Anxiety Flashcards
Describe the biological aetiology of anxiety
Noradrenalin and Serotonin neurotransmitters
Disregulation of the GABA and cholecystokinin (CCK) systems
Hypothalamus-Pirtuitary-Adrenal axis overactive (cortisol increase=stress hormone)
What is the psychosocial aetiology of anxiety
Trauma
Negative child rearing
Outline the pharmacological treatment of GAD
•1st line = SSRIs and SNRIs e.g. escitalopram, fluoxetine, sertraline, venlafaxine
•Start at low dose, increase over few weeks
•Continue 9 months – 1 year
•Antidepressants vs Anxiolytics: slow and steady vs quick and dirty
•Benzodiazepines: BEWARE!
•SHORT TERM ONLY (max 2-4 weeks)
Outline the Benzodiazepine withdrawal timeline
1-4 days :
Sweating
Headaches
Anxiety
Panick attacks
5-19 days
Weight loss
Depression
Hallucinations
Seizures
Months-years
Reduced symptoms
May persist for up to 1 year or more depending on severity of addiction
Describe the pharmacological management of phobias
•SSRIs
•Pregabalin, Gabapentin
•Propranolol: performance anxiety only
•Clonazepam as augmentation
•Only consider switching to second-line medication after dosage of the first drug has been optimised, an adequate duration of treatment has been allowed (at least 6 weeks), treatment adherence is confirmed and alternative or comorbid diagnoses have been considered.
•Referral to a specialist psychiatrist should be considered in patients who do not respond to first line agents.
List cardiac issues that may present as anxiety
Angina
Cardiac temponade
Valvular heart failure
Arrhythmia
Congestive heart failure
Myocardial infarction
Which substances are associated with anxiety symptoms
Anticonvulsants
Antihypertensives
Antibiotics
Antidepressants
Marijuana
Bronchodilators
Corticosteroids
Many others
What are the benefits of Benzodiazepine
Quick onset of action
Cardiac patients
Cancer patients
Hat are the side effects of benzodiazepine
Risk of dependence
Risk of falling in older people
Possible disinhibition in some people
