Anxiety disorders Flashcards
what are compulsions
repetitive intentional behaviour or mental progressions
in response to an obsession
excessive
OCD definition
presence of either obsessions or compulsions
causes marked distres or anxiety
time consuming
impairment in function
OCD onset
onset around age 10 and 21
gradual
OCD goals of therapy
reduce frequency, severity, distress
improve QOL
restor function
decrease time spent in compulsive behaviour….
NT critical for antiobessional effects
serotonin
treatment of OCD
clomipramine
SSRI
CBT
time for response in treatment of OCD
onset 3 weeks
12 weeks ot see full clinical impact
time for ocd treatment to reach target
at least4-6 week at max tolerated dose
8-12 weeks total
if a partial response to an ocd treatment
push the dose if tolerated to get max dose by week 4-8
no response to ocd treatment after 8 weeks
switch to another SSRI
after 2 SSRIs try clomipramine
can augment SSRI with
CBT
clomipramine
second gen antipsychotic
duration of ocd treatment
1-2 years then gradual taper 10% every 2 months
AE of clomipramine
antihistaminic, alpha adrenergic, and antimuscarinic side effects serotonin side effect increase cardiac toxicity seizure risk monitor serum levels
potential causes of PTSD
overactive alarm center may lead to prolonged excessive NE release
increase corticotropin releasing factor and decreased cortisol
NT imbalance - NE, dopammine, serotonin, GABA
PTSD treatmetn
CBT
antidepressants
psychoeducation
dont use benzos
goals of therapy for treatment
decrease hyperarousal, reexperience and avoidance
length of antidepressant treatment in ptsd
12 week trials, 12 month maintenance
benzos whould be what in panic disorder
scheduled
agoraphobia
afraid to go out in public
targets for long term management of panic disorder
worry and behaviour change
medical conditions associated with panic disorder
thyroid prob asthma arrhythmia excesive caffiene intake withdrawal from alcohol corticosteroids pheuchromocytoma
panic attack symptoms
abrupt development of at least 4 sx peaks in 10 min and lasts 20min accelrated HR intense fear sweating trembling ....
goals of treatment for panic disoreder
decrease frequency of attacks
decrease phobic avoidance
decrease physical symptoms
substance that could precipitate panic attacks
caffiene
drugs f abuse
stimulants
panic disorder treatement
benzos for acute relief
SSRI or venlafaxine
treat for 2 years
benefits of benzos
rapid onset 1-2 weeks
no tolerance to antipanic effect
high response rate
disadvantages of benzos
sedation dependence abuse wtihdrawal sx reapid reemergence after abrupt discontinuation
dose of benzos in panic disorder compared to anxiety disorder
increased
SSRI advantages
no abuse or dependence
antidepressant
alter underlying cause
disadantages of SSRIs
3-5 week onset ip to 12 weeks
mild hyperstimulation - start low go slow
sleep disturbance
sexual disturbance
treatment duration of panic disorder
1-2 years then taper over 4-6 months
combo of benzo and SSRI for panic disorder
rapid onset needed
greater adherance
want to take benzo off after but often hard
medications associated with anxiety
CNS stimulant - caffiene, steroids, cocain
withdrawal of CNS depressant - narcotic, alcohol
anticholinergics, antidepressant, antopsychotic, thyroid supplement,
age of onset for generalized anxiety
20s
gradual
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 *
generalized anxiety non pharm
counseling stress management meditation exercise avoid caffiene, alcohol CBT
what is the basic principle of CBT
it is not the situation but our perception that determine feelings
benzos more effective in treating ____ sx
somatic/autonomic
which benzo has increased lipid solubility thus rapid absorption
diazepam
metabolit gives long half life
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
benzo DI
CNS depressants increase sedation
alcohol increases levels but chronic drinkers it metabolized faster
cyp 3A4 interactions
increased metabolism form smoking
benzo withdrawal sx
common - anxiety, insomnia, agitation, rebound of what they were taking it for
less frequent - malaise, nightmares, ataxia
rare- tinnitus, confusion, seizures
increased incidence of benzo withdrawal if
regularly used >3month higher doses sudden cessation short acting benzo used - lorazepam history of dependence
prevention of benzo withdrawal
use for 3 week sonly
decrease dose 10% every week
switch to longer half life agent - diazepam
first line treatment for anxiety
antidepressants - doesnt matter which one
antidepressants better treat ___ sx than benzo in anxiety
psychic
worrk, apprehension
duration of antidepressant theray in anxiety
response may take 6 weeks
then at least 12 months before tapering
buspirone MOA
serotonin 1A partial agonist
binds to pre and post synaptic receptors to serotonergic transmission, increase serotonin
advantages of buspirone
no abuse, dependence, withdrawal
no interaction with alcohol
fewer CNS effects then benzos
fewer GI than SSRI
time for buspirone to take effect
max effect in 4-6 weeks
maintain for 1 year
initiation of buspirone
start low dose and titrate up
AE of buspirone
dizzy headache nausea drowsy dysphoria nervous
buspirone DI
MAOI - hypertension
increases cyclosporin and haloperidol levels
increased by CCB, itraconazole, erythromycin
