Anxiety Flashcards
What is GAD?
Worrying about worry which can lead to physical symptoms e.g. nervousness, muscle tension, sweating
At what point would you initiate medications for anxiety?What does this step. involve?
Step 3 when there is GAD with inadequate response to interventions such as eduation, low intensity psychological interventions, individual self help.
Step. 3 involves high intensity psychological interventions e.g. CBT or a drug SSRI
What is CBT?
Helps make sense of overwhelming problems by breaking them down into smaller parts - stops negative thought cycles
Explain the stepped care model for. anxiety
Step 1: all known and. suspeced presentations, edication, assessment, treatment options, monitoring
Step 2: diagnosed GAD that has not improved after. education and monitoring. Low intensity psychological. interventions, non-facilitated self help, guided self help, psychoeducational groups
Step3: GAD with inadequate response to step 2 interventions or marked functional impairment. Choice of high intensity psychological intervention e.g. CBT, or a medication e.g. SSRI Sertraline
Step 4: complex treatment refractory GAD and very marked functional impairment e.g. self neglect, risk of harm. Specialist treatment and complex treatment, crisis, inpatient.
What is anxiety?
Prolonged or exaggerrated response to a real or imagined threat which interferes with normal life and cannot be attributed to any known neurologic or organic dysfunction
What are the psychiatric features of anxiety?
Apprehension, tension, fear, on edge.
Labile moods, hostility, insomnia
Inability to concentrate, circling thoughts, easily distracted, lapses of memory
What are somatic features of anxiety?
Palpitations, bradycardia, tachybardia, flushing
Rapid shallow breathing(hypervenilation), breathlessness
Diarrhoea, dyspepsia, dysphagia, churning stomach
Agitation, restless, tremor, muscle tension
Increased glucose
excess sweating, urge to defacate or urinate
What is the diagnosis of GAD based on DSMV?
At least 6 months of excessive, difficult to control worry about. everyday issues that. is disproportionate to the risk and causes distress/impairment
Worry not confined to feaures of another mental disorder, or due to substance abuse/meds
Person experiences at. least 3 symptoms most of the time:
Restless, nervous, fatigue, poor concentration, irritable, muscle tension, sleep disturbance
What treatments are considered 1st line for anxiety?
want to discover cause and address/remove it, assess severity and relieve stress Counselling CBT Exposure therapy Mindfulness, relaxation. therapy
What is the management of acute anxiety?
Benzodiazepines for fast acting relief of severe anxiety/debilitating - short term 2-4 weeks. Not in primary care except in a crisis.
can also use buspirone HCl
Name some drug treatments used in anxiety
(1) SsRI e.g. sertraline (and SNRI)
- pregabalin
- TCAs useful in phobias but muscarinic s/e
- beta blockers for somatic symptoms
When do you get anxiolytic effects with SSRIs? (time frame)
1 week+
What is the risk of using SSRIs in anxiety?
Risk activation e.g. anxiety, agitation, insomnia
How long do you have to take SSRis for?
At least 1 year to avoid relapse. Take after remission
If there is only a partial improvement with drug therapy - what could you add?
Non-pharmacological therapies
