Medical Chronicle May Teaser 2020

Page 13

ONLINE CPD

Etifoxine – a unique anxiolytic Prescribing drugs for anxiety disorders is one of a psychiatrist’s most common tasks.

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NXIETY DISORDERS ARE the most prevalent psychiatric disorders and are associated with a high burden of illness. Anxiety is an emotional experience that is characterised by a state of arousal and the expectation of danger. Anxiety and adjustment disorders are frequently comorbid with other medical conditions. It has an adaptive role, preparing the body to deal with future threatening stimuli arising from the environment. Nevertheless, processing of such aversive information by the brain, particularly by the amygdala circuits, is associated with a negative subjective state. When excessive, a pathological anxious condition may be diagnosed. In DSM-5, these states include panic disorder, generalised anxiety disorder, separation anxiety disorder, specific phobias, social anxiety disorder and adjustment disorder with anxiety.

adverse events mostly concern skin and subcutaneous tissue disorders, which generally resolve with treatment discontinuation. CONCLUSION Clinical studies have demonstrated the efficacy of etifoxine in the symptomatic

treatment of anxiety, particularly in patients with ADWA, with daily doses of 150-200mg. The tolerability profile of etifoxine is better than that of BZDs, notably because of a lack of effect on memory and vigilance. In addition, treatment cessation does not induce drug dependence, withdrawal, or rebound anxiety.

The anxiolytic efficacy of etifoxine, its good tolerability and the absence of drug dependence is strong arguments in favour of using etifoxine in the management of ADWA.

References available on request.

BRAND

Story Every day, thousands of South Africans make donations to the South African National Blood Service. These donors don’t just give us their blood. These remarkable human beings give so much more.

GABAAR Brain imaging studies have demonstrated that prolonged dysregulation of brain networks involving cortical and specific subcortical areas (amygdala, hippocampus, thalamus, prefrontal, and cingulate cortex) contributes to the expression of anxiety symptoms. In particular, reduced inhibitory GABAergic transmission in the CNS has been shown to be critical for the manifestation of anxiety. In this respect, the structure and function of the GABA A receptor have been under intense scrutiny. GABA AR is a heteropentamer made of five subunits delimiting a chloride/ bicarbonate-permeable channel. It is activated by at least two molecules of γ-aminobutyric acid (GABA), an amino acid neurotransmitter synthesised from glutamate in neurons expressing glutamate decarboxylase enzymes (i.e. GABAergic neurons). As for many ligand-gated receptor-channels the apparent affinity of GABA ARs for GABA varies from low to high micromolar range. This parameter strongly depends on the subunit composition and, more specifically, on α-β subunit dimers forming together the agonist binding site for GABA. The anxiolytic effect of drugs binding to the GABA A receptor is attributed to the facilitation of chloride channel opening, thereby amplifying neuronal inhibition in response to GABA. Over the last halfcentury, numerous GABA A receptor ligands have been developed as therapeutic agents, including anxiolytics, hypnotics, muscle relaxants, and antiepileptics. SAFETY OF ETIFOXINE Over the 30 years since etifoxine was first licensed, drug safety monitoring has confirmed the low risk of drug dependence or withdrawal symptoms following treatment cessation. The few reported

This is a summary of a longer, CPD accredited article available on www.medicalacademic.co.za

Selflessly, without praise or compensation, they donate experiences, opportunities and potential. They donate blank pages onto which others can now write new chapters. Thanks to our donors, an old woman has the chance to knit a jersey for her grandchild, a young man gets to marry his childhood sweetheart, and a little girl has the opportunity to win first prize at her school science fair. These stories are at the heart of everything SANBS does. It’s the reason we get up every morning and never look at a blood bag as just a pint of blood. Instead, we see a lifeline which extends from one human to another, and continues on to form the lines of the pages on which new stories can be told. A blood donation seems like such a small act and yet it has incredible significance. It allows stories like these to live.

BECAUSE AT THE END OF THE DAY, IT’S NOT BLOOD. IT’S LIFE.

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MEDICAL CHRONICLE | MAY 2020 13


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