Anxiety 3 Flashcards
Cognitive therapy focuses on helping manage anxiety by focusing on which negative thoughts/cognitive distortions ______ (3).
- Catastrophizing
- Generalization
- Overestimating (probability of negative outcome)
Lifetime prevalence of general anxiety disorder
Lifetime Prevalence: 4-7%
–12 mo prevalence 0.9% adolescents, 2.9% adults
(female:male = 2:1)
Age of onset general anxiety disorder
Early twenties
General anxiety disorder: genetics
- SATB1 (chromo 3)
- ESR 1 (chromo 6)
Course of general anxiety disorder
Chronic
(severity fluctuates)
Complications of general anxiety disorder (3)
- MDD
- Substance abuse
- Panic disorder
General anxiety disorders may be comorbid with MDD and this increases the likelihood of
(GAD shows significant impairment at an emotional and physical level)
General anxiety disorder is the excessive anxiety and worry occurring more days than not for at least_____about a number of events or activities
six months
(they have difficulty controlling a worry)
General anxiety disorder criteria: anxiety and worry associated with three or more of the following symptoms (or one for children): feeling restless/”keyed up”, easily fatigued _____ (4).
- Difficulty concentrating
- Irritability
- Muscle tension
- Sleep disturbance
In general anxiety disorder the worry and anxiety or physical symptoms cause significant distress or impairment in _____(3).
- Social
- Occupational
- Other areas of functioning
General anxiety disorder first-line treatment
- SNRIs
- SSRIs
- CBT
General anxiety disorder second-line treatment (4)
- Benzos
- Buspirone
- TCAs
- Antihistamines
Prevalence of separation anxiety disorder
3%
Separation anxiety disorder may be a precursor to _____
Panic disorder
(maybe related to academic, athletic problems or social skills)
Criteria for separation anxiety: developmentally inappropriate and excessive anxiety with three or more of the following: Distress about separation from attachment figure, _______(4).
- Fear of harm to or separation event from attachment figure
- Refusal to go to school
- Fear of being alone or sleeping
- Nightmares about separation
Separation anxiety duration
At least 4 weeks
Separation anxiety disorder does NOT occur exclusively during the course of a _______(3), and is not better accounted for by Panic Disorder with Agoraphobia.
- Pervasive Developmental Disorder
- Schizophrenia
- Other psychotic disorder
Separation anxiety management (2)
- Identify thoughts about anxiety
- Parental interventions
What’s parental interventions can you offer for parents of separation anxiety disorder?
- Education about anxiety (effective over protection in maintaining anxiety)
- Parental management techniques
- Application of exposure hierarchies
Define selective mutism
How to speak in specific social situations where there is an expectation for speaking
(interferes with occupation and social communication)
Duration of selective mutism
At least one month
Failure to speak in selective mutism is not attributed to ______ (2).
Lack of knowledge or comfort with the language spoken
Prevalence and course of selective mutism
Rare
Begins before the age of 5
Use of benzodiazepine is linked to ____abuse
opioid
_______ are the most prescribed of the psychotropics
anxiolytics
(most believe these are over-prescribed)
Anxiolytics are typically used for ________ (duration).
short periods
(rarely abused)
List the long-acting benzodiazepines (5)
- Lorazepam
- Diazepam
- Clonazepam
- Chlordiazepoxide
- Chlorazapate
List the short-acting benzodiazepines (2)
- Alprazolam
- Oxazepam
Benzodiazepine indications
- anxiety
- insomnia
- musculoskeletal disorders
- seizure disorders
- alcohol withdrawal
- anesthesia induction
Drug-drug interactions and toxicity with benzodiazepines
- Few drug-drug interactions
- Little toxicity
Benzodiazepine mechanism of action
Bind to benzodiazepine receptors (part of GABA receptor complex) → potentiate effects of GABA
Indications & duration for benzodiazepine with general anxiety
- When severe
- Usually short-term (months to weeks)
Indication for benzodiazepine with panic disorder
Second line behind SSRIs
Indication for benzodiazepine with anxiety and depression
- More effective for anxiety than antidepressants
- BZD withdrawn when antidepressant becomes effective
Indication for benzodiazepine with adjustment disorder with anxiety
Treatment of Time limited
Benzodiazepines are _____ (tolerability) with alcohol during alcohol withdrawal.
cross-tolerant
Benzodiazepines: Pharmacokinetics
- Rapid onset
- Lipophilic (facilitating crossing of the BBB)
Benzodiazepines should be avoided in ____(2)
- Pregnancy (neonatal anxiety & withdrawal)
- Caution with elderly
Discontinuation of benzodiazepines involves ______(2).
- Slow tapering
- Change to longer acting med
Benzodiazepine side effects: drowsiness, reduced motor coordination, _____(3)
- Memory impairment
- Sleepwalking
- Disinhibition
Physiologic dependence of benzodiazepines is more likely with ________
Longer drug exposure
Use benzodiazepines cautiously in patients with histories of _______ (2).
- Drug or alcohol
- Unstable personalities
(avoid combining with alcohol or opiates)
Patients should avoid combining benzodiazepines with ______ (2).
Alcohol or opiates
Benzodiazepine withdrawal symptoms include insomnia, agitation, ______ (3).
- Anxiety rebound
- GI distress
- Seizures
Buspirone is indicationed for ______.
Generalized anxiety disorder
(ineffective for panic attacks, phobias or Obsession and compulsion)
Buspirone is not effective for _____(3)
- Panic attacks
- Phobias
- Obsessions and compulsions
(indicated for general anxiety disorder)
Buspirone takes ______ for effect
1-2 weeks
(no withdrawal or alcohol potentiation)
Buspirone mechanism of action
5HT1A receptor Agonist
(Does not interact with BZD receptor)
Buspirone has no ______ or ____ properties.
(5HT1A receptor agonist, tx for GAD)
- Anticonvulsant
- Muscle relaxing
Panic attacks are seen in panic disorder, GAD & SAD, which one is:
- Initially unexpected?
- Related to worry?
- Panic Disorder
- GAD
What causes anticipatory anxiety in Panic Disorder, GAD, SAD?
- PD: having another panic attack
- GAD: different types of situations
- SAD: social or performance situations
What are the typical cognitions present in
- GAD
- SAD
- PD
- GAD: money, safety, future, relationships
- SAD: embarrassment, negative evals
- PD: worry about dying, losing control, heart attack
Typical sx seen in panic attack?
- Dyspnea
- Palpitations
- Lightheadedness
(they think they’re having a heart attack)
Typical SAD physical sx (3)
- blushing
- sweating
- trembling
(how you get when you do presentations in class)
Typical physical sx in GAD
- Tension
- Insomnia
- Restlessness
What situations are avoided in patients with :
- GAD
- SAD
- PD
- GAD: reminders of worry
- SAD: public speaking, social situations
- PD: closed spaces, being alone
(GAD & PD seek reassurance)
