Anxiety Flashcards
Is an anxiety disorder self-limiting?
No
What is the most common anxiety disorder?
GAD =
Generalised Anxiety Disorder
What physiological symptoms can be associated with anxiety?
-Fearful anticipation
-Irritability
-Worrying thoughts
-Insomnia
-Night terrors
What physical symptoms can be associated with anxiety?
-Dry mouth
-Headache
-Palpitations
-Constriction of chest
-Breathlessness
-Hyperventilation
What is first line for anxiety?
SSRI’s
What benzodiazepines help with anxiety?
Lorazepam, Diazepam, Oxezepam, Clobazam
What antipsychotics can be used for anxiety?
-Risperidone
-Olanzapine
-Quetiapine
-Pericyazine
What medications can be use for GAD?
-Venlafaxine
-Duloxetine
If SSRI is not tolerated and patient has a panic disorder, what should be offered?
Tricyclic antidepressants
-Clomipramine
-Imipramine
What can be used for GAD, Epilepsy and Neuropathic pain?
Pregabalin
What other treatment is unlicensed for anxiety but useful for depression, sleep issues and anxiety?
Mirtazapine
-Has a anti-histamine side effect to help with sleep
How long does it take for Buspirone to have an effect for anxiety?
4 weeks at 10mg TDS
What can Propranolol help with in anxiety?
10-120mg OD for palpitations
What antihistamines can be used for anxiety?
Promethazine and Hydroxyzine
What anti-depressants are licensed for GAD?
SSRI - Escitalopram, Paroxetine
SNRI - Venlafaxine, Duloxetine, Pregabalin
What anti-depressants are licensed for panic disorders?
SSRI’s - Escitalopram, Citalopram, Sertraline, Paroxetine
SNRI - Venlafaxine
What antidepressants are licensed for OCD?
SSRI - Escitalopram, Sertraline, Paroxetine, Fluoxetine
What antidepressants are licensed for social anxiety disorder?
SSRI’s - Escitalopram, Sertraline, Paroxetine
SSNI - Venlafaxine
What antidepressants are licensed for PTSD?
SSRI’s - Sertraline, Paroxetine
What is Clomipramine (TCA) licensed for?
Obsessional and phobic states
What is Propranolol licensed for?
Relief of situational anxiety and generalised anxiety symptoms, particularly those of somatic type
Can SSRI’s worsen symptoms initially?
Yes - Low dose and increase as s/e with tolerability
How long do you need to wait to see response from SSRI’s for Anxiety?
12 WEEKS
What dose of escitalopram do we start at for anxiety?
5mg/day
What dose of Fluoxetine do we start at for Anxiety?
5-10mg/day
What dose paroxetine do we start at for anxiety?
Paroxetine 5-10mg/day
What dose Sertraline do we start at for anxiety?
25mg/day
What dose Citalopram do we start at for anxiety?
5-10mg/day
When do we increase the dose of antidepressants in anxiety?
Every two weeks or as tolerated
What can be prescribed alongside the SSRI’s initially to help with anxiety?
Benzodiazepines
How many weeks does it take for diazepam to not have any effect?
4 weeks - leave plenty of time in-between dose reductions
If anxiety doesn’t go away and lasts for at least 6 months, what can this be classed as?
GAD
Can people with GAD be suicidal?
Yes
When is the onset of GAD?
Early adulthood and tends to evolve with age.
What is the DSM IV criteria for GAD?
Must have both Major symptoms and 3 Additional symptoms.
What are the two major symptoms of GAD?
must have both
-Excessive anxiety and worry about a number of events and activities
-Difficulty controlling the worry
What are the additional symptoms of GAD?
must have 3/6
-Restlessness or feeling keyed up or on edge
-Being easily fatigued
-Difficulty concentrating or mind going blank
-Irritability
-Muscle tension
-Sleep disturbance
What is the differential diagnosis of GAD?
-Depression
-Schizophrenia
-Dementia
-Substance misuse
-Physical illness - Hypo or Thyrotoxicosis
Step 1 of GAD: All known and suspected presentations of GAD, what do we do?
Identification and assessment - active monitoring
Step 2 of GAD: Diagnosed GAD that has not improved after education or marked functional impairment. What do we do?
-Low intensity psychological interventions
-Individual non-facilitated self-help
-Individual guided self-help and psychoeducational groups
Step 2 of GAD: GAD with an inadequate response to step 2 interventions or marked functional impairment. What do we do?
Choice of a high-intensity psychological intervention (CBT/applied relaxation) or a drug treatment.
Step 4: Complex treatment-refractory GAD and very marked functional impairment, such as self-neglect or high risk of self-harm. What do we do?
-Highly specialist treatment such as complex drug and or psychological treatment regiments; input from MDT, crisis, day hospitals or inpatient care.
What is first line for GAD?
SSRI’s (fluoxetine or sertraline off-license)
Venlafaxine
Pregabalin
Mirtazapine
How should beta-blockers be used for GAD?
Low dose short-term
How should antihistamines be used for GAD?
Low dose short-term
What is first line for OCD?
Clomipramine
What is first line for Social Anxiety?
SSRI’s - Escitalopram or Venlafaxine
What is first line for Panic Disorders?
First line - SSRI’s such as Escitalopram, Sertraline, Citalopram and Paroxetine
What is second line for panic disorders?
Imipramine or Clomipramine. If SSRI not suitable or no improvement after 12-week course.
What is used for mod/severe panic disorders?
Venlafaxine
Benzodiazepines are not recommended for use in Panic disorders but when could they be used?
In Emergency Management
