Anxiety Flashcards
Which gender is more likely to develop anxiety?
Females
Average age of onset for GAD
24-31
Comorbidities associated with anxiety
Depression
Alcohol or Substance abuse
What may cause anxiety?
Moderate genetic risk
Life stressors
Coping means
Etc.
Symptoms of GAD
Excessive anxiety/worry involving multiple events or activities occurring more days than not for at least 6 months, and associated with at least 3 of the following: restlessness easily fatigued poor concentration irritability muscle tension insomnia unsatisfying sleep
Psychiatric medical conditions that may cause, contribute, or exacerbate anxiety symptoms
Mood disorders hypochondriasis personality disorders alcohol/substance abuse/withdrawal other anxiety disorders
Neurologic medical conditions that may cause, contribute, or exacerbate anxiety symptoms
CVA seizure disorders dementia stroke migraine encephalitis vestibular dysfunction
CV medical conditions that may cause, contribute, or exacerbate anxiety symptoms
angina arrhythmias CHF mitral valve prolapse MI
Endocrine and metabolic medical conditions that may cause, contribute, or exacerbate anxiety symptoms
Hypo/hyperthyroidism hypoglycemia Cushing's disease Addison's disease pheochromocytoma hyperadenocorticism hyponatremia hyperkalemia B12 deficiency
Respiratory medical conditions that may cause, contribute, or exacerbate anxiety symptoms
asthma COPD pulmonary embolism pneumonia hyperventilation
Other medical conditions that may cause, contribute, or exacerbate anxiety symptoms
carcinoid syndrome
anemias
SLE
Medications that may cause, contriute, or exacerbate anxiety symptoms
anticonvulsants antidepressants antihypertensives antimicrobials antiparkinson's bronchodilators corticosteroids decongestants herbals NSAIDs stimulants thyroid hormones Toxicity Abrupt withdrawal of CNS depressants
Nonpharmacologic therapies for GAD
Psychoeducation
Exercise
Stress management
Psychotherapy
Role of antidepressants in GAD management
1st line treatment for chronic GAD
Which antidepressants are 1st line for anxiety?
BDZs are first line overall
SNRI or SSRI
What is used if BDZs, SNRIs, or SSRIs fail?
Change to a different SSRI or SNRI imipramine buspirone pregabalin Last: atypical antipsychotic or BDZ for somatic symptoms
Symptoms of anxiety reduced by antidepressants
Psychic symptoms like worry and apprehension
Autonomic or somatic symptoms like tremor, rapid heart rate, and sweating
Takes ~8 weeks for onset
SSRIs used to treat GAD
citalopram escitalopram fluoxetine fluvoxamine paroxitine sertraline
SNRIs used to treat GAD
venlafaxine
duloxetine
TCAs used to treat GAD
imipramine
When are BDZs used in GAD treatment?
Recommended for acute treatment when short-term relief is needed
as adjunct during initiation of antidepressant therapy
to improve sleep
GAD symptoms reduced by BDZs
Somatic symptoms (less on psychic symptoms)
Disadvantages of BDZs
Lack of effectiveness in treating depression
Risk of dependency and abuse
Potential interdose
BDZ Mechinism
Enhances transmission of GABA through GABAa receptor complex
