2.2, 2.3 Anxiety, management Flashcards
What are the features of generalized anxiety disorder?
Excessive anxiety or worry about a number of activities or events for at least 6 months
-difficult to control the worry
Anxiety or worry associated with at least 3 of the following for the past 6 months:
- restlessness
- fatigue
- difficulty concentrating
- irritability
- muscle tension
- sleep disturbance
What are the features of panic attacks?
Discrete period of intense fear or discomfort that develop abruptly and peak in 10 minutes.
Physical symptoms prominent.
Mental symptoms:
-restlessness, irritability, mind blank, sleep disturbance, poor concentration, feeling out of control, fears of going mad
How is blood/injury/needle phobia different from other phobias?
The fear is associated with: -A FALL in BP -BRADYcardia -pallor (vasovagal/syncope like) -sweating -nausea -tinnitus
It is one of the phobias that could result in DEATH due to vasovagal collapse.
What are the two main treatment approaches to blood/needle/injury phobia?
Systematic desensitization
More recently, applied tension
Name 6 drugs and drug classes that are used to treat anxiety?
- Barbiturates (not recommended)
- benzodiazapines
- antidepressant drugs
- buspirone
- pregabalin
- beta-blockers (propranolol)
What are the pharmacological effects of benzodiazepines?
reduced anxiety and aggression hypnosis and sedation muscle relaxation anticonvulsant affect anterograde amnesia
Where in the body is glycine restricted to?
spinal cord and brain stem
What are the clinical uses of benzodiazapines?
acute tx of extreme anxiety hypnosis alcohol withdrawal mania delirium rapid tranqualisation premedication before sx or during minor procedures status epilepticus
What are the main problems with benzodiazapines?
paradoxical aggression
anterograde amnesia and impaired coordination
tolerance
dependence= rebound anxiety on withdrawal and physical symptoms
What are the symptoms and consequences of rapid withdrawal of benzodiazepines??
confusion
toxic psychosis
convulsions
insomnia, anxiety, loss of appetite, loss of body weight, tremor, perspiration, tinnitus, perceptual disturbances
What is the mechanism of neuroadaptation to GABA stimulation?
chronic treatment with GABA agonists results in decreased density og BZ receptors –> anxiety/convulsions
What is the protocol for withdrawing benzodiazepines?
- Transfer patient to equivalent daily dose of diazepam/chlordiazepoxide preferably taken at night
- Reduce dose every 2–3 weeks in steps of 2 or 2.5mg; if withdrawal symptoms occur, maintain this dose until symptoms improve
- Reduce dose further, if necessary in smaller steps; it is better to reduce too slowly rather than too quickly
- Stop completely; time needed for withdrawal can vary from about 4 weeks to a year or more
Which antidepressants are useful in the treatment of anxiety?
- SSRIs- panic disorder, OCD, PTSD, phobias, GAD (escitalopram, paroxetine)
- TCA- clomipramine, imipramine - 2nd line for panic disorder, OCD
- Venlafaxine- GAD
- Moclobemide- social anxiety disorder
How do monoamines (NA, 5HT) affect anxiety?
In stressful situations,
- increased NA release from locus coeruleus neurons that project to frontal cortex and hippocampus
- increased 5HT release from neurons that project to dorsal raphe nucleus
Benzodiazapines block these increases, thus blocking the monoamine effect, and the anxiety inducing effects.
What is the mechanism of action for SSRIs in their use in anxiety?
Initially, increased extracellular 5HT, anxiogenic properties!!
but chronically, mayt involve neuroadaptive changes and increased neurosteroid synthesis
