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PSYCH Therapeutics > Anxiety > Flashcards

Anxiety Flashcards

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1
Q

Social Anxiety Disorder (SAD)
1. Risk factors such as ?
P,G,T,F,E,L,E

  1. DSM5Criteria SAD (FAAIINT) :
    -Marked __ or __ about 1 or more social situations exposed to possible scrutiny by others such as : social interactions (meeting unfamiliar people), being observed (while eating), performing in front of others (giving a speech)
    -A
    -I
    -I
    -N
    -T
  2. The fear or anxiety is ___ to the actual threat posed by the situation
A
  1. Psychiatric comorbidities (concurrent anxiety, depression and or SUD) , Genetics, temperamental, familial (parental over control or over protection), early childhood anxiety disorders (separation anxiety), Life stressors, environmental (adverse life experiences, cultural)
  2. Fear, anxiety
    -Avoidance of situation
    -Individual fears their reaction will be assessed negatively
    -Impairment of functioning or distress
    -NOT due to secondary causes
    -Timing (> 6 months)
  3. out of proportion
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2
Q

Panic Disorder :
1. Risk factors
-Gender?
-E?
-___ personality types
-____ life events
-G

  1. CHRONIC ____ and _____course
  2. DSM5 Criteria (PANIICCCSSS)
    -Recurrent , unexpected panic attacks.
    -Whats a panic attack?
    -During this time, 4 or more of the following sx’s occur? (PANIICCCSSS)
  3. At least 1 of the attacks has been followed by 1 month or more of one or both of the following? (2)
A
  1. Women > Men (2:1)
    - Environmental –> history life stressors, triggers
    -Anxious
    - Stressful (Major transitional events, family problems, financial probs)
    -Genetics
  2. Waxing, waning
  3. abrupt surge of intense fear or discomfort that reaches a peak within minutes
    -Palpitations
    -Abdominal distress or nausea
    -Numbness/derealization /depersonalization
    -Intense fear of death or losing control
    -instability or dizziness
    -choking sensation, chills/hot flashes, CHEST pains
    -Sweating, shaking, SOB
  4. Persistent concern or worry about having another panic attack or their consequences
    -Signif change in behavior bc of attack
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3
Q

Anxiety Vs Panic Attack

  1. Compare both in terms of Onset, cause, Impact
A

ANXIETY :
-Onset is gradual build in intensity over time
-Cause : Generally, has clear trigger or circumstance
-Impact : Disruptive, but less severe than panic attacks; still can impact daily functions

PANIC :
-Onset is RAPID;ABRUPT
-Cause : Doesnt have clear trigger
-Impact : Severely intense physical sx’s;often extremely disruptive

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4
Q

AGORAPHOBIA : DSM5 Criteria (COOPE)
1. marked fear or anxiety about 2 or more of :
(COOPE)

  1. Fears/avoids these situations bc thoughts of ?
  2. Situations almost always provoke?
  3. Situations are actively ___, require presence of?
  4. Fear or anxiety is ____ to the actual danger of situation
A
  1. Crowded area (or standing in line)
  2. Open spaces
  3. Outside of the home alone
  4. Public transportation
  5. Enclosed places
  6. escape might be difficult or help might not be available
  7. fear or anxiety
  8. avoided, a companion or are endured w/intense fear or anxiety
  9. out of proportion to the actual danger posed by the situation
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5
Q

Generalized Anxiety Disorder : GAD
1. RIsk factors:
-Sex
-socio Economics?
-Wat kind of event?
-Genetics?

  1. GAD has __ and ___ course
  2. DSM5 CRITERIA : GAD (WATCHERS)
    -Excessive __ and __ that’s diff to control
    -Associated w/3 or more of : (?) (TCHERS)
  3. Signif ____ or ___ (social, occupational, or other areas of functioning)
  4. Occuring how many times of a week for at least how many months?
A
  1. women > men (2x)
    -Economically disadvantaged and minoritized groups have higher risk
    -stressful or traumatic
    - 25% 1st degree relative with GAD
  2. chronic waxing , waning
  3. worry, anxiety
    -tension in muscles
    -concentration difficulty
    -Hyperarousal or irritable
    -energy loss
    -restless or feeling keyed up or on edge
    -sleep disturbance
  4. Distress, functional impairment
  5. most days of a week, 6 months
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6
Q

OCD :

  1. Etiology/Risk Factors (unknown vs infections)

DSM5 CRITERIA

  1. Obsessions :
    A. Recurrent and persistent ___ (3)
    - Experienced as __ and ___
    -cause marked __ or ___
    B. Attempts to ignore/suppress thoughts , urges, or images or to neutralize them w/some other ?
  2. Compulsions :
    A. Repetitive ___ or __ that pt feels driven to perform in response to an obsession
    B. This is aimed at preventing or reducing ___
A
  1. Genetics/environment (unkown)
    -Streptococcal infxns in pediatric pt’s

3A. thought, urges, images
-intrusive , unwanted
-anxiety, distress

3B. Thought or action (by performing a compulsion)

4A. Behaviors (handwashing), Mental acts (counting/repeating words silently)
B. anxiety or distress

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7
Q

OCD Cycle of Sx’s
1. Obsessions such as ?
2. Followed by ?
3. Leads to ? such as
4. Relief, temporary that reinforces __

A
  1. Fears, intrusive thoughts (fear of contaminations, pathological doubts, concerned about throwing away something valuable)
  2. anxiety (feeling need to react)
  3. compulsions (actions or mental rituals to reduce anxiety) –> washing hands, repeated checking, hoarding
  4. compulsions
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8
Q

PTSD RISK FACTORS :
1. Pre traumatic exposure such as?
-Past ___
-Sex?
-Personality
-Lower__ and Low ___
-R
-___ as a child
-Previous ___
-Family hx of __

  1. Post Traumatic exposure such as? (3)
  2. DSM5 criterion A
  3. DSM5Criterion B
  4. DSM5 Criterion C
  5. DSM 5 Criterion D
  6. DSM 5 Criterion E
A
  1. Past dx of a psych disorder, history of substance or alc use
    -being female
    -Lower socioeconomic status
    -Lower educational level
    -Race (minority status)
    -Maltx as a child
    -family hx of psych disorders
    -previous trauma
  2. Perceived lack of social support
    -dysfunctional patterns of social interaction
    -subsequent life stresses
  3. exposure to actual or threatened death, serious injury, or sexual violence
  4. Re-experiencing /intrusive thoughts
    (recurrent dreams of event, intrusive memories of event, physiologic rxn to reminders of trauma)
  5. Avoidance (avoidance of or efforts to avoid distressing mems, thoughts, feels about or closely associated with traumatic event)
  6. Negative alterations in cognitions and mood
    (Persistant negative emotional state, inability to experience positive emotions)
  7. Hyperarousal (irritable behavior, reckless, hypervigilance, sleep disturbance, probs with concentration )
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9
Q

SEE CHART ON FDA INDICATIONS AND DRUGS

A

SEE CHART

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10
Q

Antidepressants :
1. SSRI’s/SNRI’s
-Can be more effective for?
-Onset of effects? (which is delayed)
-need to initiate at __
-For OCD, what kind of doses?

  1. TCA’s
    -Which are most studied for GAD and panic?
    -For OCD?
    -Onset?
    -AE’s? (4)
    -Lethal in ___
A
  1. Core psychiatric sx’s
    -4-12 weeks
    -LOW DOSES (bc can initially cause anxiety in panic disorders) 25-50% of dose in depression
    -Doses greater than package insert’s max daily dose
  2. Imipramine
    -CLomipramine
    -4-12 weeks
    -Anticholinergic ae’s, ortho hypo, qt prolong, decr seizure threshold
    -OD
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11
Q

Anxiolytics : Buspirone
1. Delayed onset at ?
2. Particularly effective in which pt’s?
3. Dosing?
4. Not effective when taken?
5. not recc for use in ?
6. AE’s? (3)
7. FDA indication?

Anxiolytics : Hydroxyzine
1. Dosing ?
2. AE’s?
3. Can be used for ??

A
  1. 2 weeks or more
  2. BZD naive
  3. 7.5-20 mg BID-TID (max 60mg/day)
  4. prn
  5. severe hepatic or renal impairment
  6. dizzy, nausea, HA (no sedation! or sex dysfunction)
  7. GAD
  8. 25-100 mg QID (Max 400mg/day)
  9. Sedation , dry mouth , blurry vision, urinary retention, constipation , prolonged qtc
  10. GAD (most effective for somatic/autonomic sx’s)
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12
Q

Pregabalin :
1. Effective in ___ , limited evidence for use in ?
2. Considered in which patients?
3. Dosing ? Pregab vs Gabapentin

  1. What are beta blockers used for?
  2. When should B blockers be taken ?
A
  1. GAD, SAD
  2. those who fail to respond to SSRI/SNRI
  3. Pregab 150-600 mg/day
    gab 300-3600 mg/day
  4. SAD (decr tremor, blush, HR, sweats)
  5. 1-2 hrs prior to performance (propanolol 10-80 mg)
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13
Q

Prazosin :
1. Used for ?
2. Dosing ? and Max dose
3. AE’s?

Clonidine :
1. Used for ?
2. DOsing start ?
3. AE”s?

A
  1. PTSD related nightmares
  2. 1mg QHS, may incr dose to 2mg after 2-3 days. then adjust by 1-5 mg every 7 days
    -max 20 mg/day
  3. Palpitations, ortho hypo
  4. PTSD related nightmares
  5. 0.1 mg IR daily, max dose of 0.6 mg/day
  6. hypotension, syncope, somnolence, bradycardia, and tachycardia
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14
Q

BZD’s Considerations :
1. Will need to ___
2. Abuse risk ?
3. Dependence/physical sx’s of withdrawal occur if ?
4. Withdrawal: new or worsening sx’s after discontinuation –>
Onset for short acting agents like Alpraz?
Long acting agents like Diazepam?
-Can occur after ___ and can last for 2-4 wks
5. Sx’s of withdrawal?
6. Tolerance develops to what effects ?
7. Not reccomended in __

** see chart!**

A
  1. Taper
  2. high risk w/mult substances
  3. ABruptly stopped without taper
  4. Short acting onset : 1-2 days
    Long acting onset : 3-8 days
  • 4wks of treatment
  1. Common : anxiety, insomnia, restlessness, muscle tension, irritability
    Other : Nausea, malaise, blurred vision, sweating,
    Rare : tinnitus, confusion, paranoid delusion, seizures
  2. Sedative, muscle relaxant, anticonvulsant
    -NOT TO ANXIOLYTIC effects
  3. PTSD
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15
Q

Treatment Algorithm :
1. What are the 1st line options?
2. Special considerations for PANIC DISORDER?
3. What to do if you have GOOD RESPONSE ?

  1. 2nd line : meaning you have NO RESPONSE… what do u do?
  2. Let’s say you had PARTIAL RESPONSE to the first line, what should you do ? (max/augment)
  3. 3rd line : Partial response to the previous? Maximize ? Augment ?
  4. 4th line : non response , what should you consider?

COMORBID CONSIDERATIONS :

  1. Insomnia (4)
  2. Depression (4)
  3. Bipolar
  4. Migraine (2)
A
  1. CBT/psychotherapy AND/OR

-SSRI/SNRI for 8-12 weeks –> FDA indicated for course purpose

  1. +/- Short term BZD (not to exceed 2-3 weeks)
  2. Continue tx for 1 yr
  3. Switch to diff SSRI/SNRI
  4. Max dose of current antidepressants
    - augment with BZD, hydroxy, buspar, or SGA
  5. max dose of current antidepressants
    -augment w/BZD, hydroxy, or Mirtaz, , pregab/gaba
  6. Consider MAOI or switch to another antidepress
  7. add sedating antidepressant, BZD, antihist, z-hypnotic
  8. augment with mirtaz, buspar, lithium, T3
  9. add mood stabilizer
  10. venlafaxine, propranolol
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16
Q

Non Pharm Therapy :
1. Psychoeducation ?
2. Should avoid?

A
  1. Short term counseling
    -stress management
    -Exercise
  2. Caffeine, non prescription stimulants (OTC), diet pills, excessive use of alc

PSYCH Therapeutics (11 decks)

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