Anxiety Flashcards
What is anxiety?
excessive worry about a number of different events associated with heightened tension
What are important differentials to consider?
- Hyperthyroidism
- Cardiac disease
- Medication-induced anxiety (NICE).
What are the treatment steps for generalised anxiety disorder?
step 1: education about GAD + active monitoring
step 2: low-intensity psychological interventions (individual non-facilitated self-help or individual guided self-help or psychoeducational groups)
step 3: high-intensity psychological interventions (cognitive behavioural therapy or applied relaxation) or drug treatment.
step 4: highly specialist input e.g. Multi agency teams
What meds can induce anxiety?
Medications that may trigger anxiety include salbutamol, theophylline, corticosteroids, antidepressants and caffeine
What drugs would you use for GAD?
First-line SSRI = sertraline
if intolerated offer an alternative SSRI or a serotonin–noradrenaline reuptake inhibitor (SNRI)
SNRIs include duloxetine and venlafaxine
If the person cannot tolerate SSRIs or SNRIs, consider offering pregabalin
What is the risk of drug treatment?
Under the age of 30 years there is increased risk of suicidal thinking and self-harm.
Weekly follow-up is recommended for the first month
How would you manage panic disorder?
step 1: recognition and diagnosis
step 2: treatment in primary care (CBT/SSRI)
step 3: review and consideration of alternative treatments
step 4: review and referral to specialist mental health services
step 5: care in specialist mental health services
What would you do if first line drug management is in-tolerated in panic disorder?
If SSRI contraindicated or no response after 12 weeks then imipramine or clomipramine should be offered
