Anxiety Disorders Flashcards
WhatsAN Anxiety Disorder?
Anxiety disorders is anxiety and associated
symptoms are irrational or experienced at a
level of severity that impairs functioning.
Whats the characteristic features of Anxiety Disorder?
The characteristic features are anxiety and
avoidance.
What’s the Noradrenergic model.
This model suggests that the
autonomic nervous system of anxious patients is
hypersensitive and overreacts to various stimuli.
What has a role in regulating anxiety, and how
The locus ceruleus may have a role in regulating anxiety, as it activates norepinephrine release and stimulates the sympathetic and parasympathetic nervous systems.
What does chronic noradrenergic overactivity cause?
Chronic noradrenergic overactivity down regulates α2-
adrenoreceptors in patients with generalized anxiety
disorder (GAD) and posttraumatic stress disorder (PTSD).
patients with social anxiety disorder react with stress by
Patients with social anxiety disorder (SAD) appear to have a hyperresponsive adrenocortical response to
psychological stress
Antianxiety medications target what receptor and why
GABA is the major inhibitory neurotransmitter in the CNS. Many antianxiety drugs target the GABAA receptor.
Benzodiazepines effects
note: Bz decrease binding= panic disorder
Benzodiazepines (BZs) enhance the inhibitory effects of GABA, which has a strong regulatory or inhibitory
effect on serotonin (5-HT), norepinephrine, and
dopamine systems.
What does it mean if theres a response of GH in response to balofen.
Growth hormone response to baclofen in patients with
generalized SAD suggests an abnormality of central
GABAB receptor function.
GAD SYMPTOMS may be due to
GAD symptoms may reflect excessive 5-HT
transmission or overactivity of the stimulatory 5-HT
pathways.
Sad response seen in drug reaction
give example
Patients with SAD + buspirone = have greater prolactin =indicating an enhanced central serotonergic response.
How do i know if i have anxiety disorder
The diagnostic criteria require persistent symptoms
most days for at least 6 months. • The anxiety or worry must be about a number of
matters and is accompanied by at least three
psychological or physiologic symptoms. • The illness has a gradual onset at an average age of 21
years. The course of illness is chronic, with multiple
spontaneous exacerbations and remissions. • There is a high percentage of relapse and a low rate of
recovery.
Anxiety symptoms associated with which illnesses
About 50% of patients with GAD have irritable bowel syndrome.
present in several major psychiatric illnesses (e.g., mood disorders,
schizophrenia, organic mental syndromes, and
substance withdrawal).
For patients with GAD, nonpharmacologic modalities
include
Short-term counseling, stress management,
cognitive therapy, meditation, supportive therapy, and
exercise. • GAD patients should be educated to avoid caffeine, stimulants, excessive alcohol, and diet pills.
Pharmacological treatment for GAD
Hydroxyzine was effective in 88% of patients for a
duration of 3 months. • Pregabalin produced anxiolytic effects similar to lorazepam, alprazolam, and venlafaxine in acute trials.
Antianxiety Medications for GAD
Venlafaxine extended release, duloxetine, paroxetine, and escitalopram are FDA approved for treatment of GAD.
Sertraline is also effective.
If patients fail to take SSRIs for anxiety
• Imipramine may be used when patients fail to respond to selective serotonin reuptake inhibitors (SSRIs).
TTT for acute anxiety
Benzodiazepines more effective for somatic
and autonomic symptoms of GAD, while
antidepressants are considered more effective for the
psychic symptoms (e.g., apprehension and worry).
Benzodiazepines dependance seen as
predictable withdrawal syndrome (i.e., anxiety,
insomnia, agitation, muscle tension, irritability, nausea,
malaise, diaphoresis, nightmares, depression,
hyperreflexia, tinnitus, delusions, hallucinations, and
seizures) upon abrupt discontinuation.
Whats a second in line agent for GAD
Buspirone is a 5-HT1A partial agonist that lacks
anticonvulsant, muscle relaxant, sedative-hypnotic,
motor impairment, and dependence-producing
properties.
• It is considered a second-line agent for GAD because of inconsistent reports of efficacy, delayed onset of effect,
and lack of efficacy for comorbid depressive and
anxiety disorders (e.g., panic disorder or SAD)
GAD treatment Plan
Acute relief–>BZs( x 1st line)–>Venlafaxine or SSRI—>Imprimine/Buspirone/Hydroxizine/Pregabline/Duloxetine
Panic Disorder Treatment Plan
Acte relief –>BZ( x 1st LINE)—> Venlefaxine/SSRIs–>
Imprimine/ Clonazepam/Alprazolam
SAD treatment plan
social anxiety disorder
Venlafaxine/Fluovaxmine/Escitalopram/ Paroxetine(SSRI)—->Buspirone/CLonazepam—Pregablin/ Gabapentin( No response)
PTSD Treatment Plan
SSRI—> Venlafaxine( no response)—>change to TCA/Mirtazapine
