Anxiety Disorders

Question 1

WhatsAN Anxiety Disorder?

Answer 1

Anxiety disorders is anxiety and associated
symptoms are irrational or experienced at a
level of severity that impairs functioning.

Question 2

Whats the characteristic features of Anxiety Disorder?

Answer 2

The characteristic features are anxiety and

avoidance.

Question 3

What’s the Noradrenergic model.

Answer 3

This model suggests that the
autonomic nervous system of anxious patients is
hypersensitive and overreacts to various stimuli.

Question 4

What has a role in regulating anxiety, and how

Answer 4

The locus ceruleus may have a role in regulating anxiety, as it activates norepinephrine release and stimulates the sympathetic and parasympathetic nervous systems.

Question 5

What does chronic noradrenergic overactivity cause?

Answer 5

Chronic noradrenergic overactivity down regulates α2-
adrenoreceptors in patients with generalized anxiety
disorder (GAD) and posttraumatic stress disorder (PTSD).

Question 6

patients with social anxiety disorder react with stress by

Answer 6

Patients with social anxiety disorder (SAD) appear to have a hyperresponsive adrenocortical response to
psychological stress

Question 7

Antianxiety medications target what receptor and why

Answer 7

GABA is the major inhibitory neurotransmitter in the CNS. Many antianxiety drugs target the GABAA receptor.

Question 8

Benzodiazepines effects

note: Bz decrease binding= panic disorder

Answer 8

Benzodiazepines (BZs) enhance the inhibitory effects of GABA, which has a strong regulatory or inhibitory
effect on serotonin (5-HT), norepinephrine, and
dopamine systems.

Question 9

What does it mean if theres a response of GH in response to balofen.

Answer 9

Growth hormone response to baclofen in patients with
generalized SAD suggests an abnormality of central
GABAB receptor function.

Question 10

GAD SYMPTOMS may be due to

Answer 10

GAD symptoms may reflect excessive 5-HT
transmission or overactivity of the stimulatory 5-HT
pathways.

Question 11

Sad response seen in drug reaction

give example

Answer 11

Patients with SAD + buspirone = have greater prolactin =indicating an enhanced central serotonergic response.

Question 12

How do i know if i have anxiety disorder

Answer 12

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.

Question 13

Anxiety symptoms associated with which illnesses

Answer 13

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).

Question 14

For patients with GAD, nonpharmacologic modalities

include

Answer 14

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.

Question 15

Pharmacological treatment for GAD

Answer 15

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.

Question 16

Antianxiety Medications for GAD

Answer 16

Venlafaxine extended release, duloxetine, paroxetine, and escitalopram are FDA approved for treatment of GAD.
Sertraline is also effective.

Question 17

If patients fail to take SSRIs for anxiety

Answer 17

• Imipramine may be used when patients fail to respond to selective serotonin reuptake inhibitors (SSRIs).

Question 18

TTT for acute anxiety

Answer 18

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).

Question 19

Benzodiazepines dependance seen as

Answer 19

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.

Question 20

Whats a second in line agent for GAD

Answer 20

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)

Question 21

GAD treatment Plan

Answer 21

Acute relief–>BZs( x 1st line)–>Venlafaxine or SSRI—>Imprimine/Buspirone/Hydroxizine/Pregabline/Duloxetine

Question 22

Panic Disorder Treatment Plan

Answer 22

Acte relief –>BZ( x 1st LINE)—> Venlefaxine/SSRIs–>

Imprimine/ Clonazepam/Alprazolam

Question 23

SAD treatment plan

social anxiety disorder

Answer 23

Venlafaxine/Fluovaxmine/Escitalopram/ Paroxetine(SSRI)—->Buspirone/CLonazepam—Pregablin/ Gabapentin( No response)

Question 24

PTSD Treatment Plan

Answer 24

SSRI—> Venlafaxine( no response)—>change to TCA/Mirtazapine