Anxiety and sleep disorders Flashcards
What is first line psychological therapy for generalised anxiety disorder?
Education and monitoring
If education and monitoring are not effective in management GAD, what is next step?
If education not effective, first-line is self-help and group education
If group education/self-help are not effective in managing GAD, what is the next step?
High intensity psychological intervention e.g. CBT, applied relaxation
When is pharmacological therapy initiated in GAD?
Those who have marked functional impairment or self-help/education not effective
What is the first line pharmacological therapy in GAD?
Sertraline
If sertraline is ineffective in GAD, what is second-line step?
Alternative SSRI or SNRI
What is given as third-line in pharmacological management of GAD?
Pregabalin
Which group of drugs are not given to GAD patients?
Antipsychotics
What are the psychological treatment options for panic disorder?
CBT - over 1-2hrs for each weekly session. Max 4 months of treatment
Facilitated or non-facilitated self-help material
If not effective add in pharmacological therapy
What are the pharmacological treatment options for panic disorder?
First line any licensed SSRI
Second-line imipramine or clomipramine
If treatment successfully used for 6 months dose can be tapered or stopped
Which drugs should not be used in panic disorder?
Antipsychotics
Benzodiazepines
Sedating antihistamines
What are the psychological treatment options in social anxiety?
Individualised CBT
CBT-based self help if decline CBT
Combine CBT with pharmacological treatment if partial/limited response
What are the pharmacological treatment options for social anxiety?
SSRI - sertraline or escitalopram
Alternative SSRI second line - venlafaxine
MAOI 3rd line - moclobemide
Which drugs should not be used in social anxiety?
Benzodiazepines TCAs antipsychotics St Johns Wort Anticonvulsants
What can propranolol be used for in anxiety?
Management of physical symptoms e.g. tremor etc.
How long may it take for antidepressants to work in anxiety?
2 weeks - short term BZD may need to be used (GAD crisis)
Which benzodiazepine is recommended in GAD crisis?
Diazepam
Which two classes of drugs can be used to treat insomnia?
Benzodiazepines
Z drugs
Name the two most commonly used benzodiazepines in treatment of insomnia
Temazepam
Nitrazepam
Which type of drugs are most likely to cause rebound insomnia?
Short-acting BZD
If patient fails to respond to one benzo, should another one be tried for insomnia?
No - try Z drugs or non-drug treatment
Same true for Z drugs
When should short-acting agents be used and when should long-acting agents be used in insomnia?
Short-acting if difficulty getting to sleep
Long-acting if early morning wakening
Name one short-acting BZD and one short-acting Z drug
Temazepam
Zolpidem
Name one long-acting BZD and one long-acting Z drug
Nitrazepam
Zopiclone
Hypnotic agents should be used long-term for insomnia. True or false?
False - should be used for shortest time period at lowest effective dose.
Who is melatonin licensed for in insomnia?
Licensed as monotherapy in over 55s
Which stages of sleep do BZD reduce?
Reduce stage 3 and 4 non-rem sleep
What is the mechanism of action of benzodiazepines?
Binds to benzodiazepine site on GABA receptor (different site to where GABA binds). The binding of benzodiazepine increases the affinity for GABA. The channel is therefore more likely to open with BDZ bound therefore increasing Cl- flux and hyperpolarisation in the post-synaptic cell.
What is the potency of BDZ limited by?
Availability of GABA
How many subunits does a GAMA receptor have?
2 alpha
2 beta
1 gamma
