Anxiety Flashcards
HAM-A
Hamilton anxiety scale 14 item scale Each item on scale of 0-4 Tota score 0-56 0-17 mild 18-24 mild-moderate 25-30 moderate to severe - response to therapy: remission: 70% reduction from baseline or score < 7 Improved: 50% decrease Partial response: 25-49% reduction sx Non-response: <25% decrease Assesses severity of anxiety sx Document response to pharmacotherapy
Diagnosis of GAD
Excessive anxiety and worry lasting > 6 months and difficulty controlling worry
Presence of 3 of the following 6 sx: - restlessness or feeling keyed up, on edge - easily fatigued - difficulty concentrating - irritability - muscle tension - sleep disturb Distress or impairment from sx Not due to other substance or dz
Impairment of social occupational or other areas
Poor coping
BAI
Beck anxiety inventory Self rated, measure severity and distinguish anxiety from depression Brief screening 0-7 minimal 8-15 mild 16-25 moderate 26-63 (!)severe
PSWQ
Penn state worry questionnaire
Evaluate pathological worry
Self rated screening
16 item scale 1 - not at all typical to 5- very typical of me
Total score is calculated by summing first 11 items and reverse scores of latter 5 items
Higher pswq score - worse anxiety
Non anxious score 60
SAS
Zung self rated anxiety scale
Measure severity of anxiety Self rated screening 20 items 20-44 normal 45-59 moderate 60-74 moderate to severe 75-80 extreme
What neuro chemical and location associate with anxiety?
Increase in norepinephrine
In the locus ceruleus (LC)
- central admin of corticosteroid releasing factor (CRF) in animals results in increases in behavior indicating anxiety
Decreased alpha-2 adrenergic receptors
SPIN
Social phobia inventory
Self rated screening Score >51 vey severe 41-50 severe 31-40 moderate 21-30 mild <20 none
Taper schedule for BZD
25% per week dose reduction till 50% of dose reached, then reduce dose by 1/8th every 4-7 days
- therapy > 8 weeks-taper 2-3 wks
- therapy > 6 months-taper 4-8 wks
- therapy > 1 year taper 2-4 months
- switch from short to long acting BZD for taper NOT supported by lit
Amount to taper SSRI in OCD
10-25% every 1-2 months while watching for sx worsening
Liebowitz social anxiety scale
LSAS
SAD scale Clinical rates 24 items w 13 for performance anxiety and 11 for social Each rated 0 non 1 mild 2 moderate 3 severe and avoidance behavior: 0 never 1 occasionally 2 often 3 usually Total score 80-120 severe illness 60-80 moderate illness 40-60 mild illness
Response: score <30
Overall subscale performance fear, performance avoidance, social fear, social avoidance
SPAI
Social phobia and anxiety index
Self rated , screening 45 items ok for pt > 14 yo Two subscales social phobia and agoraphobia- overall= severity of social phobia Social minus agora = purer SAD No response guidelines
