Anxiety Disorders Flashcards
Food restrictions for MAOIs (tyramine-free diet)
No: Wine, Beer, Age cheese, Pickles, Aged Meats, Chocolate, etc.
*can cause hypertensive crisis
Diffuse, unpleasant, vague sense of apprehension; often accompanied with headache, perspiration, palpitations and restlessness
Anxiety
What draws the line between normal and pathologic anxiety? (4 total)
Autonomy: no trigger
Intensity: exceeds patient’s capacity
Duration: persistent
Behavior: disabling
Common medical conditions that can MIMIC anxiety disorders
Endocrine: thyroid dysfunction, hyperadrenalism
Hypoxia (CHF, angina, COPD)
Metabolic acidosis
Seizures
Parts of brain thought to be the etiologic agents for Anxiety
Locus Coeruleus (high NE) Limbic system (low GABA) *also low 5HT
Treatments for Anxiety Disorders
- CBT (1st line); exposure therapy (graded vs flooding)
- SSRI/SNRIs (good prophylactic)
- Benzodiazepines (short term)
Childhood anxiety disorder; developmentally appropriate from age 1-3, but NOT older kids or adults; recurrent, excessive distress when separated from home or attachment figures (clues: school refusal, somatic symptoms like headaches/stomachaches)
Separation Anxiety Disorder
Discrete episodes of intense anxiety WITH a clear trigger; SUDDEN onset, peaks within minutes; associated with at least 4/13 symptoms of autonomic arousal (PANICC) (SOB, sweats, chills, trembling, nausea, palpitations, fear of going crazy, fear of dying
Panic Attacks
Mnemonic for Panic Attack symptoms
PANICC
P: pulmonary (SOB)
A: autonomic arousal (sweats, chills, hot flashes)
N: neurologic (shaking, dizzy, faintness)
I: GI (nausea)
C: cardiac (palpitations, chest pain)
C: cognitive (fear of going crazy/dying)
Syndrome of recurrent, unexpected panic attacks (at least 4 in one month); LACK a trigger; followed by at least 1 months of concern of having another attack and behavior changes b/c of the attacks
Panic Disorder
How many panic attacks do you need in a month to qualify for Panic Disorder
at least 4
Anxiety or avoidance of places where escape might be difficult or embarrassing (cars, buses, parking lots, shops, theaters, crowds); become extremely homebound as a consequence; usually have panic attacks before the onset
Agoraphobia (marked fear about at least 2/5 situations)
Excessive anxiety and worry that occurs more day than not for 6 months (PERSISTENT rather than discrete like in panic attacks); difficult to control worry and causes impairment of function & significant distress; NO specific trigger
Generalized Anxiety Disorder
Difference between Panic Disorder vs. Generalized Anxiety Disorder
PD: discrete attacks
GAD: persistent anxiety, but can fluctuate
Treatment for GAD
- CBT
- Antidepressants (SSRI/SNRI)
- Benzodiazepines
- Buspirone (partial agonist for serotonin 5HT receptors; NO ABUSE potential)
drug used for GAD; partial agonist for serotonin 5-HT1 receptor (autoreceptor); useful for those with anxiety due to substance abuse issues
Buspirone
Marked and persistent fear that is excessive and unreasonable of a specific object or situation; actively avoids the phobic stimulus; causes significant impairment in function and distress
** 2/3 of phobia patients have >1 phobia
Specific Phobia
Therapy for those with specific phobias; gradual exposure to the phobia to help alleviate the anxiety and dysfunction
Graded Exposure (aka. systemic desensitization)
- could be imaginary or in vivo
Marked fear or anxiety about social situations in which the individual is exposed to POSSIBLE SCRUTINY BY OTHERS (meeting new people, public restrooms, performances, etc.) –> leads to hyperarousal and avoidance
Social Anxiety Disorder
Social anxiety disorder is frequently comorbid with
depression and substance abuse
Treatment for Social Anxiety Disorder
- CBT
- Antidepressants (SSRI/SNRI/MAOI)
- Benzodiazepine or beta-blocker (propranolol) for INFREQUENT events/before public speaking
