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Neurology > Anxiety & Anxiety-Related Disorders > Flashcards

Anxiety & Anxiety-Related Disorders Flashcards

1
Q

Noradrenergic model

A
  • Autonomic nervous system is hypersensitive and overreactive to various stimuli
  • Stimulants release of glutamate (excitatory)
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2
Q

GABA-receptor model

A
  • GABA has a strong inhibitory effect on 5-HT, NE, and DA
  • Proposed to be lower GABA concentrations in anxiety disorders
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3
Q

Serotonin (5-HT) Model

A
  • Data suggest dysregulation of serotonin in those with anxiety disorders
  • May lead to imbalance of other neurotransmitter
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4
Q

What is the GAD Diagnostic Criteria?

A

At least six months of the following:
* Excessive anxiety or worry on most days
* PLUS three of the following:
- Restlessness
- Poor concentration
- Easily fatigued
- Irritability
- Sleep changes
- Muscle tension

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5
Q

What is the DOC of GAD?

A

SSRIs

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6
Q

What are some adverse effects of SSRIs?

A
  • Stomach upset
  • Nausea
  • Diarrhea
  • Appetite changes
  • Sexual dysfunction
  • Weight gain
  • GI bleed
  • SIADH
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7
Q

SNRIs

A
  • Duloxetine (Cymbalta)
  • Venlafaxine (Effexor)
  • Desvenlafaxine (Pristiq)
  • Levomilnacipran (Fetzima)
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8
Q

What are the adverse effects of SNRIs?

A
  • Increased blood pressure
  • Nausea
  • Constipation
  • Sexual dysfunction
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9
Q

What is the mechanism of action benzodiazepine?

A
  • Bind to GABA receptors in the brain which allows the opening of chloride channels and an influx of chloride into the cell
  • Hyperpolarization and decreased action potentials
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10
Q

What is the place in therapy of benzodiazepines?

A
  • PRN short-term relief in patients with severe anxiety that limits their ability to complete daily tasks
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11
Q

What are the adverse effects of benzodiazepines?

A
  • Sedation
  • Confusion
  • Memory impairment
  • Physical dependence
  • Risk of respiratory depression
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12
Q

What is the discontinuation of benzodiazepines?

A
  • May take weeks-months if done as an outpatient or if on high doses for long periods of time
  • ** DECREASE dose by 10-25% every 1-3 weeks**
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13
Q

What is the withdrawal of benzodiazepines?

A
  • Concern if taking for > 2 weeks
  • Onset: 1-2 days if short half-life, 3-8 days if long half-life
  • Symptoms usually last 1-2 weeks
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14
Q

What are some common symptoms of withdrawal of benzodiazepines?

A
  • Anxiety
  • Restlessness
  • Insomnia
  • Muscle tension
  • Tremor
  • Elevated BP
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15
Q

What are some less common symptoms of withdrawal of benzodiazepines?

A
  • Nausea
  • Blurry vision
  • Diaphoresis
  • Depression
  • Hyperreflexia
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16
Q

What are some rare symptoms of withdrawal of benzodiazepines?

A
  • Tinnitus
  • Confusion
  • Seizures
  • Psychosis
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17
Q

Buspirone (Buspar)

A
  • 5-HT-1A partial agonist
  • Delayed onset of action
  • No potential for dependence
  • Dose: 10-60 mg/day divided BID-TID
  • GAD
18
Q

Hydroxyzine (Vistaril)

A
  • H1 antagonist
  • Useful for mild anxiety symptoms
  • Dose: 25-100 mg as needed
  • Max: 400 mg/day
  • GAD
19
Q

Vilazodone (Viibryd)

A
  • SSRI/5-HT-1A partial agonist
  • Useful in those with comorbid depression
  • Dose: 20-40 mg/day
  • GAD
20
Q

Diphenhydramine (Benadryl)

A
  • H1 antagonist
  • Useful for mild anxiety symptoms
  • Dose: 25-50 mg as needed
  • Max: 300 mg/day
  • GAD
21
Q

What are the diagnostic criteria of Panic Disorder?

A

At least four of the following symptoms:
* Palpitations
* Sweating
* Shaking
* SOB
* Choking
* Chest pain
* Stomach upset
* Dizziness
* Chills or heat
* Sensations
* Etc.
AND
At least one month of worry about future panic attacks with maladaptive behavior changes

22
Q

What is the first line of therapy for Panic Disorder?

A
  • SSRIs
23
Q

What is the second line therapy for Panic Disorders?

A

SNRIs

24
Q

What other medications can treat panic disorder?

A
  • Alprazolam
  • Clonazepam
  • Imipramine
  • Clomipramine
25
Q

What is the diagnostic criteria of social anxiety disorder?

A
  • At least six months of the following:
    • Marked fear or anxiety about social situations is which the individual is exposed to possible scrutiny by others
  • Fear of others witnessing
  • Provokes fear or anxiety
  • Causes avoidance or endurance with great fear
  • Out of proportion to actual threat
  • Social or occupational dysfunction
26
Q

What is the first line of therapy for Social Anxiety Disorder?

A

SSRI

27
Q

Which SNRI is not indicated for Social Anxiety Disorder?

A

Duloxetine

28
Q

Monoamine Oxidase Inhibitors

A
  • Isocarboxazid (Marplan)
  • Phenelzine (Nardil)
  • Selegiline (Emsam)
  • Tranylcypromine (Parnate)
  • Third line for SAD, generally avoided
29
Q

What are some other agents for SAD?

A
  • Alprazolam and clonazepam
  • Propranolol
30
Q

What is the first line treatment for OCD?

A

SSRIs

31
Q

Clomipramine

A
  • Similar efficacy as compared to SSRIs for OCD
32
Q

What are some adverse effects of Clomipramine?

A
  • Dizziness
  • Drowsiness
  • Headache
  • Orthostatic hypotension
33
Q

Which SSRIs are NOT approved for OCD?

A
  • Citalopram
  • Escitalopram
34
Q

What is the treatment for refractory OCD?

A
  • Dual therapy with SSRI + clomipramine
  • Venlafaxine or mirtazapine
  • Deep brain stimulation
35
Q

Which medications should be avoided for pregnancy and lactation for OCD?

A

Clomipramine and paroxetine

36
Q

Which medications should be avoided for elderly patients for OCD?

A

Avoid clompramine

37
Q

Acute Distress Disorder

A

Symptoms for at least 2 days but less than 1 month

38
Q

PTSD

A

Symptoms for at least 1 month

39
Q

What are some other treatments for PTSD?

A
  • TCAs
  • Mirtazapine
  • Phenelzine
  • Mood stabilizers
  • Antipsychotics
  • Clonidine
40
Q

What medication can help with PTSD nightmares?

A

Prazosin

Neurology (21 decks)

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