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Clinical 2.0 winter > Anxiety disorders > Flashcards

Anxiety disorders Flashcards

1
Q

what are compulsions

A

repetitive intentional behaviour or mental progressions
in response to an obsession
excessive

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2
Q

OCD definition

A

presence of either obsessions or compulsions
causes marked distres or anxiety
time consuming
impairment in function

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3
Q

OCD onset

A

onset around age 10 and 21

gradual

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4
Q

OCD goals of therapy

A

reduce frequency, severity, distress
improve QOL
restor function
decrease time spent in compulsive behaviour….

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5
Q

NT critical for antiobessional effects

A

serotonin

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6
Q

treatment of OCD

A

clomipramine
SSRI
CBT

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7
Q

time for response in treatment of OCD

A

onset 3 weeks

12 weeks ot see full clinical impact

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8
Q

time for ocd treatment to reach target

A

at least4-6 week at max tolerated dose

8-12 weeks total

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9
Q

if a partial response to an ocd treatment

A

push the dose if tolerated to get max dose by week 4-8

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10
Q

no response to ocd treatment after 8 weeks

A

switch to another SSRI

after 2 SSRIs try clomipramine

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11
Q

can augment SSRI with

A

CBT
clomipramine
second gen antipsychotic

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12
Q

duration of ocd treatment

A

1-2 years then gradual taper 10% every 2 months

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13
Q

AE of clomipramine

A 
antihistaminic, alpha adrenergic, and antimuscarinic side effects
serotonin side effect
increase cardiac toxicity 
seizure risk 
monitor serum levels
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14
Q

potential causes of PTSD

A

overactive alarm center may lead to prolonged excessive NE release
increase corticotropin releasing factor and decreased cortisol
NT imbalance - NE, dopammine, serotonin, GABA

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15
Q

PTSD treatmetn

A

CBT
antidepressants
psychoeducation
dont use benzos

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16
Q

goals of therapy for treatment

A

decrease hyperarousal, reexperience and avoidance

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17
Q

length of antidepressant treatment in ptsd

A

12 week trials, 12 month maintenance

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18
Q

benzos whould be what in panic disorder

A

scheduled

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19
Q

agoraphobia

A

afraid to go out in public

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20
Q

targets for long term management of panic disorder

A

worry and behaviour change

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21
Q

medical conditions associated with panic disorder

A 
thyroid prob
asthma 
arrhythmia
excesive caffiene intake 
withdrawal from alcohol 
corticosteroids 
pheuchromocytoma
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22
Q

panic attack symptoms

A 
abrupt development of at least 4 sx
peaks in 10 min and lasts 20min 
accelrated HR 
intense fear 
sweating 
trembling ....
23
Q

goals of treatment for panic disoreder

A

decrease frequency of attacks
decrease phobic avoidance
decrease physical symptoms

24
Q

substance that could precipitate panic attacks

A

caffiene
drugs f abuse
stimulants

25
panic disorder treatement
benzos for acute relief SSRI or venlafaxine treat for 2 years
26
benefits of benzos
rapid onset 1-2 weeks no tolerance to antipanic effect high response rate
27
disadvantages of benzos
``` sedation dependence abuse wtihdrawal sx reapid reemergence after abrupt discontinuation ```
28
dose of benzos in panic disorder compared to anxiety disorder
increased
29
SSRI advantages
no abuse or dependence antidepressant alter underlying cause
30
disadantages of SSRIs
3-5 week onset ip to 12 weeks mild hyperstimulation - start low go slow sleep disturbance sexual disturbance
31
treatment duration of panic disorder
1-2 years then taper over 4-6 months
32
combo of benzo and SSRI for panic disorder
rapid onset needed greater adherance want to take benzo off after but often hard
33
medications associated with anxiety
CNS stimulant - caffiene, steroids, cocain withdrawal of CNS depressant - narcotic, alcohol anticholinergics, antidepressant, antopsychotic, thyroid supplement,
34
age of onset for generalized anxiety
20s | gradual
35
treatment of generalized anxiety
give benzo first and see how they respond in 2-4 weeks to make sur enot just temporary anxiety then use antidepressant for 12 months then start tapering down *
36
generalized anxiety non pharm
``` counseling stress management meditation exercise avoid caffiene, alcohol CBT ```
37
what is the basic principle of CBT
it is not the situation but our perception that determine feelings
38
benzos more effective in treating ____ sx
somatic/autonomic
39
which benzo has increased lipid solubility thus rapid absorption
diazepam | metabolit gives long half life
40
length of benzo use in generalized anxiety
2-3 weeks should not exceed 4-6 months | if recurring 3-4 week pulses of therapy but if persistent may need continuous
41
benzo DI
CNS depressants increase sedation alcohol increases levels but chronic drinkers it metabolized faster cyp 3A4 interactions increased metabolism form smoking
42
benzo withdrawal sx
common - anxiety, insomnia, agitation, rebound of what they were taking it for less frequent - malaise, nightmares, ataxia rare- tinnitus, confusion, seizures
43
increased incidence of benzo withdrawal if
``` regularly used >3month higher doses sudden cessation short acting benzo used - lorazepam history of dependence ```
44
prevention of benzo withdrawal
use for 3 week sonly decrease dose 10% every week switch to longer half life agent - diazepam
45
first line treatment for anxiety
antidepressants - doesnt matter which one
46
antidepressants better treat ___ sx than benzo in anxiety
psychic | worrk, apprehension
47
duration of antidepressant theray in anxiety
response may take 6 weeks | then at least 12 months before tapering
48
buspirone MOA
serotonin 1A partial agonist | binds to pre and post synaptic receptors to serotonergic transmission, increase serotonin
49
advantages of buspirone
no abuse, dependence, withdrawal no interaction with alcohol fewer CNS effects then benzos fewer GI than SSRI
50
time for buspirone to take effect
max effect in 4-6 weeks | maintain for 1 year
51
initiation of buspirone
start low dose and titrate up
52
AE of buspirone
``` dizzy headache nausea drowsy dysphoria nervous ```
53
buspirone DI
MAOI - hypertension increases cyclosporin and haloperidol levels increased by CCB, itraconazole, erythromycin

Clinical 2.0 winter (28 decks)

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