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Thomas People diagnosed with schizophrenia or depression sometimes experience anxiety or panic attacks as part of their mental illness. Sarah Stadler, MD, who privately practices general adult psychiatry in San Francisco, addressed these debilitating problems at our September 28 meeting. "Anxiety is a big area, " Dr. Stadler said, "with many different manifestations in many different disorders." The most common elements are an awareness of being nervous; physical manifestations such as shortness of breath, pounding heart, trembling, sweating, flushing, and nausea; and neurological changes. Awareness of the physical sensations, she said, often brings on the feeling of being threatened. Laboratory experiments, however, show that a rise in pulse rate often precedes everything else, including awareness. This indicates a chemical change in the nervous system. Treatment for anxiety and panic disorders includes a variety of therapies, including behavioral and cognitive therapies, and medications such as benzodiazepine brand name Canax ; or antidepressants such as tricyclics, monoamine oxidase inhibitors MAOIs ; , and Prozac. "But all anxiety disorders can be treated without medication, " Dr. Stadler said. She then defined the major categories of disorder and some of their symptoms. Panic Disorder is a distinct syndrome characterized by intense feelings, an abrupt and spontaneous onset of ten minutes or less, and symptoms that are obvious to the person and sometimes to others as well. These feelings often engender agoraphobia--a fear of being alone in public places--as a learned response. This is a coping mechanism that the person adopts to conceal the problem. Treatment for panic disorder can involve benzodiazepine, which can have differing subjective responses: either it masks the fear, or leaves the person aware of the fear but makes him or her uncaring of it. The trouble with this drug is its addictive nature, which makes it frequently subject to abuse. Antidepressants can also be used with panic disorder, but because of their slightly stimulating nature they can initially exacerbate the anxiety. Social and Simple Phobias relate to a single object, like a dreaded animal, or an experience, like flying, or a situation, like public speaking. These phobias often are not detected clinically because people are good at either masking or mastering them. Dr. Stadler noted that many times a person will try to experience the fear in order to overcome it--such as taking up rock climbing to master a fear of heights. The key to these phobias is that the person knows they are irrational but can't do anything about them. 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Genzyme's cash flow remains strong with Cerezyme sales growing 17.5% in '03 to reach $880m in '08 '03 sales $730m ; Renagel inventory levels have come down to 3-5wk range, with no further reduction necessary Expanded sales force, launch in Brazil and new K DOQI guidelines focusing on calcium management of chronic kidney disease patients should continue to contribute to Renagel's growth sales of $575m in '08; '03 sales $280m ; Continued focus on calcium management will expand the market for non-calcium phosphate binders especially with Fosrenol and Cinacalcet entering the market nest year ; as calcium accounts for 70% of current use. Fabrazyme approval in the US in 2Q03 launched in Europe in `02 ; with orphan drug status further leverages GENZ's leadership in the ERT market. TKTX's efforts to undo this exclusivity seems unlikely to succeed Aldurazyme launched in Europe and US in `03 SangStat merger provides GENZ with Thymoglobulin to help reinforce its global.
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