Anxiety and Related disorders Flashcards
What is the prognosis of the anxiety disorders?
- 1/3 sx free
- 1/3 sx improve
- 1/3 no improvement, poor life
When does anxiety become pathological?
- fear out of proportion
- sx persist/are continuous (even after removal of threat)
- functional impairment
- comorbid mental conditions (eg. depression, substance use)
What is the DSM-V criteria for GAD?
- excessive anxiety + worry
- difficult to control
- at least 6 months (more days that not)
- with 3 or more associated Sx (CFIRST)
- causing sig distress and/or fxn impairment
- not due to MMS
List the associated sx for GAD
CFIRST
- concentration issues / mind blank
- fatigue
- irritability
- restlessness / on edge
- sleep disturbances
- tension (muscles, headaches)
when is the usual age of onset for GAD
adolescence
How do you treat GAD?
What is the time until sx improvement?
CBT
- cog restructuring
- exposure therapy
- relaxation and breathing techniques
Pharms
- SSRI (1st line) - 6-8wks until effect (can be 10-12)
- BZD (quick action, caution) - days
- Buspirone (refractory GAD)
What are the adv + disadv of BZD?
Adv
- quick onset
- relieve sx quickly
Disadv
- habit forming
- tolerance + withdrawal
- cause resp depression in all
- cause paradoxical disinhibition (hyperactive, aggressive, suicidal) in kids and elderly
Names + dosages of common SSRIs
- Escitalopram 10-20mg
- Citalopram 20-50mg
- Fluoxetine 20-60mg
- Paroxetine 20-60mg
- Sertraline 50-200mg
What is a panic attack
- abrupt, unexpected
- surge of intense fear/anxiety
- peak within minutes (10-20)
- with 4 or more physical/psychologic sx of intense anxiety/autonomic arousal
What is a limited sx attack
- same criteria as panic attack
BUT - less than 4 associated sx of intense anxiety/autonic arousal
what are the associated sx in the criteria for panic and limited sx attacks?
- STUDENTS FEAR THE 3 C’s
- Sweating
- Trembling
- Unsteadiness, dizziness
- Depersonalization/derealization
- Excessive heart rate, palpitations
- Nausea
- Tingling
- Shortness of breath
- FEAR of dying, losing control, going crazy
- 3C’s - chest pains, chills, choking
What is the DSM-V criteria for Panic DISORDER?
- Recurrent, unexpected panic attacks with 1/both of the following for at least 1 month - continuous worries about the attacks - dysfxnal behav due to the attacks following at least 1 prev attack * pt sx free between attacks
Psychotherapy for Panic disorder
- CBT (cognitive restructuring)
- exposure (desensitization)
- relaxation, breathing
Pharmacotherapy for Panic disorder
SSRI
BZD
- prophylaxis = Alprazolam, Clonazepam
- acute = lorazepam 0.5-2mg + rx SSRI SE
What is the duration of the fear of a Specific Phobic d/o?
> 6 months
How do you treat a specific phobic disorder?
CBT
What is social anxiety disorder?
- intense fear/anxiety (> 6 mo)
- in social and/or performance situations
- where unfamiliar people and possible scrutiny
- if act in embarassing or humiliating way
What is unique about social anxiety disorder?
It is the only phobic disorder that responds to pharmacotherapy
- SSRI, B blocker
- avoid alcohol + BZD
Which 5 situations can a person with Agoraphobia fear?
- using public transport
- wide open spaces
- enclosed spaces
- standing in line / being in a crowd
- being out of the house alone
How does Agoraphobic affect pts life?
- situation are actively avoid / endured with great distress / always require company
- in the fear that escape may be difficult
- or no help available if they get panic attack sx or embarrassing sx (fall, incontinence)
What are the specifier for Substance/medication induced anxiety disorder?
- specified according to onset
- during intoxication / withdrawal or shortly after exposure
Explain the process of discontinuing Rx for anxiety disorders
- treatment is usually lifelong discontinuation can only be considered when - 1 yr full remission (sx free) - full functional restoration - pt has sense of well being - it is the right time in pts life - taper down slowly over months - if relapse, restart Rx immediately at effective dose
