-SIZE: 9pt"><font face="Century">the <b>limbic
system</b>,which receives noradrenergic and serotonergic innervation and
contains a highconcentration of GABA receptors: the limbic system monitors the
environment forlife-threatening cues<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">13.
<b>FacultyComments<br></b></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">One in four people have met the
criteriafor an anxiety disorder. Lifetime prevalence for an anxiety disorder in
womenis about 30% and lifetime prevalence for an anxiety disorder in men
isapproximately 20%.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">14.
<b>FacultyComments<br></b></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">An estimated 60% of psychiatricconditions
are treated by primary care physicians. In fact, studies haveimplicated anxiety
as the fifth most common diagnosis overall among primarycare physicians. This
is not surprising as anxiety is the chief complaint ofover 10% of patients
presenting in primary care settings.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">Specialist practices also see a
highpercentage of patients with anxiety disorders. Up to 15% of patients
incardiology practices suffer from Panic Disorder, compared to 1% of the
generalpopulation.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">15.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><u><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">DSM-IV-TR
300.02</font></span></u><b style="mso-bidi-font-weight: normal"><u><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">全般性不安障害</span></u></b><u><span lang="EN-US"
style="FONT-SIZE: 9pt"><br></span></u></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">A: (</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">仕事や学業など</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
多数の出来事または活動についての過剰な不安と心配</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">(</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">予期配慮</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
が</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
少なくとも</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">6</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">ヶ月間</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
起こる日の方が起こらない日よりも多い</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">.<br>
B:</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
その人は</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
その心配を制御することが難しいと感じている</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">.<br>
C:</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
不安と心配は</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
以下の６つの症状のうち</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">3</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">つ</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">(</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">またはそれ以上</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
を伴っている</span> <span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">(</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">過去</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">6</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">ヶ月間</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
少なくとも数個の症状が</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
ある日の方が無い日より多い</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">)<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 10.1pt; mso-para-margin-left: .96gd"><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
注</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">:</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
子供の場合は</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">1</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">項目だけが必要</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">.<br>
(1)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
落ち着きのなさ</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
または緊張感</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
または過敏</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">.<br>
(2)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
疲労しやすいこと</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">.<br>
(3)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
集中困難</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
または心が空白になること</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">.<br>
(4)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
刺激に敏感</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">.<br>
(5)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
筋肉の緊張</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">.<br>
(6)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
睡眠障害</span> <span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">(</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">入眠または睡眠を続けることが困難</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
又は落ち着かず熟睡感のない睡眠</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">).<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt 0.05pt"><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">D:</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
不安と心配の対象が</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
他の障害の特徴に限られていない</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
例えば</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
不安または心配が</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">, (</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">パニック障害のように</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
パニック発作が起こること</span> <span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">(</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">社会恐怖のように</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
人前で恥ずかしくなること</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">, (</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">強迫性障害のように</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
汚染されること</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">, (</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">分離不安障害のように</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
家庭または身近な家族から離れること</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">, (</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">神経性無食欲症のように</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
重大な疾患があること</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
によるものではない</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
また</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
その不安と心配は外傷後ストレス障害の期間中にのみ起こるものでもない</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">.<br>
E:</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
不安</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
心配</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
または身体症状が臨床的に明らかな苦痛</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
または社会的職業的な重要な領域における機能の障害を引き起こしている</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">.<br>
F:</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
不安障害が</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
物質</span> <span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">(</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">例</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">:</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
乱用薬物・投薬</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
または一般的な身体疾患の直接的な生理学的作用によるものではなく</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
気分障害</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
精神病性障害</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
広汎性発達障害の期間中にのみ起こるものではない</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><u><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">ICD-10 F41.1</font></span></u><b style=
"mso-bidi-font-weight: normal"><u><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">全般性不安障害</span></u></b><u><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">Generalizedanxiety
disorder<br></font></span></u></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
本質的な病像は全般的かつ持続的であるが</span><span lang=
"EN-US" style="FONT-SIZE: 9pt"><font face="Century">,</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">きわめて優勢であっても</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
いかなる特殊な周囲の状況にも限定されない</span> <span lang=
"EN-US" style="FONT-SIZE: 9pt"><font face="Century">(</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">すなわち「自由に浮動する」</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
不安である</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
他の不安障害と同様に</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
主要症状はきわめてさまざまであるが</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
たえずいらいらしている</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
振戦</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
筋緊張</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
発汗</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
頭のふらつき</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
動悸</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
めまいと心窩部の不快などの訴えがよく認められる</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
患者か身内がすぐにでも病気になるのではないか</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
あるいは事故にあうのではないかという恐怖がさまざまな他の心配事や不吉な予感とともに</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
しばしば口にされる</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
この障害は女性により一般的で</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
しばしば慢性の環境的ストレスと関連している</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
その経過はさまざまであるが</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
動揺し</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
慢性化する傾向を示す</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><b style=
"mso-bidi-font-weight: normal"><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
診断ガイドライン</span></b><b style=
"mso-bidi-font-weight: normal"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><br></span></b></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
患者は</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
少なくとも数週</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
通常は数カ月</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
連続してほとんど毎日</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
不安の一次症状を示さなければならない</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
それらの症状は通常</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
以下の要素を含んでいなければならない</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">(a)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
心配</span> <span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">(</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">将来の不幸に関する気がかり</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">「いらいら感」</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
集中困難など</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">).<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">(b)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
運動性緊張</span> <span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">(</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">そわそわした落着きのなさ</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
筋緊張性頭痛</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
振戦</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
身震い</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
くつろげないこと</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">).<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">(c)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
自律神経性過活動</span> <span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">(</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">頭のふらつき</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
発汗</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
頻脈あるいは呼吸促迫</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
心窩部不快</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
めまい</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
口渇など</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">).<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
小児では頻回に安心させる必要があったり</span><span lang=
"EN-US" style="FONT-SIZE: 9pt"><font face="Century">,</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">繰り返し身体的訴えをすることがあったりするかもしれない</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
他の症状</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
とりわけ抑うつが一過性に</span> <span style=
"FONT-SIZE: 9pt"><font face="Century"><span lang=
"EN-US">(</span></font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">一度につき</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">2, 3</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">日間</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
出現しても</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
主診断として全般性不安障害を除外することにはならないが</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
患者はうつ病エピソード</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">(F32.-),</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
恐怖症性障害</span> <span style="FONT-SIZE: 9pt"><font face=
"Century"><span lang="EN-US">(F40.-),</span></font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
パニック障害</span> <span style="FONT-SIZE: 9pt"><font face=
"Century"><span lang="EN-US">(F41.0),</span></font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
あるいは強迫性障害</span> <span style="FONT-SIZE: 9pt"><font face=
"Century"><span lang="EN-US">(F42.-)</span></font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
の診断基準を完全に満たしてはならない</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">9</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">含</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">:</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
不安神経症</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
不安反応</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
不安状態</span><span lang="EN-US" style="FONT-SIZE: 9pt"><br></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">9</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">除</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">:</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
神経衰弱</span> <span style="FONT-SIZE: 9pt"><font face=
"Century"><span lang="EN-US">(F48.0)<br></span></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">16.
<b>FacultyComments<br></b></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">GAD has a lifetime prevalence of 5%.
TheFemale to Male ratio is 2:1. The age of onset is usually in the 20s, with
thegradual appearance of symptoms. One third of patients with GAD seek
psychiatrichelp - most patients see their primary care physician, cardiologists
orpulmonologists, gastroenterologists with
somaticcomplaints.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">17.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
孤立状態にある</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
一人にされるのではないかという恐れが強く</span><span lang=
"EN-US" style="FONT-SIZE: 9pt"><font face="Century">,</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">世話好きであることが多い</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
怒ると人を遠ざけてしまうのでめったに怒らない</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
不正や不公平には敏感</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
絶えず緊張し</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
表情は不安そうで</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
手指の震えや精神的発汗あり</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
心悸亢進</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
不眠に悩まされる</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
浮動性不安</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
浮動性の身体症状</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
経過とともに慢性化する傾向にあり</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
パーソナリティ化することもある</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">Faculty Comments<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">Most patients with GAD report
feelinganxious and nervous most of their lives. Many patients present by their
earlytwenties, but patient may present at any age. The course is chronic,
withsymptoms waxing and waning. Stressful life situations naturally worsen
thesymptoms of GAD.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">Nonpharmacologic treatment should betried
if the anxiety is mild and does not significantly interfere withfunctioning.
Relaxation techniques and biofeedback are often very effective.Cognitive
therapy has also proven successful in patients, as they are taught toview their
worries more realistically.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">If the patients anxiety is causing
asignificant impairment in daily functioning, pharmacologic treatment
isindicated.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">Benzodiazepines are beneficial intreating
patients with GAD, particularly if combined with cognitive or behaviortherapy.
During the worsening of GAD symptoms five years ago, Dr. Johnsonbenefited from
a trial of <b style=
"mso-bidi-font-weight: normal">diazepam</b>(Valium<sup>�</sup>).<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">Some patients with GAD will
significantlyimprove with 2-6 weeks of treatment with benzodiazepines. However,
mostpatients require treatment longer than six months in order to prevent a
relapseof symptoms. The long term use of a benzodiazepine is safe and
beneficial formany patients. However, it is a good idea to taper medication
periodically toevaluate if continued use is necessary. The benefits and risks
ofbenzodiazepine use will be discussed in the
follow-upcase.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><font face="Century"><b style=
"mso-bidi-font-weight: normal"><span lang="EN-US" style=
"FONT-SIZE: 9pt">Buspirone</span></b> <span lang="EN-US" style=
"FONT-SIZE: 9pt">(BuSpar<sup>�</sup>) is another medication used to treat
GADthis will also be discussed later.<br></span></font></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">18.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
パニック発作</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">19.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><b style=
"mso-bidi-font-weight: normal"><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
パニック発作</span></b><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">: (DSM-IV)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
強い恐怖または不快を感じるはっきりと他と区別できる期間でその時</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
以下の症状のうち</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">4</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">つ</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">(</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">またはそれ以上</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
が突然に発現し</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">, 10</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">分以内にその頂点に達する。</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century"><br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; TEXT-INDENT: 9pt; mso-char-indent-count: 1.0"><span lang=
"EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">(1)</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">動悸</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
心悸亢進</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
または心拍数の増加</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century"><br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; TEXT-INDENT: 9pt; mso-char-indent-count: 1.0"><span lang=
"EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">(2)</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">発汗</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century"><br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; TEXT-INDENT: 9pt; mso-char-indent-count: 1.0"><span lang=
"EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">(3)</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">身震いまたは震え</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century"><br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; TEXT-INDENT: 9pt; mso-char-indent-count: 1.0"><span lang=
"EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">(4)</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">息切れ感または息苦しさ</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century"><br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; TEXT-INDENT: 9pt; mso-char-indent-count: 1.0"><span lang=
"EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">(5)</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">窒息感</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century"><br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; TEXT-INDENT: 9pt; mso-char-indent-count: 1.0"><span lang=
"EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">(6)</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">胸痛または胸部の不快感</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century"><br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; TEXT-INDENT: 9pt; mso-char-indent-count: 1.0"><span lang=
"EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">(7)</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">嘔気または腹部の不快感</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century"><br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 18.05pt; TEXT-INDENT: -9pt; mso-para-margin-left: .86gd; mso-char-indent-count: -1.0">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">(8)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
めまい感</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
ふらつく感じ</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
頭が軽くなる感じ</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
または気が遠くなる感じ</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century"><br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 18.05pt; TEXT-INDENT: -9pt; mso-para-margin-left: .86gd; mso-char-indent-count: -1.0">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">(9)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
現実感消失</span> <span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">(</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">現実でない感じ</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">),</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
または離人症状</span> <span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">(</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">自分自身から離れている</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">)<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 18.05pt; TEXT-INDENT: -9pt; mso-para-margin-left: .86gd; mso-char-indent-count: -1.0">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">(10)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
コントロールを失うことに対する</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
または気が狂うことに対する恐怖</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century"><br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; TEXT-INDENT: 9pt; mso-char-indent-count: 1.0"><span lang=
"EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">(11)</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">死ぬことに対する恐怖</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century"><br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; TEXT-INDENT: 9pt; mso-char-indent-count: 1.0"><span lang=
"EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">(12)</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">異常感覚（感覚麻痺またはうずき感）</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century"><br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; TEXT-INDENT: 9pt; mso-char-indent-count: 1.0"><span lang=
"EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">(13)</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">冷感または熱感</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><br></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 9.05pt; mso-para-margin-left: .86gd"><span lang="EN-US"
style="FONT-SIZE: 8pt"><font face="Century">S. Freud</font></span><span style=
"FONT-SIZE: 8pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">は</span><span lang="EN-US"
style="FONT-SIZE: 8pt"><font face="Century">,</font></span><span style=
"FONT-SIZE: 8pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">最初性生活の不全に</span><span lang="EN-US"
style="FONT-SIZE: 8pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
その後</span><span lang="EN-US" style="FONT-SIZE: 8pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
人格内部の葛藤に由来すると考えて不安発作と呼んだが</span><span lang="EN-US"
style="FONT-SIZE: 8pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
この発作にイミプラミンが有効なこと</span><span lang="EN-US"
style="FONT-SIZE: 8pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
乳酸ナトリウムで引き起こすことのできることが判明して</span><span lang="EN-US"
style="FONT-SIZE: 8pt"><font face="Century">,</font></span> <u><span style=
"FONT-SIZE: 8pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
生物学的基盤</span></u><span style=
"FONT-SIZE: 8pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">を有すると考えられるようになり</span><span lang="EN-US"
style="FONT-SIZE: 8pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 8pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
呼び名もパニック発作となった</span><span lang="EN-US" style=
"FONT-SIZE: 8pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><b style=
"mso-bidi-font-weight: normal"><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
パニック障害</span></b><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">:</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
特別な状況や環境的背景に限定されず</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
したがって予期できずに起こる反復性の重篤な不安発作</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">(</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">パニック発作</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
を主な病像とする障害</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 8.9pt; mso-para-margin-left: .85gd"><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">(DSM-IV)<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 8.9pt; mso-para-margin-left: .85gd"><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">(1)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
と</span> <span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">(2)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
の両方を満たす</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 8.9pt; mso-para-margin-left: .85gd"><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">(1)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
予期しないパニック発作が繰り返しおこる</span><span lang=
"EN-US" style="FONT-SIZE: 9pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 8.9pt; mso-para-margin-left: .85gd"><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">(2)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
少なくとも一回の発作の後</span> <span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">,</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">約</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">1</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">か月間</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">(</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">またはそれ以上</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">),</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
以下のうち</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">1</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">つ</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">(</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">またはそれ以上</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
が続いていたこと</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 8.9pt; TEXT-INDENT: 9pt; mso-para-margin-left: .85gd; mso-char-indent-count: 1.0">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">(a)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
もっと発作が起こるのではないかという心配の継続</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><br></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 8.9pt; TEXT-INDENT: 9pt; mso-para-margin-left: .85gd; mso-char-indent-count: 1.0">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">(b)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
発作またはその結果が持つ意味についての心配</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><br></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 8.9pt; TEXT-INDENT: 9pt; mso-para-margin-left: .85gd; mso-char-indent-count: 1.0">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">(c)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
発作と関連した行動の大きな変化</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><br></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">20. FacultyComments<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">The age of onset for Panic Disorder
isusually between the late-teens and mid-30s. A bimodal distribution exists,
withone peak in late adolescence and a smaller peak in the mid-30s.
However,isolated Panic Attacks and Panic Disorder may present at
anyage.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">21. FacultyComments<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">Patients with Panic Disorder may
presentwith attacks occurring once a week over many weeks to months. Patients
may alsodisplay symptoms of attacks daily for one to two weeks followed by
months beingsymptom free. The course is typically chronic, but waxing
andwaning.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">Because the symptoms of panic attacks
areoften seen in other medical conditions, patients seen in the emergency room
areoften evaluated for the following conditions: cardiac (arrhythmias,
SVT),pulmonary (asthma attacks), endocrine (hyperthyroidism,
hyperparathyroidism),neurological (seizures), and substance abuse. Frequent
Emergency Room visitscan drain finances and put a strain on work or
schoolresponsibilities.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">22. FacultyComments<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">The lifetime prevalence of Panic
Disorderhas been determined to be between 1.5% and 3.5% by epidemiological
studiesthroughout the world.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">23. FacultyComments<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">Anxiety in general seems to have
afamilial association.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">Twin studies implicate a geneticcomponent
to Panic Disorder, and first degree relatives of patients have a fourto seven
times greater chance of developing Panic Disorder than the
generalpopulation.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">However, there has been no conclusivedata
on familial patterns of Generalized AnxietyDisorder.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">24. #9</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
を参照</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">25.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
抗不安薬が主</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
ベンゾジアゼピン誘導体を主に用いる</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
抗精神病薬を併用することもある</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
パニック発作に対しては三環系抗うつ薬</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">(</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">イミプラミン</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
クロミプラミン</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">), SSRI (</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">パロキセチン</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
が有効</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
ベンゾジアゼピン系のアルプラゾラムも有効</span><span lang=
"EN-US" style="FONT-SIZE: 9pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">Faculty Comments<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">Up to two-thirds of patients withsymptoms
of depression also have symptoms of anxiety. And research hassuggested that up
to 80% of patients with Panic Disorder have had an episode ofmajor depressive
disorder. The relationship between GAD and MDD is not
asclear.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">26.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
ベンゾジアゼピン誘導体はシナプス膜の特定の部位に結合し</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face=
"Century">,GABA<sub>A</sub></font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">受容体機能を充進させる</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">.</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">この結合部位をベンゾジアゼピン受容体と呼び</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face=
"Century">,GABA<sub>A</sub></font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">受容体の</span><span lang="EN-US"
style="FONT-SIZE: 9pt; FONT-FAMILY: Symbol">g</span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">サブユニットがベンゾジアゼピン結合に重要である</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">. GABA</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">の存在下にベンゾジアゼピン誘導体が受容体に結合すると</span><font face="Century"><span lang="EN-US"
style="FONT-SIZE: 9pt">Cl</span></font><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">が細胞内へ流入し</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
シナプス膜に過分極が起こり</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face=
"Century">,GABA<sub>A</sub></font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">受容体機能が克進する</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
ベンゾジアゼピン受容体は大脳皮質</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
辺縁系および間脳に多く分布し</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
それらの部位の機能にベンゾジアゼピン誘導体の作用点を求めることができる</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
抗不安作用は辺縁系</span> <span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">(</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">扁桃</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
海馬</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
臭球</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
および大脳皮質のベンゾジアゼピン受容体と関連し</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face=
"Century">,GABA<sub>A</sub></font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">受容体機能を克進させ</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
これらの部位の神経過剰活動を抑制し不安を減少させると考えられている</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
海馬ではコリン性神経</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
セロトニン神経の過剰活動がベンゾジアゼピン誘導体により抑制される</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">Faculty Comments<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">Isolated Panic Attacks, as is the
casewith Dr. Johnsons one episode, requires no long-term pharmacological
treatment- a one-time dose of a benzodiazepine may be used if the patient is
seen in theoffice or ER.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">If a patient presents with
recurrentattacks and criteria is met for Panic Disorder, a number of
medications can beused for treatment:<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">-benzodiazepines high-potency benzos
aremost effective<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">-Selective Serotonin Reuptake
Inhibitors(SSRIs) - includes Celexa (citalopram), Prozac (fluoxetine),
Lovox(fluvoxamine), Paxil (paroxetine), Zoloft
(sertraline)<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">-B-Blockers such as propranolol
oratenolol<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">The optimal duration of treatmentunknown.
It is recommended that benzodiazepines and SSRIs be tapered after 6months of
being symptom-free in order to reassess the need for
continuedmedication.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">27.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt; FONT-FAMILY: Century; mso-fareast-font-family: "ＭＳ 明朝"; mso-bidi-font-family: "Times New Roman"; mso-font-kerning: 1.0pt; mso-ansi-language: EN-US; mso-fareast-language: JA; mso-bidi-language: AR-SA">
</span><br></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">29, 30.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
ブスピロン：</span><span lang="EN-US" style=
"FONT-SIZE: 9pt; mso-bidi-font-weight: bold"><font face=
"Century">buspirone(</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">本邦になし</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
類似薬としてはタンドスピロン</span> <span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">(</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">セデイール</span><font face="Century"><sup><span lang="EN-US"
style="FONT-SIZE: 9pt">�</span></sup><span lang="EN-US" style=
"FONT-SIZE: 9pt">))<br></span></font></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
クエン酸タンドスピロン</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">:</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
非ベンゾジアゼピン系・セロトニン神経系に選択的に作用</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
【重要な基本的注意】</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><br></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 24.1pt; TEXT-INDENT: -9pt; mso-para-margin-left: 1.44gd; mso-char-indent-count: -1.0">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">(1)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
神経症においては</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
罹病期間が長い</span> <span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">(3</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">年以上</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
例や重症例あるいは他剤</span> <span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">(</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">ベンゾジアゼピン系誘導体</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
での治療効果が不十分な例等の治療抵抗性の患者に対しては効果が現れにくい</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">. 1</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">日</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">60mg</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">を投与しても効果が認められないときは</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
漫然と投与することなく中止する</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 24.1pt; TEXT-INDENT: -9pt; mso-para-margin-left: 1.44gd; mso-char-indent-count: -1.0">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">(2)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
使用にあたっては</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
高度の不安症状を伴う患者の場合効果が現れにくいので</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
慎重に症状を観察する等注意する</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 24.1pt; TEXT-INDENT: -9pt; mso-para-margin-left: 1.44gd; mso-char-indent-count: -1.0">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">(3)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
眠気・めまい等が起こることがあるので</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
投与中の患者には自動車の運転等危険を伴う機械の操作に従事させないように注意する</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 24.1pt; TEXT-INDENT: -9pt; mso-para-margin-left: 1.44gd; mso-char-indent-count: -1.0">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">(4)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
ベンゾジアゼピン系誘導体とは交差依存性がないため</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
ベンゾジアゼピン系誘導体から直ちに本剤に切り替えると</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
ベンゾジアゼピン系誘導体の退薬症候が引き起こされ</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
症状が悪化することがあるので</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
前薬を中止する場合は徐々に減量する等注意する</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
【重大な副作用】</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><br></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 24.1pt; TEXT-INDENT: -9pt; mso-para-margin-left: 1.44gd; mso-char-indent-count: -1.0">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">(a)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
肝機能障害</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
黄疸</span> <span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">(0.1%</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">未満</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">): AST, ALT,
ALP,G-GT</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">の上昇等を伴う肝機能障害や黄疸が現れることがあるので</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
観察を十分に行い</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
異常が認められた場合には中止するなど</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
適切な処置を行う</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 24.1pt; TEXT-INDENT: -9pt; mso-para-margin-left: 1.44gd; mso-char-indent-count: -1.0">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">(b)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
セロトニン症候群</span> <span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">(</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">頻度不明</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">):</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
興奮</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
ミオクロヌス</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
発汗</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
振戦</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
発熱等を主症状とするセロトニン症候群が現れることがあるので</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
これらの症状が出現した場合には</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
中止し</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
水分補給等の全身管理とともに適切な処置を行う</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face=
"Century">====================================<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">1.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
消化管からよく吸収される</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
代謝は主に脱メチル化</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
脱アミノ</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
および水酸化反応により不活性かされ尿中へ排出</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
肝・腎機能が低下すると排泄が遅れ体内に蓄積される</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">(</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">グルクロン酸抱合は加齢や肝障害の影響を受けにくい</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">).<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">2. Faculty Comments<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">It is estimated that 10% of adults
havetaken a benzodiazepine for at least one month during the
lastyear.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">3. Faculty Comments<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">The benzodiazepines with a rapid changein
drug level cause an initial high.<span style=
"mso-spacerun: yes"> </span>These drugs include:<br></font></span></p>
<ul style="MARGIN-TOP: 0mm" type="disc">
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l15 level1 lfo17">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">triazolam(Halcion) - high potency,
short-acting<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l15 level1 lfo17">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face="Century">diazepam(Valium)
- low potency, long-acting<br></font></span></li>
</ul>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">5.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
腎機能</span><span lang="EN-US" style="FONT-SIZE: 9pt"><br></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">Faculty Comments<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><font face=
"Century"><span lang="EN-US" style="FONT-SIZE: 9pt">Benzodiazepine use in
olderadults is associated with increased risk of falls, including falls that
resultin hip fracture. Increased likelihood of automobile accidents and
cognitivedysfunction are more likely in older adults using benzodiazepines.
Therefore,begin with low doses of the</span> <span lang="EN-US" style=
"FONT-SIZE: 9pt">LOT</span> <span lang="EN-US" style=
"FONT-SIZE: 9pt">drugs.<br></span></font></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">6.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
妊婦・授乳婦には慎重投与</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">7, 11.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
バルビツレート誘導体と比較すると頻度は少ないが</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
長期服用によって耐性や精神･身体依存が起こることがある</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
長期投与後退薬すると</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
不安</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
不眠</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
興奮</span><span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
痙攣などの禁断症状</span> <span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">(</font></span><span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">退薬症状</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">)</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
が現れることがある</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
半減期の短い薬は蓄積を越しにくいが</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">,</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
退薬症状はより急激で程度も強い</span><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">.</font></span> <span style=
"FONT-SIZE: 9pt; FONT-FAMILY: "ＭＳ 明朝"; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
半減期の長い薬は蓄積しやすいが退薬症状は現れても軽度である</span><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">8. Faculty Comments<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">Patients with a personality disorder or
aprevious history of drug or alcohol abuse. It is estimated that ten to
twentypercent of alcoholics who have used prescription benzodiazepines
willeventually abuse them. Surprisingly, it is estimated that up to 40%
ofalcoholics receive prescription benzodiazepines.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">9. Faculty Comments<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">Guidelines for
prescribingbenzodiazepines:<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 13.55pt; TEXT-INDENT: -4.5pt; mso-para-margin-left: .86gd; mso-char-indent-count: -.5">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face="Century">1- diagnosismade
of a benzodiazepine- responsive syndrome<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 13.55pt; TEXT-INDENT: -4.5pt; mso-para-margin-left: .86gd; mso-char-indent-count: -.5">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face="Century">2- use
ofnon-pharmacological therapies if indicated<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 13.55pt; TEXT-INDENT: -4.5pt; mso-para-margin-left: .86gd; mso-char-indent-count: -.5">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face="Century">3- assessment
ofduration of treatment -- forewarn patients that extra medication will not
beprescribed unless a dose increase is recommended by the prescribing
physiciandocument this in the patient chart to alert colleagues in your office
who mayreceive requests from your patient when they are on-call for
thepractice<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 13.55pt; TEXT-INDENT: -4.5pt; mso-para-margin-left: .86gd; mso-char-indent-count: -.5">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face="Century">4-
considerrisk-benefit ratio screen patients for alcohol and drug abuse, and use
inpatients with a history of abuse (a relative<br></font></span></p>
</div>
<span lang="EN-US" style=
"FONT-SIZE: 9pt; FONT-FAMILY: Century; mso-fareast-font-family: "ＭＳ 明朝"; mso-bidi-font-family: "Times New Roman"; mso-font-kerning: 1.0pt; mso-ansi-language: EN-US; mso-fareast-language: JA; mso-bidi-language: AR-SA"><br style="PAGE-BREAK-BEFORE: auto; mso-break-type: section-break"
clear="all"></span>
<div class="Section2" style="LAYOUT-GRID: 14.6pt none">
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 13.55pt; mso-para-margin-left: 1.29gd"><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">contraindication) only if there
isno treatment alternative and arrangements have been made for close
follow-upduring treatment<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 13.55pt; TEXT-INDENT: -4.5pt; mso-para-margin-left: .86gd; mso-char-indent-count: -.5">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face="Century">5-adjust dose
totreat symptoms but minimize side effects such as
drowsiness--<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 13.55pt; mso-para-margin-left: 1.29gd"><span lang="EN-US"
style="FONT-SIZE: 9pt"><font face="Century">warn patients about
possiblesedation and warn patients to avoid driving or operating heavy
machinery untilthey are certain their dose does not cause sedation or
motorincoordination<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 13.55pt; TEXT-INDENT: -4.5pt; mso-para-margin-left: .86gd; mso-char-indent-count: -.5">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face="Century">6- monitor
forabuse, suggested by unsupervised dose acceleration<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 13.55pt; TEXT-INDENT: -4.5pt; mso-para-margin-left: .86gd; mso-char-indent-count: -.5">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face="Century">7- slowly
taperthe drug after an appropriate trial to see if further
treatmentnecessary<br></font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 13.55pt; TEXT-INDENT: -4.5pt; mso-para-margin-left: .86gd; mso-char-indent-count: -.5">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face="Century">8-
reconsiderdiagnosis if patient responding poorly or if patient requiring doses
higherthan originally anticipated<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">(from <i style=
"mso-bidi-font-style: normal">Handbook of Psychiatric
DrugTherapy</i>)<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">10. FacultyComments<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">Benzodiazepine
intoxicationproduces:<br></font></span></p>
<ul style="MARGIN-TOP: 0mm" type="disc">
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l3 level1 lfo16">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">slurredspeech<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l3 level1 lfo16">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">incoordination<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l3 level1 lfo16">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">unsteadygait<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l3 level1 lfo16">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face=
"Century">nystagmus<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l3 level1 lfo16">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face="Century">impairment
inattention or memory<br></font></span></li>
<li class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt; tab-stops: list 36.0pt; mso-list: l3 level1 lfo16">
<span lang="EN-US" style="FONT-SIZE: 9pt"><font face="Century">stupor
orcoma<br></font></span></li>
</ul>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">12. FacultyComments<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">In such circumstances the physician
canswitch the patient from alprazolam (Xanax) to another high-potency drug that
islonger-acting, such as clonazepam (Klonopin). This switch takes about one
weekand is accomplished as follows:<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">1- Administer clonazepam at one-half
thedaily alprazolam dose divided into two doses one in the early morning and
onemid-afternoon.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">2- Discontinue regular alprazolam
doses,but allow PRN dosing of alprazolam (up to the previous does) for the
firstseven days. Stop the alprazolam entirely after 7 days of
clonazepamuse.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">3- If more medication is requires
forsymptom control, increase clonazepam 0.25 to 0.5 mg q week until
symptomsabate.<b style=
"mso-bidi-font-weight: normal"><br></b></font></span></p>
</div>
<b style="mso-bidi-font-weight: normal"><span lang="EN-US" style=
"FONT-SIZE: 9pt; FONT-FAMILY: Century; mso-fareast-font-family: "ＭＳ 明朝"; mso-bidi-font-family: "Times New Roman"; mso-font-kerning: 1.0pt; mso-ansi-language: EN-US; mso-fareast-language: JA; mso-bidi-language: AR-SA"><br style="PAGE-BREAK-BEFORE: auto; mso-break-type: section-break"
clear="all"></span></b>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><font face="Century">4.<br></font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span lang="EN-US" style=
"FONT-SIZE: 9pt"><br></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
