Anxiety

Question 1

what is anxiety disorder?

Answer 1

• severe, excessive, persistent anxiety & irrational fears that impairs functioning with everyday living
• anxiety is out of proportional to the actual damage/threat of situation
• persit long after original trigger disappear
• increase risk for cardiovascular, cerebrovascular, GI & respiratory disease

Question 2

what are the 5 anxiety disorder that are amendable to treatment?

Answer 2

generalized anxiety disorder (GAD)
panic disorder (PD)
social anxiety disorder (SAD)
obsessive compulsive disorder (OCD)
post traumatic stress disorder (PTSD)

Question 3

what are the conditions associated with anxiety?

Answer 3

CVD: CHF
endocrine - hyperthyroidism
neurologic - demntia, delirium
respiratory - asthma, COPD

Question 4

what are the drugs that can cause anxiety?

Answer 4

sympathomimetics (pseudoepihedrine)
stimulatns (amphetamines)
theophylline, caffeine
thyroid hormone (levothyroxine)
corticosteroids
antidepressants
dopamine agonits (levodopa)
beta-adrenergic agonists (calbutamol)
drug withdrawal (Caffeine, alcohol, sedatives, BZD)
drug intoxication (anticholinergics, antihistamins, digoxin)

Question 5

what is GAD?

Answer 5

excessive anxiety & worry for >/= 6 months
cause functional impairment

Question 6

what is PD?

Answer 6

recurrent unexpected panic attacks
persistent anticipatory anxiety/worry about implications of panic attack/sig change in behaviour relating to panic attacks

Question 7

what is SAD?

Answer 7

marked & persistent fear of >/= 1 social/performance situations
afraid of being humilitated/embarrased
duration > 6 months
avoid situation, impair functioning

Question 8

what is OCD?

Answer 8

obessisions: recurrent & persistent thoughts/impulses/images that are intrusive & inappropriate, a product of his own mind
compulsion: repetitive behaviours/mental acts, aim to prevent/reduce distress but NOT connected in a realistic way, clearly excessibe
person recognize obsession/compulsions
obsession/compulsion is time consuming/impair function

Question 9

what is PTSD

Answer 9

exposed to traumatic event –> persistently re-experience –> cause avoidance

Question 10

non-pharmacological for anxiety disorder

Answer 10

CBT - 1st line, tgt with pharm
relaxation therapy

Question 11

treatment for GAD?

Answer 11

SSRI
venlafaxine XR
pregabalin
TCA, beta-blocker, hydroxyzine, busiprone

Question 12

treatment for PD

Answer 12

SSRI
TCA

Question 13

treatment for SAD

Answer 13

SSRI
MAOIs +/- benzodiazepines

Question 14

treatment for OCD

Answer 14

SSRI
clomipramine

Question 15

treatment for PTSD

Answer 15

SSRI
TCA

Question 16

should the starting dose be low or high?

Answer 16

low - transient jitteriness at initial 1-2w
consider short term benzodiazepine as adjunct

Question 17

should maintenance dose be high or low?

Answer 17

high

Question 18

how long does sertonergic antidepressant take to work?

Answer 18

onset 1-2 months
full onset 3 month

Question 19

how long should duration of treatment be?

Answer 19

1-2 year

Question 20

what is benzodiazepine use for?

Answer 20

as an adjunct, short term (3-4months)
effective for physical symptoms
fast onset: 30mins
high potency prefered eg clonazepem, lorazepem, alprazolam

Question 21

should benzodiazepine be combine with opioid?

Answer 21

NO - increase mortality, CNS depression

Question 22

which benzodiazepine does not form major active metabolites?

Answer 22

alprazolam, lorazepem

Question 23

dose of alprazolam for anxiety?

Answer 23

0.5mg (0.25-0.5mg BD-TDS)

Question 24

dose of clonazepam for anxiety?

Answer 24

1mg/day, 0.5mg BD

Question 25

dose of diazepam for anxiety?

Answer 25

10mg (2-10mg BD-QDS)

Question 26

dose of lorazepam for anxiety

Answer 26

1mg, 1-3mg/day

Question 27

which benzodiazepines are long acting?

Answer 27

clonazepam, diazepam

Question 28

which benzodiazepines are short acting?

Answer 28

alprazolam, lorazepem