Anxiety

Question 1

SAD def

Answer 1

chronic, long-term illness requiring extended therapy. after improvement at 8 weeks, continue tx for 6-12 months

Question 2

SAD first line options

Answer 2

SSRIs or venlafaxine

Question 3

brain regions in anxiety

Answer 3

anygdala
LC-locus ceruleus
hypothalamus

Question 4

ntms in anxiety

Answer 4

NE, GABA, 5HT, CRF, cholecystokinin

Question 5

GAD s/sx
dx

Answer 5

excessive anxiety, worries difficult to control, feeling on edge, poor concentration, mind going blank

restlessness, fatigue, muscle tension, sleep disturbances, irritability
sx are unrealistic and or excessive
persistent sx for most days for at least 6 months

Question 6

drugs that can induce anxiety

Answer 6

anticonvulsants, ADs, BP meds, ABX, bronchodilators, CS, DA ag, herbal agents, illicit substances, stimulants, toxicity, w/drawal

Question 7

GAD
SNRIs
SSRIs
can use vs FDA approved

Answer 7

duloxetine, venlafaxine XR can use and FDA approv

escitalopram, paxil, zoloft - can use
zoloft - not FDA-ap

Question 8

GAD 2nd, 3rd line

Answer 8

2nd = hydroxizine or change AD
3rd = quetiapine XR, divalproex
can do benzo (chlordiazepoxide, clorazepate, lorazepam, alprazolam, diazepam)

Question 9

benzos in liver dysfunction

Answer 9

LOT
lorazepam
oxazepam
temazepam

Question 10

PD s/sx

Answer 10

fear of losing control, going crazy, and dying
depersonalization
de-realization
abdominal distress/pain
chest pain, discomfort
chills/hot flashes
SOB
trembling/shaking
sweating
agoraphobia

Question 11

agoraphobia

Answer 11

anxiety about being in at least 2 situations or places where escape is difficult or help unavailable
may be secondary to panic attack but panic attack may be never experienced

Question 12

panic disorder AD onset

Answer 12

8-12 weeks for full effect, 4 weeks to see anti-panic effect

Question 13

non-pharm options for PD

Answer 13

CBT
psychosocial tx psychoeducation
avoid stimulants and alcohol
inc physical activity

Question 14

high potency benzos are ______ over benzos that need high doses
which benzos are for each

Answer 14

preferred
high pot = alprazolam and clonazepam
high dose IM = lorazepam and diazepam

Question 15

A. patient e PD starts taking fluoxetine
after 12 weeks response is inadequate
options?

B. same patient, after 12 weeks of taking the therapy recommended in part A there is an inadequate response.
options?

C. same patient, failed second option from part B. options?

at any step, if response is adequate, how long should therapy be continued for?

Answer 15

change SSRI to paroxetine or sertraline
change to venlafaxine

change SSRI
change to venlafaxine

add BZD or gabapentin or atypical AP

continue for 12-24 months

Question 16

when dc med for PD, how long should discontinuation take

Answer 16

6 months

Question 17

BZD should or should not be used in pts doing CBT? Why?

Answer 17

should NOT
you want pt to be fully present and at their normal baseline

Question 18

SAD s/sx

Answer 18

tachycardia, flushing, sweating, phobic avoidance, social anxiety

Question 19

how long is SAD tx acute phase, continuation phase and maintenance phase

Answer 19

4-12 weeks
3-6mo
6 mo+

Question 20

FDA approved not approved meds for SAD

Answer 20

approved: paroxetine, sertraline, venlafaxine

not approv: fluvoxamine, escitalopram, pregabalin, gabapentin

Question 21

SAD: what is used for acute performance sx management

Answer 21

BBs: propranolol and atenolol

Question 22

SAD: what to avoid in pregnancy

Answer 22

avoid paroxetine and benzos

Question 23

when is CBT recommended in SAD

Answer 23

at any time w or w out tx
not to be done if pt is on benzos

Question 24

FDA approved for OCD

Answer 24

paroxetine, fluoxetine, fluvoxamine, sertraline

Question 25

when is clomipramine used in OCD

Answer 25

when pt fails SSRI due to ADR

Question 26

when can you augment with APs in OCD

Answer 26

when patient has failed three different medications, one of them being clomipramine

Question 27

when can pt be tapered off medication for OCD

Answer 27

after 1-2 years