Anxiety disorders in children and adolescents are receiving more attention from clinicians and researchers. Psycho-pharmacological approaches to controlling symptoms of anxiety are possible as part of a multi-model treatment approach. This paper provides an overview of some recent findings in child and adolescent anxiety disorders that may influence treatment decisions. It also reviews studies of the use of benzodiazepines and tricyclic antidepressants in treating children and adolescents who suffer from anxiety disorders, and suggests methods of integrating pharmacological treatment with other modalities in these disorders.
References
1.
LapouseI.Fears and worries in children. Am J Orthopsychiatry1959; 29: 803–818.
2.
GarlandJ, SmithD.Panic disorder on a child psychiatric consultation service. J Am Acad Child Adoles Psychiatry1990; 29: 785–788.
3.
KashaniJ, BeckN, HooperE, Psychiatric disorders in a community sample of adolescents. Am J Psychiatry1987; 144: 584–589.
4.
KashaniJ, CarlsonG, BeckN, Depression, depressive symptoms, and depressed mood among a community sample of adolescents. Am J Psychiatry1987; 144: 931–933.
5.
HaywardC, KillenJD, TaylorCB. Panic attacks in young adolescents. Am J Psychiatry1989; 146: 1061–1062.
6.
WeissmanMM, LeckmanJF, MerikangasKR, Depression and anxiety disorder in parents and children. Am J Psychiatry1984; 41: 845–852.
7.
AndersonJ, WilliamsS, McGeeR, DSM-III disorders in pre-adolescent children. Arch Gen Psychiatry1987; 44: 69–76.
8.
McGeeR, FeehanM, WilliamsS, DSM-III disorders in a large sample of adolescents. J Am Acad Child Adolesc Psychiatry1980; 29: 611–619.
9.
PliszkaS.Effect of anxiety on cognition, behaviour, and stimulant response to ADHD. J Am Acad Child Adolesc Psychiatry1989; 28: 882–887.
10.
BradleyS, WachsmuthJ, SwinsonR, A pilot study of panic attacks in a child and adolescent psychiatric. Presented at the Canadian Academy of Child Psychiatry,Toronto ON, 1986.
11.
AlessiN, RobbinsD, DilsaverS.Panic and depressive disorders among psychiatriclly hospitalized adolescents. Psychiatr Res1986; 20: 275–283.
12.
LastC.Anxiety disorders of childhood or adolescents. In: LastC, ed. Handbook of child psychiatric diagnosis.New York: John Wiley and Sons, 1989: 156–169.
13.
TurnerS, BeidelD, CostelloA.Psychopathology in offspring of anxiety disorder patients. J Consult Clin Psychol1987; 55: 229–235.
14.
Gittleman-KleinR.Psychiatric characteristics of relatives of school phobic children. In: Sankar, ed. Mental health in children.Westbury: PJD Publications, 1975: 326–330.
15.
BernsteinG, GarfinkelB.School phobia: the overlap of affective and anxiety disorders. J Am Acad Child Adolesc Psychiatry1986; 25: 235–241.
16.
LastC, HersenM, KazdtnA, Anxiety disorders in children and their families. Arch Gen Psychiatry1991; 48: 928–937.
17.
CroweP.A family study of panic disorder. Arch Gen Psychiatry1983; 40: 1065–1069.
18.
NuttD, GlueP, LawsonC.The neurochemistry of anxiety — an update. Progr Neuropsychopharmacol Biol Psychiatry1980; 14: 737–752.
19.
HommerD, SkolnickP, PaulS.The benzodiazepine/GABA receptor complex and anxiety. In: MeltzerH, ed. Psychopharmacology: the third generation of progress.New York: Raven Press, New York, 1987: 997–984.
20.
NuttD, GlueP, LawsonC, Flumazenil provocation of panic attacks — evidence for altered benzodiazepine receptor sensitivity in panic disorder. Arch Gen Psychiatry1990; 47: 917–925.
21.
A task force report: benzodiazepine dependence, toxicity and abuse.Washington DC: American Psychiatric Press, Inc., 1990.
22.
D'AmatoG.Chlordiazepine in management of school phobia. Dis Nerv Syst1962; 3: 292–295.
23.
KraftI.A clinical study of chlordiazepoxide used in psychiatric disorders of children. Int J Neuropsychiatry1965; 1: 433–437.
24.
FrommerE.Treatment of childhood depression with antidepressant drugs. Br Med J1967; 1: 729–732.
25.
SimeonJG, FergusonHB. Alprazolam effects in children with anxiety disorders. Can J Psychiatry1987; 32(7): 570–574.
26.
SimeonJ, FergusonB, KnottV, Clinical, cognitive and neurophysiological effects of alprazolam in children with over anxious and avoidant disorders. J Am Acad Child Adolesc Psychiatry (in press).
27.
BiedermanJ.Clonazepam in the treatment of pre-pubertal children with panic-like symptoms. J Clin Psychiatry1987 (Suppl); 48: 28–41.
28.
KutcherS, MackenzieS.Successful clonazepam treatment of adolescents with panic disorder. J Can Psychopharmacol1988; 8: 299–301.
29.
ReiterS, KutcherS.Disinhibition and anger outbursts in adolescents treated with clonazepam. J Can Psychopharmacol1991; 11: 268.
30.
KutcherS, ReiterS.High potency benzodiazepines in child and adolescent anxiety disorders. Presented at the meeting of the American College of Psychiatry and Neuroscience, 1990.
31.
Gittleman-KleinR, KleinD.Controlled imipramine treatment of school phobia. Arch Gen Psychiatry1971; 25: 204–207.
32.
BerneyT.School phobia: a therapeutic trial with clomipramine and short term outcome. Br J Psychiatry1981; 138: 110–118.
33.
BernsteinG, GarfinkelB, BachardtC.Comparative studies of pharmacotherapy for school refusal. J Am Acad Child Adolesc Psychiatry1990; 29: 773–781.
34.
KleinR, Kopel WilzH, KannerA.Imipramine treatment of children with separation anxiety disorder (in press).
35.
CoxW.An indication for use of imipramine in attention deficit disorder. Am J Psychiatry1982; 139: 1059–1060.
36.
PliszkaS.Tricyclic antidepressants in the treatment of children with attention deficit disorder. J Am Acad Child Adolesc Psychiatry1987; 26: 127–132.
37.
GarfinkelB, WenderP, SlomanL, Tricyclic antidepressant and methylphenidate treatment of attention deficit disorder in children. J Am Acad Child Adolesc Psychiatry1983; 22: 343–348.
38.
BiedermanJ, BaldessariniR, WrightV, A double-blind-placebo-controlled study of desipramine in the treatment of ADD efficacy. J Am Acad Child Adolesc Psychiatry1989; 28(6): 903–911.
39.
BiedermanJ.Sudden death in children treated with a tricyclic antidepressant — a commentary. Biological Therapies in Psychiatry Newsletter1991; 14: 1–4.
40.
WeissmanM, KleinmanG, Suicidal ideation and suicide attempts in panic disorder and attacks. N Engl J Med1989; 321: 1209–1214.
