anxiety disorders

  1. what is anxiety disorders
    unhealthy level of anxiety which becomes excessive  or irrational and becomes a disabling disorder
  2. risk factors for anxiety disorders
    • FH
    • stressfull life event
    • decreased communication with friends/family
    • poor diet
    • lack of exercise
    • alcohol, amphetamines, caffeine, cocaine
  3. Types of anxiety disorders
    • GAD
    • PD (social anxiety disorder)
    • Phobias
    • OCD
    • PTSD
  4. pts with GAD are also likely to have what
    • panic disorder
    • dysthmia
    • bipolar I dsorder
  5. panic disorder is strongly associated with what disorder
    bipolar I disorder
  6. causes of differential diagnosis of anxiety disorder
    • hyperglycemia
    • hyperthyroidism
    • electrolyte abnormalities
    • arryhythmias
    • angina
    • pseudoephedrine
    • trauma
    • alcohol
    • nicotine
    • BZD withdrawal
    • excessive caffeine intake
    • substance abuse
  7. what is GAD
    anxiety over unidentified cause or "everything"
  8. diagnosis of GAD
    • sx must be present most days for 6 mths
    • three or more of the symptoms
    • rule out substance abuse
  9. symptoms of GAD
    • easily fatigued
    • sleep problems
    • trouble concentrating
    • restlessness
    • irritability
    • muscle tension
  10. what is cognitive behavioral thinking (CBT)
    a psychotherapeutic approach that aims to solve problems
  11. what is CBT effective for
    anxiety disorders
  12. what does CBT identify
    it identifies distorted patterns of thinking which leads to feelings and behavior
  13. what does CBT teach
    it teaches the pt how to change distorted thoughts (behaviors)
  14. alprazolam
    xanax (fast)
  15. clonazepam
  16. diazepam
    valium (very fast)
  17. lorazepam
  18. oxazepam
    serax (slow)
  19. chlorazepate
    tranxene (fast)
  20. chlordiazepoxide
  21. parenteral BZDs
    • Diazepam (valium)
    • Lorazepam (ativan)
    • Chlordiazepoxide (librium)
    • midazolam (versed)
  22. BZDs used for elderly and pts with liver disease
    lorazepam (ativan), oxazepam (serax), temazepam (restoril)
  23. ADEs of BZDs
    • sedation
    • feeling of tiredness
    • drowsiness
    • difficulty concentrating
    • anterograde amnesia
    • delayed reaction
    • balance impairment
  24. FDA SSRIs approved for the treatment of GAD
    • escitalopram (lexapro)
    • paroxetine (paxil)
  25. how do you want to implement the SSRI medication
    start low, go slow to minimize ADE
  26. how much can SSRIs overlap with BZDs
    over a 2-4 week course
  27. how long does it take for adequate trial when given SSRI
    8-12 weeks
  28. which SNRIs are FDA approved to treat GAD
    duloxetine (cymbalta) and venlafaxine (effexor)
  29. escitalopram
  30. paroxetine
  31. duloxetine
  32. venlafaxine
  33. buspirone
  34. facts about Buspirone for the treatment of GAD
    • slow onset of action (2-4 wks)
    • well tolerated
    • no sexual dysfunction
    • safe in OD
    • not a controlled substance
    • less effective in pts with hx of BZD treatment
  35. Mirtazapine
  36. mirtazapine has a low incidence of what as an ADE
    low incidence of anxiety
  37. what are the non SSRI antidepressants
    • Mirtazapine (remeron)
    • nefazodone
  38. diagnosis of panic disorder
    • must have at least 2 panic attacks
    • must present with 4 symptoms
  39. physical symptoms of panic disorder
    • abdominal pain
    • chest pain/discomfort
    • chills
    • dizziness
    • hot flashes
    • nausea
    • sweating
  40. SSRIs used to treat Panic disorder
    • fluoxetine (prozac)
    • paroxetine (paxil)
    • sertraline (zoloft)
  41. SNRIs used to treat panic disorders
    venlafaxine (effexor)
  42. duloxetine
  43. escitalopram
  44. how are BZDs used in panic disorders
    • -to alleviate short term panic attacks
    • -initiate activation while pts become stable on long term treatments
  45. which BZDs may be preferred in panic disorders
    clonazepam (klonopin) due to long DOA
  46. other drugs that have been used in the treatment of panic disorders
    • nefazodone
    • mirtazapine (remeron)
    • valproic acid (depakote)
  47. sx of SAD
    • blushing
    • trembling
    • butterflies
    • sweating
    • increased heart rate
    • phobic avoidance
  48. first line for treating SAD
  49. which SSRIs are FDA approved to treat SAD
    • Venlafaxine
    • paroxetine
    • sertraline
  50. second line treatment for SAD
    BZDs- usually PRN
  51. which drug is used as augmentation with other therapies to treat SAD
    gabapentin (neurontin)
  52. what are B-blockers used for in treating SAD
    used to decrease physical symptoms of anxiety (tremor, flushing, tachycardia)
  53. how are MAOIs used in SAD treatment
    used for treatment resistant patients
  54. 5 subtypes of phobia
    • animal
    • natural environment
    • blood-injection
    • situation
    • others
  55. antidepressants should not be used to treat which disorder
    phobias (only responsive to behavioral therapy)
  56. what is PTSD
    traumatic disorder that occurs following exposure to a traumatic event
  57. symptoms of PTSD
    • re-experiencing traumatic event
    • reduced responsiveness
    • hyperarousal
    • increased symptoms of arousal
    • marked avoidance of usual activities
  58. diagnosing PTSD
    • precipitating traumatic event
    • Sx must significantly disrupt normal activities
    • must last for more than one month
  59. first line agent for PTSD
  60. first line SSRIs used to treat PTSD
    • sertraline (zoloft)
    • paroxetine (paxil)
  61. second line for treatment of PTSD
  62. how long is the treatment of PTSD
    minimum of 12 weeks
  63. how are BZDs used in treating PTSD
    • for treating Sx of:
    • anxiety
    • irritablilty
    • insomnia
    • *does not reduce core Sx
  64. what medications do you consider if SSRI is not working when treating PTSD
    • nefazodone
    • trazodone
    • venlafaxine
    • mirtazapine
    • buproprion
  65. which drug is used for augmentation in the management of nightmares
  66. which drug has the ability to reduce stress and emotional arousal in PTSD
  67. how long should therapy be maintained for the treatment of PTSD
    minimum of 1 year, 2 years with residual sx
  68. First line for OCD
    CBT and/or SSRI
  69. which first line agents are used for the treatment of OCD
    • fluoxetine
    • fluvoxamine (faverin, luvox)
    • paroxetine
    • sertraline
    • venlafaxine (effexor)- SNRI
  70. what drug can be used as second line to treat OCD
  71. how many times must an SSRI be tried before trying clomipramine
    2-3 times
Card Set
anxiety disorders