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neurology/psychiatry > Anxiety & Related Disorders > Flashcards

Anxiety & Related Disorders Flashcards

1
Q

what are some drugs that may cause anxiety

A

steroids
dopamine agonists
stimulants
thyroid hormones
sympathomimetics
antidepressants

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2
Q

what are some disease states that may cause anxiety

A

angina
arrhythmias
hyperthyroidism
asthma
COPD
IBS
Crohn’s
PUD

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3
Q

what are some pathophysiology models that are hypothesized to cause anxiety disorders

A

noradrenergic model
GABA receptor model
serotonin model

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4
Q

noradrenergic model

A

autonomic nervous system is hypersensitive & overreactive to various stimuli

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5
Q

GABA receptor model

A

GABA has a strong inhibitory effect on 5HT, NE, DA

proposed to be lower GABA in anxiety disorders

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6
Q

serotonin model

A

dysregulation of serotonin in those with anxiety disorders

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7
Q

which gender is more common to have GAD

A

female

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8
Q

median age of onset for GAD

A

30 years
peaks in middle age

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9
Q

which ethnicity is more common to have GAD

A

european

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10
Q

DSM-V criteria for GAD

A

at least 6 months of:
-excessive anxiety or worry on most days
PLUS at least 3 of the following
-restlessness, poor concentration, easily fatigued, irritability, sleep changes, muscle tension

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11
Q

how long should GAD be treated

A

at least 12 months

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12
Q

nonpharmacological treatments for GAD

A

CBT, stress management, exercise, support groups

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13
Q

SSRI doses for GAD

A

generally need higher doses for anxiety than for depression

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14
Q

1st line drugs for GAD

A

SSRIs:
escitalopram, sertraline, fluoxetine, paroxetine, citalopram, fluvoxamine

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15
Q

SSRI side effects

A

upset stomach, appetite changes, sexual dysfunction, weight gain, GI bleed, SIADH

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16
Q

SNRIs

A

Duloxetine, venlafaxine, desvenlafaxine, levomilnacipran

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17
Q

SNRI side effects

A

increased blood pressure, nausea, constipation, sexual dysfunction

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18
Q

when are benzos indicated for GAD

A

for prn short term relief

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19
Q

how to dc benzos

A

decrease dose by 10-25% every 1-3 weeks

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20
Q

which benzo is more lipophilic and accumulates in tissues

A

diazepam

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21
Q

do not take benzos in combination with ___

A

alcohol

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22
Q

which populations are we cautious with benzos

A

history of substance use disorder
elderly (kidney/liver, fall risk, ADEs)
pregnancy & lactation

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23
Q

what are some antidepressants that are INEFFECTIVE in anxiety

A

bupropion & mirtazapine

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24
Q

clinical pearl when using antidepressants initially for GAD

A

they can initially increase anxiety. may take 2-4 weeks to see an improvement

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25
Q

buspirone class

A

5HT1 partial agonist

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26
Q

hydroxyzine and diphenhydramine class

A

H1 antagonist, useful for mild anxiety

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27
Q

vilazodone class and when is it used

A

SSRI/5HT-1a partial agonist
useful for comorbid depression

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28
Q

which gender more commonly has panic disorder

A

females

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29
Q

median age for panic disorder

A

20-24 years
peaks in young adulthood

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30
Q

which race/ethnicity more common for panic disorder

A

non-hispanic white, indigenous

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31
Q

DSM-V criteria for panic disorder

A

at least 4 symptoms of panic attack (ie palpitations, shaking, swearing, SOB, fear of dying, etc)

AND at least one month of worry about future panic attacks with maladaptive behavior changes

32
Q

1st line for panic disorder

A

SSRIs

33
Q

2nd line for panic disorder

A

SNRIs: venlafaxine most studied

34
Q

note when dosing for panic disorder

A

higher doses are necessary and adequate trial duration is 6 weeks. increase dose every 1-2 weeks

35
Q

other agents that may be used for panic disorder

A

benzos– alprazolam & clonazepam for short term use only

TCAs– imipramine & clomipramine may reduce panic attacks but side effects are bad

36
Q

duration of treatment for panic disorder

A

at least 12 months after symptoms resolve

37
Q

gender more common for SAD

A

females

38
Q

median age for SAD

A

13 years, peaks in adolescence

39
Q

race/ethnicity more common for SAD

A

indigenous

40
Q

DSM-V criteria for SAD

A

at least 6 months of:
-marked fear about social situations
-fear of others causes avoidance out of proportion to the actual threat

41
Q

first line for SAD

A

SSRIs

42
Q

second line for SAD

A

SNRIs (venlafaxine)

43
Q

third line for SAD

A

MAOIs

44
Q

short term use for SAD

A

benzos: alprazolam & clonazepam

45
Q

drug that can be used for performance-based situations in SAD

A

propranolol

46
Q

nonpharm for SAD

A

CBT

47
Q

treatment duration for SAD

A

6-12 months, adequate trial is 8-12 weeks

48
Q

gender more common in OCD

A

females

49
Q

median age for OCD

A

19.5 years, peaks in adolescence to young adulthood

50
Q

OCD DSM-V criteria

A

time consuming obsessions, compulsions, or both (defined as 1 hour time consuming)

51
Q

1st line for OCD

A

SSRIs (not citalopram/escitalopram)

52
Q

adequate trial for OCD for pharm therapy

A

12 weeks

53
Q

adequate trial in OCD for CBT

A

3-5 months of weekly sessions
or 3 weeks of daily sessions

54
Q

1st line in OCD for SEVERE or comorbid conditions

A

CBT + SSRI

55
Q

agents that are not first line for OCD

A

TCAs (clomipramine)– only after failure of 2 SSRIs (bad side effects)
3rd line would be to augment with haloperidol/SGAs

56
Q

options for refractory cases of OCD

A

dual therapy: SSRI + clomipramine

can also try venlafaxine, mirtazapine, deep brain stimulation

57
Q

treatment duration for OCD

A

at least 1-2 years for medicine then slow taper 10-25% decrease every 1-2 months

for therapy: should have quarterly or biannual booster CBT sessions

58
Q

OCD options for pregnant/lactating patients

A

consider CBT
avoid clomipramine, paroxetine

59
Q

OCD options for elders

A

avoid clomipramine
start low and go slow

60
Q

OCD options for children

A

CBT first line
CBT+SSRI second line

if ineffective, can switch to another SSRI or clomipramine

61
Q

who is more likely to develop civilian PTSD

A

females

62
Q

what are some causes of civilian PTSD

A

sexual violence, interpersonal network trauma, interpersonal violence, organized violence

63
Q

DSM-V criteria for PTSD

A

exposure to ACTUAL or THREATENED death, serious injury, etc that leads to at least one of the following: intrusive memories, dreams, flashbacks, distress

and at least one: avoidance of thoughts/feelings/convos or avoidance of external reminders

and 2 impairments in mood or cognition (ie blame, diminished interest)

and 2 evidences of arousal such as aggressive behavior, self destructive, or sleep disturbance

symptoms must occur for more than one month and cause significant distress/impairment

64
Q

what are some PHYSICAL symptoms of PTSD

A

pain, sweating, tachycardia, hypertension, weakness, dizziness, dyspnea

65
Q

what are some BEHAVIORAL symptoms of PTSD

A

guilt, fear, denial, depression, anxiety, social withdrawal

66
Q

difference between PTSD and acute distress disorder

A

PTSD is for one month
acute distress disorder is for at least 2 days but less than a month

67
Q

benzos for PTSD

A

NO
all guidelines recommend against

68
Q

what can we use for nightmares in PTSD

A

prazosin (alpha1 antagonist)

69
Q

prazosin side effects

A

dizziness, hypotension, orthostasis, fatigue, headache

70
Q

which drug has evidence in pediatrics for PTSD

A

clonidine

71
Q

first line for PTSD

A

CBT

72
Q

drug options for PTSD

A

SSRIs: sertraline, paroxetine (fluoxetine off label)
SNRI: venlafaxine off label
adequate trial 8 weeks

less ideal options: TCAs, mirtazapine, phenelzine, mood stabilizers, antipsychotics

73
Q

when to start meds for PTSD

A

3-4 weeks after trauma experienced

74
Q

_______ reduce the 3 PTSD symptom clusters & treat comorbid anxiety/depression, reduce suicidal behaviors, with minimal side effects

A

SSRIs and SNRIs

75
Q
A

neurology/psychiatry (22 decks)

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