Anxiety Flashcards

1
Q

Diagnostic Criteria for General Anxiety Disorder (GAD)

A

persistent symptoms for at least 6 months
accompanied by at least 3 psychologic or physiologic symptoms
- excessive anxiety
- worries that are difficult to control
- feeling on edge
- poor concentration
- restlessness
- fatigue
- muscle tension
- sleep disturbances
- irritability
- social / occupational impairment
- poor coping skills

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2
Q

Diagnostic Criteria for Panic Disorder

A

Series of unexpected, spontaneous attacks of intense fear
Attack followed by at least 1 month of fear of recurrence
>/= 4 symptoms during attack:
- Fear of losing control, going crazy, dying
- depersonalization
- de-realization
- abdominal distress/ nausea
- chest pain/discomfort
- chills/hot flashes
- palpitations/tachycardia
- SOB
- trembling
- sweating

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3
Q

Diagnostic Criteria for Social Anxiety Disorder (SAD)

A

duration must be at least 6 months
fears:
- judgement
- embarrassment
- humiliation

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4
Q

Diagnostic Criteria for Post Traumatic Stress Disorder (PTSD)

A

Exposure to traumatic event is required
- threatened death or serious injury
- possible harm to self or others

Patients must have at least:
- 1 intrusion symptom
- 1 avoidance symptom
- 2 negative alterations in cognition and mood
- 2 symptoms of increased arousal

Symptoms must be present > 1 month

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5
Q

Intrusion Symptoms (PTSD)

A
  • recurrent, intrusive, distressing memories of the trauma
  • recurrent, disturbing dreams of the event
  • dissociative flashbacks
  • physiologic reaction or psychological distress from reminders of trauma
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6
Q

Avoidance Symptoms (PTSD)

A
  • avoiding conversations, thoughts, or feelings about the event
  • avoiding people, places, or activities that are reminders of the event
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7
Q

Negative alterations in cognition and mood (PTSD)

A
  • inability to recall an important aspect of the trauma
  • anhedonia (lack of pleasure)
  • estrangement from others
  • restricted affect
  • negative beliefs about oneself
  • distorted beliefs about oneself
  • distorted beliefs causing one to blame others or themselves for the trauma
  • negative mood state
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8
Q

Increased Arousal Symptoms (PTSD)

A
  • decreased concentration
  • easily startled
  • hypervigilance
  • sleep disorders
  • agitation, irritability, outbursts
  • self destructive behavior
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9
Q

Diagnostic Criteria for Obsessive Compulsive Disorder (OCD)

A

obsession- persistent recurrent idea-thought-impulse that is intrusive and inappropriate and produces marked anxiety

compulsion- repetitive behavior or mental act performed in response to an obsession.

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10
Q

Common Antidepressant Side Effects

A
  • HA
  • GI upset
  • insomnia
  • sexual dysfunction
  • weight gain
  • increased anxiety (early)
  • drowsiness
  • tremor
  • increased bleed risk
  • Serotonin syndrome
  • withdrawal/ discontinuation syndrome
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11
Q

SSRI’s approved for GAD

A

Escitalopram (Lexapro)
Paroxetine (Paxil)

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12
Q

SNRI’s approved for GAD

A

Duloxetine
Venlafaxine

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13
Q

GAD nonbenzodiazepine anti-anxiety agents

A

Vortioxetine (Trintellix)
Pregabalin (Lyrica)
Quetiapine XR (Seroquel XR)

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14
Q

1st line treatment for GAD

A

SSRI:
- escitalopram
- paroxetine
- sertraline

SNRI
- duloxetine
- venlafaxine XR

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15
Q

2nd line treatment GAD

A

Buspirone
Imipramine

Antihistamines
- Hydroxyzine

Antipsychotics
- Quetiapine XR

Benzodiazepines (If no SUD)

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16
Q

NOT recommended for GAD

A

ziprasidone
propranolol
tiagabine

17
Q

Drug reserved for treatment resistant GAD

A

Bupropion XL

18
Q

Benzodiazepines used for anxiety

A

Alprazolam (Xanax)
Chlordiazepoxide (Librium)
Clonazepam (Klonopin) panic only
Clorazepate (Tranxene)
Diazepam (Valium)
Lorazepam (Ativan)

19
Q

Less lipophilic benzodiazepines

A
  • lorazepam
  • oxazepam

slower absorption / onset of action
longer duration of action

20
Q

more lipophilic benzodiazepines

A
  • diazepam
  • clorazepate

faster absorption / onset of action
shorter duration of action

21
Q

High potency benzos

A

clonazepam
alprazolam

22
Q

High lipophilicity benzos -> fast onset + euphoria

A

diazepam
clorazepate
alprazolam

23
Q

Lower lipophilicity benzos -> slower onset + less euphoria

A

lorazepam
oxazepam

24
Q

Long duration benzos

A

diazepam
chlordiazepoxide
clonazepam

25
short duration benzos
alprazolam, lorazepam, oxazepam
26
Benzodiazepine discontinuation : therapy > 8 weeks
taper over 2-3 weeks
27
Benzodiazepine discontinuation : therapy > 6 months
taper over 4-8 weeks
28
Benzodiazepine discontinuation : therapy > 1 year
taper over 2-4 months
29
SSRIs approved for Panic Disorder
Fluoxetine (Prozac) Paroxetine (Paxil) Sertraline (Zoloft)
30
SNRIs approved for Panic Disorder
Venlafaxine
31
NOT recommended for panic disorder
Buspirone Propranolol Tiagabine Trazodone
32
When can benzos be used as first line for panic disorder
severe urgency -> high potency (alprazolam, clonazepam) preferred but diazepam and lorazepam are possibly effective at higher doses
33
SSRIs approved for SAD
Paroxetine (Paxil) Sertraline (Zoloft)
34
SNRIs approved for SAD
Venlafaxine XR
35
NOT recommended for SAD
Buspirone Atenolol Imipramine Levetiracetam Quetiapine
36
SSRIs approved for PTSD
Paroxetine (acute) Sertraline (long term)
37
PTSD augmentation agents for patients experiencing persistent symptoms or partial response to SSRI therapy
Intrusive thoughts / hypervigilance: - risperidone - quetiapine - olanzapine Nightmares - prazosin Anger - lamotrigine Sleep - trazodone Anxiety, sleep, nightmares - clonidine
38
SSRIs approved for OCD
Fluoxetine (Prozac) Fluvoxamine (Luvox) Paroxetine (Paxil) Sertraline (Zoloft)