Anxiety Flashcards
Define anxiety. When does it become a problem?
Anxiety is a natural bodily reaction to stressful stimuli which acts as a defensive mechanism, teaching the organism what stimuli to avoid. Anxiety only becomes a problem when there are no external stimuli, but the symptoms of anxiety persist.
Name the class of drugs which treat anxiety.
Anxiolytics.
Give the life time prevalence, symptoms, drugs used to treat, other treatments for, and the prognosis of general anxiety disorder.
5.1%. Non-specific anxiety. SSRI & benzos. CBT. 65-75% recover.
Give the life time prevalence, symptoms, drugs used to treat, other treatments for, and the prognosis of panic disorder.
3.5%. Recurrent panic. SSRI & alprazolam. Exposure. 25.45% improve.
Give the life time prevalence, symptoms, drugs used to treat, other treatments for, and the prognosis of phobia (specific).
11.3%. Fear of specific stimulant. Possibly benzos to allow exposure. Exposure. Reduction is common but less rare.
Give the life time prevalence, symptoms, drugs used to treat, other treatments for, and the prognosis of phobia (social).
13.3%. Fear of social situations. SSRI. CBT. 35-75% relapse on drug withdrawal.
Give the life time prevalence, symptoms, drugs used to treat, other treatments for, and the prognosis of OCD.
2.5%. Repetitive irrational actions. SSRI. CBT & surgery. 60% improve within 1 year.
Give the life time prevalence, symptoms, drugs used to treat, other treatments for, and the prognosis of PTSD.
1-3%. Sequel to trauma, recurring fear and memories. TCA, SSRI, MAOI. CBT. <50% leave clinical class.
Anxiety or worry is associated with 3 or more of what symptoms?
Restlessness, easily fatigued, difficulties with concentration, irritability, muscle tension, sleep disturbances.
Who are more likely to seek help for anxiety; men or women? Why?
Women are about twice as likely to seek help than men; this is mainly due to social pressures on men to ‘bottle up’ their emotions.
List three interventions that have evidence for treatment in GAD?
Psychological therapy (CBT), pharmacological therapy (SSRIs), self-help (bibliotherapy).
How long can benzodiazepines be used for? Why cant they be used for longer?
They should not normally be used for longer than 2-4 weeks due to the risk of dependence and potential withdrawal symptoms.
What is the current pharmacological treatment for GAD?
Current therapy is SSRI plus benzodiazepine during the initial 3-4 weeks to control initial exacerbation of symptoms and provide immediate relief. Benzodiazepines are then slowly withdrawn with SSRIs remaining.
Give some classes of anxiotytic drugs.
Opiates, barbiturates, alcohol, buspirone, benzodiazepines, SSRIs, beta-blockers.
How do benzodiazepines act to alleviate the symptoms of anxiety?
All benzodiazepines potentiate GABA by acting on the benzodiazepine site on the GABAA/Cl- channel macromolecule; this inhibits anxiety symptoms. They are very selective for their receptors so cause no problem side effects due to non-selectivity.
As well as being anxiotytic, what other affects do benzodiazepines have?
Sedation, anti-epileptic, amnesia, impulsivity, loss of inhibitions, dependence risk.
List commonly used anxiolytic benzodiazepines.
Bromazepam, chlordiazepoxide, clorazepate, diazepam, ketazolam, lorazepam, oxazepam.
List the problems with using barbiturates.
Low therapeutic index, marked respiratory depression, fatal in overdose, rapid tolerance, dangerous in withdrawal, induce liver enzymes.
What should one do if a patient doesn’t respond to one SSRI?
Individual patients may prefer, or respond better to a certain class; thus, multiple trials with a patient is not uncommon.
What form of anxiety are beta blockers used to treat? Which drug is preferred?
Beta blockers are useful in the treatment of performance anxiety with propranolol is the drug of choice.
List the symptoms that appear during a panic attack.
Palpitations, raised heart rate, SOB, nausea, abdominal distress, depersonalisation, numbness, flushes, tingling sensations.
List three interventions used in PD.
Psychological therapy (CBT), pharmacological therapy (SSRIs), self-help (bibliotherapy).
Which benzodiazepine is licensed for treatment of PD?
Alprazolam.
Which antidepressants effectively and frequently used to treat PD?
SSRIs, tricyclic antidepressants, monoamine oxidase inhibitors.
Define OCD.
This illness is characterised by repetitive fruitless physical activity e.g. washing of hands as well as intrusive and repetitive thoughts that cause distress.
Explain the intervention used in OCD.
CBT is offered to alleviate the condition; if the patient is unable to effectively engage in CBT or there is no adequate response, an SSRI is introduced.
