Anxiety Flashcards
Diagnostic Criteria for General Anxiety Disorder (GAD)
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
Diagnostic Criteria for Panic Disorder
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
Diagnostic Criteria for Social Anxiety Disorder (SAD)
duration must be at least 6 months
fears:
- judgement
- embarrassment
- humiliation
Diagnostic Criteria for Post Traumatic Stress Disorder (PTSD)
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
Intrusion Symptoms (PTSD)
- recurrent, intrusive, distressing memories of the trauma
- recurrent, disturbing dreams of the event
- dissociative flashbacks
- physiologic reaction or psychological distress from reminders of trauma
Avoidance Symptoms (PTSD)
- avoiding conversations, thoughts, or feelings about the event
- avoiding people, places, or activities that are reminders of the event
Negative alterations in cognition and mood (PTSD)
- 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
Increased Arousal Symptoms (PTSD)
- decreased concentration
- easily startled
- hypervigilance
- sleep disorders
- agitation, irritability, outbursts
- self destructive behavior
Diagnostic Criteria for Obsessive Compulsive Disorder (OCD)
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.
Common Antidepressant Side Effects
- HA
- GI upset
- insomnia
- sexual dysfunction
- weight gain
- increased anxiety (early)
- drowsiness
- tremor
- increased bleed risk
- Serotonin syndrome
- withdrawal/ discontinuation syndrome
SSRI’s approved for GAD
Escitalopram (Lexapro)
Paroxetine (Paxil)
SNRI’s approved for GAD
Duloxetine
Venlafaxine
GAD nonbenzodiazepine anti-anxiety agents
Vortioxetine (Trintellix)
Pregabalin (Lyrica)
Quetiapine XR (Seroquel XR)
1st line treatment for GAD
SSRI:
- escitalopram
- paroxetine
- sertraline
SNRI
- duloxetine
- venlafaxine XR
2nd line treatment GAD
Buspirone
Imipramine
Antihistamines
- Hydroxyzine
Antipsychotics
- Quetiapine XR
Benzodiazepines (If no SUD)
NOT recommended for GAD
ziprasidone
propranolol
tiagabine
Drug reserved for treatment resistant GAD
Bupropion XL
Benzodiazepines used for anxiety
Alprazolam (Xanax)
Chlordiazepoxide (Librium)
Clonazepam (Klonopin) panic only
Clorazepate (Tranxene)
Diazepam (Valium)
Lorazepam (Ativan)
Less lipophilic benzodiazepines
- lorazepam
- oxazepam
slower absorption / onset of action
longer duration of action
more lipophilic benzodiazepines
- diazepam
- clorazepate
faster absorption / onset of action
shorter duration of action
High potency benzos
clonazepam
alprazolam
High lipophilicity benzos -> fast onset + euphoria
diazepam
clorazepate
alprazolam
Lower lipophilicity benzos -> slower onset + less euphoria
lorazepam
oxazepam
Long duration benzos
diazepam
chlordiazepoxide
clonazepam
short duration benzos
alprazolam, lorazepam, oxazepam
Benzodiazepine discontinuation : therapy > 8 weeks
taper over 2-3 weeks
Benzodiazepine discontinuation : therapy > 6 months
taper over 4-8 weeks
Benzodiazepine discontinuation : therapy > 1 year
taper over 2-4 months
SSRIs approved for Panic Disorder
Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)
SNRIs approved for Panic Disorder
Venlafaxine
NOT recommended for panic disorder
Buspirone
Propranolol
Tiagabine
Trazodone
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
SSRIs approved for SAD
Paroxetine (Paxil)
Sertraline (Zoloft)
SNRIs approved for SAD
Venlafaxine XR
NOT recommended for SAD
Buspirone
Atenolol
Imipramine
Levetiracetam
Quetiapine
SSRIs approved for PTSD
Paroxetine (acute)
Sertraline (long term)
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
SSRIs approved for OCD
Fluoxetine (Prozac)
Fluvoxamine (Luvox)
Paroxetine (Paxil)
Sertraline (Zoloft)
