12 Anxiety Flashcards
Generalized anxiety disorder
- 6 months >1/2 days with extensive, uncontrolled worry about a number of different things
- 3/6 symptoms
- Restless/keyed up/on edge
- Easily fatigued
- Difficulty concentrating/blank mind
- irritability
- muscle tension
- sleep disturbance
- Not anxiety about another Axis 1 disorder
- Significant distress or interference
- Not a substance, general med condition, not exclusively during a mood disorder, psych disorder, or pervasive devo disorder
- does not have patterns of other disorders like specific phobia, panic attacks, or OCD
High cortisol
Stress hormone
- increases BP
- increases HR
- interferes with neuronal connections- reduces learning and memory
- disrupts immune response
Social anxiety disorder
- Persistent fear of social or performance situations and embarrassment
- Exposure to these feared situation causes anxiety and or panic attacks
- Anxiety recognized as excessive or unreasonable by subject
- event is avoided or endured with severe anxiety
- Significant interference
- Not due to substance, general medical condition, and not better accounted for by another mental disorder
Anxiety Tx
- Social Tx
- Psychological treatment
- diaphragmatic breathing
- guided imagery
- Pharmacologic treatments
Lorazapam
- PO, IM, IV
- Benzo- fast acting
- Kidney excretion
- Tolerance, Dependance, withdrawl
ANS arousal symptoms
Sweating Tachycardia and palpitations cold, clammy hands dry mouth/ lump in throat GI upset Urination and diarrhea
Sleep stages
REM- low voltage random fast waves with sawtooth waves- NE predominates
Stage 1- Theta waves
Stage 2 - Sleep spindles and K complexes
Stage 3/4- Delta waves - Serotonin predominates
Gaba channel
Cl- ion channel
Buspirone
- Partial 5HT1a agonist- Opens K+ channel and inhibits adenylate cyclase.
- Binder of dopamine receptors
- less sedating than BZDs and no cross tolerance
- Will not interact with others and does not improve BZD withdrawl
BZDs for anxiety
Alprazolam* Diazepam*- also muscle relaxant Lorazepam* Clonazepam*- acute mania Chlorodiazepoxide*- alcohol withdrawl Clorazepate Oxazeepam Prazepam
Hypnotics
Flurazepam, Tamazepam, lorazepam
also non BZD
Zolpiidem, zapeplon and eszopiclone
Lipophilicity in hypnotics/antipanics
More lipophilicity (diazepam>lorazepam) causes faster absorption and onset. Diazepam also has active metabolites (lorazepam and oxazepam dont)
BZD and hypnotics effects
Decreased anxiety
sedation
hypnosis (decreased latency and awakenings)
Muscle relaxation
anterograde amnesia (IV)
Anticonvulsant
minimal respiratory effects at therapeutic doses
BZD withdrawl
Anxiety insomnia irritability HA Hyperacusis Hallucinations Seizures
Additional anti-anxiety meds
SSRI SNRI-panic attacks and GAD
Beta blockers-performance anxiety
Other sedatives (rarely)
