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)
Zolpidem and Zaleplon
- Non BZD hypnotics
- Binds BZD receptor
- Mainly hypnotic but has other BZD properties in weak amounts
- Stage 3/4 preserved, minimal rem effects
- FLUMAZENIL ANTAGONIZES
Eszopiclone
- Non BZD
* Binds Gaba channel allosterically
Ramelteon
Mealtonin MT1 and MT2 receptor
For use with sleep latency insomnia
Barbiturates
- Can open GABA channel
- Rapid absoption and distribution- lipophilicity
- inducement of metabolism
- Renal excretion
Barbiturate Effects
- CNS depression/sedation/hypnosis/anesthesia
- Anticonvulsant
- Respiratory depression
- CV depression at high maintained doses
- Hepatic induction
- porphyria exacernation
- Tolerance
- Physical dependance
- Acute poisoning
Barbiturates onset and actions
Thiopental- ^Lipophilic -30 sec onset- 12 minute duration- induction
Secobarbital- =Lipo - 10-15 min onset- 3-4 hr duration- insomnia
Phenobarbital- low lipo- 1 hr onset- 10-12 hr duration- insomnia and seizures
Baclofen
MUSCLE RELAXANT
- GABA B receptor mimetic- presynaptic hyperpolarization
- Decreased glutamate release***
- Less sedative muscle relaxant
Tizanidine
Alpha 2 adrenergic agonist- pre and post synaptic inhibition
SE:drowsiness, hypotension, dry mouth,asthenia
Interactions with cipro and flucoxamine
Panic disorder
High grade- episodic and recurrent
- 10-30 minutes in duration
- 1 month or more with anxiety about subsequent attacks
- 40-60% genetic predisposition
- Watch for comorbid EtOH abuse
Tx: psychotherapy and abdominal breathing, systematic exposure
Acute: Benzos
Lng term: SSRI/SNRI
Generalized anxiety dsorder
*6 months uncontrolled anxiety
Tx: Cognative therapy
Buspirone
SSRI/SNRI
Treatment for specific phobias, social phobias
Systematic desensitization
PRN Betablockers and benzos for performance related issues
CBT and SSRIs for SAD
OCD/OCPD
OCD Egodystonic- OCPD syntonic
- obsessions and compulsions
- Psychotherapy: Eposure and response prevention (CBT)
- High dose anti-OCD antidepressants (clomipramine and SSRIs 3X)
Benzos not oxidized in liver
Lorazepam, Oxazepam, tomazepam
