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How many sxs for adults and children, duration?
- >3 for adults and 1 for children
- 6 months
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WATCHERS
- Worry
- Anxiety
- Tension in muscles
- Concentration difficulty
- Hyperarousal (irritability)
- Energy loss
- Restlessness, keyed up
- Sleep disturbances
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Criteria for panic attack
- abrupt
- 4+ physcial
- 1+ psychological
- Peaks within 10 minutes
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Criteria for panic disorder with or w/o agoraphobia
- recurrent and unexpected anxiety attacks
- one or more of:
- concern for another attack
- worry about consquences
- sig behavior
- with or without agraphobia
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Criteria for agoraphobia
- marked fear of 2+
- public transportation
- open spaces
- enclosed places
- standing in crowd
- being outside home alone
- -avoid activities
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Which NT are involved in GAD/panic disorder
NE, SER, GABA
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First and 2nd line for panic disorder and caution with what med
- SSRI (fluoxetine d/t initial agitation)
- Effexor
- TCAs
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Which benzo has the longest half life?
Diazepam with 20-80 hours
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What onset do all benzos have
15-30 minutes
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What is withdrawal benzo similar to and why
ETOH due to GABA
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How do we taper ativan
no faster than 0.25mg per week due to delirium and sz
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How do we taper diazepam
reduce 10-20% every 1-2 weeks as tolerated
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Criteria for social phobia
1+ social situations where person exposed to unfamiliar people or possible embarrassment
-
First line meds for social phobia
- SSRIs--> SNRIs
- + Buspirone, benzos
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First line meds for specific social phobia
- performance anxiety
- BB (propan or atenolol 1 hr prior to med)
- or maybe short term Benzo
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Criteria for OCD
obsessions or compulsions that are 1+ hour a day
-
First & second line tx and med for OCD
Augment?
- CBT with MI
- SSRIs (often need higher doses)
- TCA (clomipramine)
- other meds: Venlafaxine, buspar, clonazepam, risperidone
Augment with valproate, lithium, carbamazepine
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What age can PTSD occur?
after 6 yo
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Criteria for PTSD
- REQUIRED
- actual or threatened death, serious injury, sexual violence
- direct exposure or of family member
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Which NT are involved in PTSD
- Noradrenergic (increased BP, sweating)
- Opiod (naloxone reversible analgesic for combat stimuli)
- Corticotropin
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First line meds for PTSD and others
- SSRI or SNRI
- Buspirone, TCAs, MAOIs, nefazodone
- Prazosin
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When does acute stress response happen (time)
0-4 days after traumtic event
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