2: Anxiety Diagnosis + Treatment Flashcards
Clinical presentations of GAD
Presence of worry and at least 3 additional symptoms:
- Restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, disturbed sleep
Physical symptoms of GAD
Signs of muscle tension, somatic symptoms, exaggerated startle response, stress-associated conditions
List 6 differential diagnoses for GAD diagnosis
- Anxiety disorder d/t another medical condition
- Substance/medication-induced anxiety disorder
- SAD
- OCD
- PTSD
- Depressive, bipolar, psychotic disorders
List 13 differential diagnosis for SAD
- Normative shyness
- Agoraphobia
- PD
- GAD
- Separation anxiety disorder
- Specific phobias
- Selective mutism
- Major depressive disorder (MDD)
- Body dysmorphic disorder
- Delusional disorder
- Autism spectrum disorder (ASD)
- Personality disorder
- Oppositional defiant disorder (ODD)
Clinical presentations of SAD
- Marked by intense fear of social situations in which individual may be scrutinized by others
- May engage in extensive avoidance behaviors
Diagnostic criteria for PD
- Recurrent unexpected panic attacks
- At least on of the attacks has been followed by (one month or more): persistent concern, maladaptive change in behavior r/t attacks
Comorbidity % of Anxiety and Depression
70%
List 4 differential diagnosis for PD
- Other specified anxiety disorder
- Anxiety disorder d/t another medical condition
- Substance/medication-induced anxiety disorder
- Other mental disorders with associated panic attacks
Characterizations of MDD with Anxiety Distress
Symptoms with at least two of the following symptoms:
- Feeling tense
- Feeling unusually restless
- Difficulty concentrating (d/t worry)
- Fear of that something awful may happen
- Fear of losing control of themselves
% of individuals that have an anxiety disorder with a combined co-morbid disorder
60%
Primary mode of anxiety disorder diagnosis
Clinical signs, symptoms, and mental status examination observations
The cornerstone of psychiatric disorder diagnosis (hallmarks of mental illnesses, including anxiety subtypes)
DSM-5
Clinician-based questionnaire that can gauge anxiety severity
HAM-A
Efforts to change thinking patterns and behavior to improve overall functioning and QOL
Cognitive Behavioral Therapy (CBT)
Binds to and enhances function of GABAa receptors, thus increasing inhibition to calm signaling in key regions that mediate anxiety
Mechanism of Benzodiazepines
Inhibits reuptake of leftover serotonin in the synapse resulting in an increased amount of sertonergic signaling in the brain. Primarily used as antidepressants but also approved to treat anxiety disorders
SSRI’s
Potent anxiolytics that work quickly; used more frequently for acute anxiety symptom management. Available in short- and intermediate/longer-acting formulations
Benzodiazepines
Describes the absorption, distribution, metabolism, and drug excretion
Pharmacokinetic (PK) properties
Maximum concentration a drug reaches following dosing
Cmax
Amount of time required for a drug to reach maximum concentration in the boxy
Tmax
Amount of time required to metabolize 50% of drug concentration (valuable measure of drug elimination)
Half-life
Intended for long-term use in treating chronic anxiety
SSRI’s
A biological process of adding an O2 molecule to a substrate to modify the structure to allow for degradation
Oxidation
When a molecule attaches to drug to inactivate drug for easy excretion
Conjugation
Drugs metabolized by glucuronidation do not require additional chemical modification for excretion, resulting in shorter half-lives than other drugs that require additional metabolic steps
Conjugation with Glucuronide
6 enzymes most drugs are metabolized by:
CYP1A2 CYP2C9 CYP2C19 CYP2D6 CYP3A4 CYP3A5
Somnolence, dizziness, drowsiness, lack of concentration/coordination, risk dependencies
Most frequent Adverse Events (AEs)
Substance examples include heroin, gamma hydroxybutyric acid (GHB), marijuana, methaqualone
Schedule 1
Substance examples include morphine, methadone, and fentanyl
Schedule II
Substance examples include anabolic steroids, codeine products with aspirin/acetaminophen, some barbiturates
Schedule III
Substance examples include alprazolam and diazepam
Schedule IV
Substance examples include cough medicines with codeine
Schedule V
Blocks CYP450 activity, which may increase bioavailability of some concomitant drugs
CYP450 Inhibitors
The metabolic pathway that breaks down lorazepam following dosing
Direct glucuronidation
A reflex response in which a sudden withdrawal of a stimulus is followed by increased activity
Rebound
