Anxiety Flashcards
What is an anxiety disorder?
Severe, excessive, persistent anxiety and irrational fears that impairs functioning with everyday living.
What is Generalized Anxiety Disorder (GAD)?
Excessive anxiety and worry, occurring more days than not for at least 6 months
What are the other types of anxiety disorders apart from GAD?
Panic disorder (anticipatory anxiety of having additional anxiety attacks); Social anxiety disorder (SAD), Obsessive-compulsive disorder (OCD) and Post-Traumatic Stress Disorder (PTSD).
What are the long term treatment goals for the various anxiety disorders?
GAD, panic disorder, SAD and PTSD:
Remission of core anxiety symptoms, recovery of function
OCD:
Complete resolution of symptoms is often difficult to achieve.
Relapse rates very high with poor medication adherence.
How do we objectively assess outcomes for anxiety?
- Psychiatric rating scales
- Identify target symptoms for each type of anxiety disorder
- Keep detailed diary to record fear levels, physical symptoms, cognitions and anxious behaviour.
What is the non-pharmacological treatment recommended for anxiety?
Cognitive behavioural therapy (CBT)
What is the treatment used for OCD?
CBT + either SSRI or clomipramine (TCA)
What is the universal pharmacological agent used for all types of anxiety?
SSRI
What pharmacological agents can be used in anxiety?
- All serotonergic agents can be used for anxiety.
SSRI > SNRI > clomipramine - In OCD: SSRI > clomipramine > SNRI (venlafaxine)
What is the approach for dosing for anxiety?
Starting dose must be LOW. Start low and go slow, gradually titrate to maximum dose range.
- Transient jitteriness in initial 1-2 weeks of starting antidepressant.
- Start antidepressant at low dose, consider benzodiazepine as adjunct.
Maintenance dose may be at HIGH end of range.
What are serotonergic antidepressants useful for?
Excessive worrying type of symptoms in anxiety
What is the onset of action of antidepressants in anxiety?
Time to response can take 6-12 weeks
Maximum response may take 3 months.
How are benzodiazepines used in anxiety?
- Not recommended for monotherapy
- Effective for physical symptoms of anxiety e.g. muscle tension
- Quick onset of effect
- Limited duration of treatment is preferred -> avoid use in persons with substance-use disorders
- Gradually taper benzodiazepines to avoid rebound anxiety
Which benzodiazepines are preferred in anxiety disorders?
High potency agents preferred e.g. clonazepam, lorazepam, alprazolam XR (for panic disorders)
Apart from benzodiazepines, what other adjuncts can be used in anxiety?
Pregabalin for GAD.
