anxiety disorders (329 E3) Flashcards
basic principles of anxiety disorders
-Strong genetic predisposition
-Symptoms often begin in childhood & early adulthood
-Often recognizes that thoughts/behaviors are irrational & emotion is an overreaction
-Behaviors are used to reduce/manage
/experience of overwhelming anxiety
-Allow continuation of behavior until other strategies are in place to manage the anxiety
separation anxiety timeline in infants
begins around 8 months of age, peaks at 18 months, and then declines
normal part of infant development
separation anxiety disorder
Exhibit developmentally inappropriate levels of concern over being away from a significant other
Fear something horrible happening that will result in permanent separation
Anxiety is so intense it interferes with normal activities, causes sleep disturbances, nightmares, and physical symptoms
In adults the symptoms manifest as harm avoidance, worry, shyness, uncertainty, lack of self-direction, impaired social and occupational functioning
general anxiety disorder (GAD)
one of the most common disorders
anxiety for more than 6 months
excessive and persistent worry, accompanied by muscle tension, autonomic hyperactivity, startle, difficulty concentrating
worry is usually centered around family and their own physical health
is not attributed to the physiological effects of a substance or another medical condition
risk factors for GAD
-unresolved conflicts
-cognitive misinterpretations
-life stressors
-genetic predisposition
-behavior inhibition: shyness, fear or becoming withdrawn in unfamiliar situations
co morbidities of GAD
Most common: Major Depressive Disorder and other anxiety disorders
Alcoholism can be a significant problem for patients with GAD
66 % of patients with GAD have at least one concurrent psychiatric diagnosis
GAD in children & adolescents
Excessive worry and fear with no real cause, revolves around:
-Future events and past behaviors
-Social acceptance, family, finances, personal abilities and school
-catastrophic events
children might be overly conforming, perfectionistic and unaware of themselves
overzealous in seeking reassurance and approval
treatments for GAD in children and adolescents
CBT
antidepressants
anti anxiety
clinical course of GAD
About half the individuals report onset in childhood or adolescence, although onset after age 20 is also common
sx cause distress or impairment that it interferes with daily life and relationships
May exhibit mild depressive symptoms
People with this disorder often present in a primary care setting with somatic complaints including muscle aches, soreness, and GI complaints
May have poor sleep habits, irritability, trembling, twitching, poor concentration, and an exaggerated startle response, a sense of ill-being and uneasiness and a fear of imminent disaster
GAD treatment
A combination of pharmacotherapy and psychotherapy
Biological - Pharmacotherapy:
-Antidepressants
-Anti Anxiety drugs
-Beta Blockers, antihistamines, anticonvulsants and anti-psychotics.
Psychological Therapies:
-Behavioral therapies
-Cognitive Behavioral therapy
behavioral therapy for GAD
teaching and physical activities to decrease anxious or avoidant behavior
modeling, systematic desensitization, flooding, and thought stopping
CBT for GAD
for pt to gain insight into what is causing the anxiety and to help them learn new responses to irrational thinking
includes education and problem solving strategies
primary focus is on learning to identify and change faulty thinking that can lead to emotional distress
medications for GAD
antidepressants: SSRIs, SNRIs, tricyclic, MAOI
benzos
considerations for SSRIs, SNRIs & Benzos for GAD
-first line for most anxiety related disorders
-anti anxiety meds are used for the somatic and psychological symptoms of anxiety disorders
-assess suicide risk
-benzos are used because they have a quick onset of action within hours but have no longer term effectiveness so only for short periods of time
-abrupt stopping of benzos can trigger severe w/drawal and intense rebound anxiety
MAOIs
Typically for refractory depression, works better for atypical depression
most serious potential problem is HTN crisis when take w/ tyramine
MAOIs SE
Food/drug interactions w/ Tyramine rich foods like aged cheese, smoked meats, yeast, red wine
CNS stimulation
Orthostatic hypotension
Can lead to rapid increases in BP, stroke, coma
Significant drug-drug interactions: antihypertensive, SSRI, indirect-acting sympathomimetics (ephedrine), TCA, merperidine
other meds used to treat anxiety
bupropion, buspirone, beta blockeres and hydroxyzine
effective over time and good for pts who do not feel an effect from the SSRIs or those who cannot be safely prescribed benzos
bupropion
Atypical antidepressant
Stimulant effect, decreased appetite
1-3 weeks for effect
doesn’t tend to affect libido and sexual function. It’s often prescribed along with other antidepressants to help counter thesexual side effects
Side effects: seizure, agitation, headache, dry mouth, constipation, weight loss, GI upset, dizziness, tremor
Buspirone
an antianxiety medication that can be prescribed for anxiety particularly when a patient is sensitive to SSRI treatment. Many patients report positive results after several weeks of treatment. Relieves anxiety with less drowsiness and abuse potential. It’s non-habit forming and has low toxicity
beta blockers
(Propranolol, Atenolol) can help to manage short-term physical symptoms of anxiety by bringing down heart rate or blood pressure
hydroxyzine
part of the antihistamine class like the over-the-counter drug Benadryl but has a different mechanism of action that makes it effective for reducing anxiety symptoms
guidelines for benzos
Use the lowest dose necessary to obtain symptom relief
Monitor sedative effects & the patient ’s risk for injury (increased fall risk)
Use caution when using machinery
Avoid caffeine use
Avoid alcohol and other sedatives. Ingestion with alcohol can be fatal
Take with food
Use cautiously in individuals with a history of substance abuse (high addiction/dependency potential)
Do not discontinue abruptly, tapper
Enhance action of GABA exerting calming anti-anxiety effect
Promotes sleep
Muscle relaxant properties
Promotes amnesia: flunitrazepam (Rohypnol) the ‘date rape’ drug
Teratogenic-– avoid while pregnant
antidote for benzos
flumazenil
teaching about antianxiety medications
-Not to change dose or frequency without approval from HCP
-Med may make it unsafe to handle mechanical equipment
-Alcohol & other antianxiety meds can potentiate depressant effects
-Caffeine & nicotine decreases the desired effects of the med
-Patient taking benzos avoid becoming pregnant as these meds can increase the risk for congenital anomalies
-These meds can be excreted in breast milk
-MAOI’s require a special diet
-Cessation of benzo’s & SSRI’s may cause withdrawal
-Take meds after meals to avoid GI symptoms
-Drug interaction can occur
systematic desensitization
gradually introduced to the feared object or experience through a series of steps, from the least frightening to the most frightening
taught to use a relaxation techniques at each step anxiety becomes overwhelming
flooding
the individual is exposed to a large amount of undesirable stimulus to extinguish the anxiety response
learns through prolonged exposure that survival is possible and that the anxiety diminishes
methods of achieving relaxation: non pharm treatment
-Promotion of self-care activities
-Deep breathing exercises
-Physical exercise
-Progressive muscle relaxation
-Mental imagery
-Meditation
-Biofeedback
