4. Generalized Anxiety Disorder Flashcards
this is known as apprehension, uncertainty, or anticipations of a future events, which can be a normal emotion under circumstances of threat
anxiety
what are the three types of symptoms that someone may experience in anxiety
physical, cognitive and behavioural symptoms
physical - getting sick
cognitive - difficulty concentrating
behavioural - substance abuse, agoraphobia, avoidance
true or false: anxiety disorders are more prevalent in men
false - more prevalent in females
true or false: anxiety disorders can be med induced
true
by anti-depressants, bronchodilators, steroids, stimulants, sympathomimetics, thyroid hormones, alcohol and sedative withdrawal sx’s
this anxiety disorder is a fearful separation from something or someone
separation anxiety disorder
this anxiety disorder is known as a failure to speak in social situations
selective mutism
this anxiety disorder is an avoidance of social or performance situations
social anxiety disorder
this anxiety disorder is avoidance of objects or situations (e.g. needles, flying on airplanes, spiders, etc.)
specific phobia
this anxiety disorder is fear of 2 or more of the following situations: being in open or closed spaces, public transport, away from home, etc. because you are afraid if you have a panic attack you won’t be able to get help
agoraphobia
true or false: GAD tends to run an acute course
false - chronic
what are some non-charm tx options for GAD
- psychoeduation / reassurance (e.g. help getting over a fear)
- lifestyle changes (e.g. avoiding substances such as caffeine, etoh, nicotine, stimulants), healthy eating, exercise, sleep hygiene
- mobilization of family/social supports
- counselling/CBT
what is the onset of action for antidepressants in GAD
2-6/52, and may not see maximal effect until 12 week period
what is the onset of action for pregabalin in GAD
1-2/52?
what is the onset of action for buspirone in GAD
2-4/52, and may not see maximal effect until 4-6 weeks
true or false: after taking a benzodiazepine for GAD, some effect may be seen after the first dose
true
true or false: benzodiazepines and anti-depressants cannot be taken together since benzodiazepines have a quick onset whereas anti-depressants have a delayed onset
false
if a patient is started on an antidepressant, they may also be started on a benzo to get some immediate relief until the effects of the antidepressant may be seen at the 2-6/52 week mark
true or false: hydroxyzine has a quick onset
true - may see some effect after the first dose
what agents should you avoid in patients with substance abuse
benzodiazepines
what agents should you avoid in patients with dementia
avoid benzodiazepines, hydroxyzine and paroxetine (paroxetine is VERY anticholinergic)
what agents should you avoid in patients with sleep apnea
avoid benzodiazepines, hydroxyzine and pregabalin
what agents should you avoid in patients with risk of Qt prolongation
avoid hydroxyzine, citalopram and escitalopram
what agents may be beneficial for someone who also have chronic pain
SNRI or pregabalin
what agents may be beneficial for someone who also has depression
SSRI or SNRI
what agents should you avoid in patients with bipolar disorder
antidepressants
what agent may be beneficial for someone who also has a seizure disorder
benzodiazepines and pregabalin (raise seizure threshold)
what are the main s/e of pregabalin
sedation, dizziness, weight gain and sexual dysfunction
what are the main s/e of hydroxyzine
sedation, anticholinergic effects, Qt prolongation
what are the main s/e of benzodiazepines
sedation, ataxia, memory loss
true or false: SSRI’s are considered safe in pregnancy and lactation
true - sertraline seems to be a favourite
true or false: when starting a patient on an antidepressant, they should be started on a high dose to optimize therapy
false - start w/ low dose so you don’t precipitate an anxiety attack
what is the suggested follow up for GAD treatment
follow up q 2 weeks for the first 6 weeks then monthly
this medication used for GAD can cause paradoxical reactions where the patient experiences irritability, agitation, hallucinations
benzo’s
true or false: cognitive impairment and anterograde amnesia is seen with all benzo’s
false - most common with highly lipophilic benzo’s (alpraz, diazepam)
true or false: benzo’s can cause respiratory depression at therapeutic doses
false - won’t cause respiratory depression on their own
usually see if take in excess quantities with etoh or other sedative.
avoid in patients with sig. compromised respiratory. function and sleep apnea
what is a risk factor for abuse potential with benzo’s
highly lipophilic benzo such as diazepam has a higher abuse potential because it gets into the brain quicker
what the an adequate duration on treatment for GAD
not clear! recommended 1 year minimum
some patients will relapse after tx d/c and long-term tx may be required
what should you do if the first treatment chosen for a patients GAD does not work?
step 1: switch to another first line agent; if this doesn’t work
step 2: add adjunct/combination therapy; if this doesn’t work
step 3: switch to second line tx
