anxiety disorders Flashcards
Characterized by excessive, uncontrollable and often irrational fear about everyday issues and not about a specific thing or at specific time
Symptoms have been occurring for more than 6 months.
3 or more somatic symptoms
More than 6 months of excessive worry
More days are spent worrying than worry free
GAD
GAD tx
- whats first line
- whats not first line
- immedate what
- 3 other drugs
Cognitive and Behavioural therapy, insight oriented therapy
**SSRIs (1st line for long term therapy), SNRIs and buspirone effective
TCAs not 1st line [Imipramine (Tofranil), Clomipramine (Anafranil)]
Benzodiazepines – may be used for short term(xanax) IMMEDIATE therapy/adjunct therapy
Pregabalin – Lyrica
Gabapentin – Neurontin
what med must be tapered off
benzo
what drugs must not be used with MAOI
buspirone and SSRI
Sudden unexpected and overwhelming anxiety lasting about 30 minutes Tachycardia Palpitations Excessive perspiration Dizziness Shortness of breath Sensation of choking Chest pain / Discomfort Numbness / Tingling Chills / Hot flashes Uncontrollable fear Fear of the next panic attack
panic d/o
Panic Attacks & Panic Disorder definition
A panic attack is the a case of extreme anxiety which typically lasts peaks within 10 minutes, declines within 30 min and rarely lasts longer than an hour.
Panic disorder is characterized by repeated, unexpected panic attacks and the fear of future panic attacks.
panic attack/disorder dx
Unexpected recurrent panic attacks with at least a month of significant behavior change which may or may not include agoraphobia(30-50% of cases)
perioral and or acral paresthesias
hyperventilation and low O2 saturation
Panic Attacks and Panic Disorder tx
- duration
- 2 **
- 1 other med
tx for 8-12 months due to relapse rates after medication discontinued
Psychotherapy(alone for milder cases)
Cognitive behavior therapy – teaches a person different ways of thinking, behaving, and reacting to situations that help him feel less anxious and fearful
Reduction of Caffeine Intake
* SSRIs for maintenance once benzo is tapered
SNRIs
TCAs [Imipramine (Tofranil), Clomipramine (Anafranil)]
* Benzodiazepines – may be used for short term therapy
Alprazolam (Xanax)
___ is a fear of other people or social situations such as performance anxiety or fears of embarrassment by scrutiny of others.
___ is a specific fear of Heights, spiders etc
____ is a generalized fear of leaving home or a familiar ‘safe’ area. Typically the fear is that there may be a problem or panic attack
Social Phobia – fear of other people or social situations such as performance anxiety or fears of embarrassment by scrutiny of others.
Specific Phobia – Heights, spiders etc
Agoraphobia – a generalized fear of leaving home or a familiar ‘safe’ area. Typically the fear is that there may be a problem or panic attack and the patient can’t escape or get to safety.
A ___ is an overwhelming, persistent and unreasonable fear of an object or situation that poses little real danger but provokes anxiety and avoidance.
Patients understand that their fear (is or is not) rational
phobia
is not
Uncontrollable panic, terror or dread when exposed to the source of fear
Total Fear avoidance
Anxiety interferes with patient’s daily activities
Sweating
Tachycardia
Difficulty breathing
A feeling of panic and intense anxiety
Feeling powerless to control fear
Anxiety
In children, possibly tantrums, clinging or crying and the patient can’t escape or get to safety.
phobias symptoms
phobia tx
Psychotherapy(insight oriented and graded exposure)
Desensitization or exposure therapy
Participant modeling and reinforced practice
SSRIs and SNRI for social and agoraphobia
Beta blockers to reduce autonomic hyperarousal sx and tremorss
Benzodiazepines – may be used for short term therapy
Alprazolam (Xanax)
episodic or situational anxiety d/o
episodic is panic d/o
situational is phobia d/o
GAD dx criteria
at least 3 of following: restlessness or hypervigilance easy fatigability irritability sleep disturbance muscle tension difficulty concentrating
pt has difficulty coping with anxiety; which usually is expressed as worry or apprehension.
however, pts often present to medical providers with somatic complaints, such as fatigue or muscle tension
GAD
high(50-90%) comorbidity with other psychiatric disorders, such as MDD, specific and social phobias, and panic disorder
GAD
must rule out what disorders when looking at GAD [5]
thyroid function, stimulant abuse, alcohol withdrawal, caffeine intoxication, cardiac arrhythmias
Exposure to a traumatic event
Persistent re-experiencing of the event
Persistent avoidance and emotional numbing
Persistent symptoms of increased arousal not present before (hypervigilance, hyper startle reflex)
Feeling of detachment from other people
Significant Impairment
Diagnostic criteria for PTSD:
Duration of symptoms for more than 1 month
psychotherapy for PTSD
- Cognitive Behavioral Therapy
- -Exposure therapy
- -Cognitive restructuring.
- -Stress inoculation training
- -Eye Movement Desensitization and Reprocessing
- -Interpersonal Psychotherapy
- -Exercise, Sports and Physical Activity
PTSD medication tx
whats first line
** SSRIs are first line
Benzodiazepines, Tricyclic antidepressants
Alpha-adrenergic antagonists
Prazosin-helps relieve or reduce nightmares
Clonidine – can be helpful with startle, hyperarousal, and general autonomic hyperexcitability
Anti-convulsants, mood stabilizers, anti-aggression agents
Serotonin antagonists
Cyproheptadine – aids in sleep disorders and nightmares
Beta blockers
Propranolol – to reduce hyperarousal symptoms, including sleep disturbances
increased state of arousal characterized by at least 2 of the following: [5]
insomnia irritability or angry outbursts poor concentration hypervigilance exaggerated startle response
How long does a typical panic attack last?
Most end by 30 minutes but may be as long as an hour
What is the most common traumatic event leading to PTSD in women? men?
women: Rape / sexual assault
men: combat
