Integrative Treatments for Masked Anxiety and PTSD in Highly Sensitive Patients
Although anxiety is not always the most obvious symptom in complex cases, it must be recognized and addressed. The following four cases represent unrecognized atypical presentations of anxiety disorders and posttraumatic stress disorder (PTSD) in patients
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Integrative Treatments for Masked Anxiety and PTSD in Highly Sensitive Patients Patricia L. Gerbarg and Richard P. Brown
9.1
Introduction
Although anxiety is not always the most obvious symptom in complex cases, it must be recognized and addressed. The following four cases represent unrecognized atypical presentations of anxiety disorders and posttraumatic stress disorder (PTSD) in patients who did not respond well to conventional psychotropic medications. In these cases, affective, cognitive, and behavioral symptoms significantly improved with integrative treatments combining medicinal herbs, nootropics, other complementary approaches, and in some cases prescription psychotropic medications. When stress-related physical symptoms, such as dystonias, become the focus of treatment, the anxiety underlying the physical condition may escape notice. Patients who do not respond well to conventional medications or who have drug sensitivities are often mislabeled as “treatment-resistant.” The urgent need for behavioral control of patients with developmental disorders, learning disabilities, and communication impairments often leads to the overuse of sedating major tranquilizers that miss the real target symptoms and exacerbate underlying cognitive and coordination dysfunctions. The treatment of anxiety, depression, and mild cognitive impairment in elderly patients with mild herbal formulas can significantly improve quality of life. Patients who do not respond adequately to prescription psychotropics and those who are sensitive to medication side effects are a large subgroup of people who benefit most from integrative and complementary approaches.
P.L. Gerbarg, MD (*) New York Medical College, Valhalla, NY, USA e-mail: [email protected]; http://www.Breath-Body-Mind.com R.P. Brown, MD Columbia University College of Medicine, New York, NY, USA © Springer International Publishing Switzerland 2017 D. Camfield et al. (eds.), Evidence-Based Herbal and Nutritional Treatments for Anxiety in Psychiatric Disorders, DOI 10.1007/978-3-319-42307-4_9
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9.2
Clinical Cases
9.2.1
Case #1 Stress and Cervical Dystonia
9.2.1.1 Presenting Complaint Eleanor, a 42-year-old dental assistant had suffered from cervical dystonia, a neurological condition characterized by painful involuntary chronic contractions or spasm of the neck muscles. Hers was mainly on the right side causing difficulty turning her head to the left. When Eleanor told her doctor that the dystonia was exacerbated by stress, she was treated with benzodiazepines, including clonazepam (Klonopin), alprazolam (Xanax), and lorazepam (Ativan). They all made her groggy and cognitively impaired. Trials of antidepressants, including fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and desipramine (Norpramine) failed to provide relief and made her jittery. During the previous 18 months, Eleanor’s symptoms became increasingly severe. She consulted a neurologist who administered Botulinum toxin B (botox) injections into the neck muscle
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