Anxiolytics & hypnotics Flashcards
Fear is
Described as short-term, stimulus-specific response.
Anatomical Localization of Fear
Basolateral, central, and medial nuclei of amygdala
Anatomical Localization of Anxiety
Basolateral amygdala projections to bed nucleus of stria terminalis
Anxiety is
Described as Sustained response influencing behavior after the stimulus is removed
Panic disorder is
a prevalent, debilitating illness associated with high utilization of multiple medical services, poor quality of life and a high incidence of suicide.
Panic disorder may lead
to anticipatory anxiety, which may induce a panic reaction or result in a related symptom of agoraphobia, here are high rates of comorbidity with other mood disorders and substance abuse.
Panic Disorder with or without
Agoraphobia
Needs to be addressed with pt’s with panic disorder
- the patient’s catastrophic misinterpretation of panic symptoms, such as their beliefs that they may die or that the attacks produce physical harm
- taught appropriate cognitive interventions
- suggest and instruct in relaxation therapies; diaphragmatic breathing; positive self-talk; scheduling “worry periods,” when the patient is encouraged to focus on just one worry at a time, saving subsequent worries for another day; keeping logs, in order to look for triggering events; smoking cessation, exercise, the appropriate increase in pleasurable activities (such as spending time with others); and elimination of the use of caffeine, alcohol and illicit substances.
Treatment of panic disorder combines
cognitive-behavioral therapy, self-management techniques, and medications, including antidepressants and anxiolytic agents.
FDA-approved medications to treat Panic Disorder
- Alprazolam (Xanax) and paroxetine (Paxil)
- experience is showing the superiority of the selective serotonin reuptake inhibitors (SSRIs) and clomipramine (Anafranil) over benzodiazepines, monoamine oxidase inhibitors (MAOIs), and tricyclic and tetracyclic drugs in terms of effectiveness and tolerance of adverse effects
- venlafaxine (Effexor), and buspirone (BuSpar) has been suggested as an additive medication in some cases, Venlafaxine is approved by the FDA for the treatment of generalized anxiety disorder and may be useful in panic disorder combined with depression.
Obsessive-compulsive disorders are set apart by an array of recurrent
- obsessive ideas or compulsive actions that significantly interfere with daily functioning
- Obsessions are persistent thoughts, images or impulses experienced as alien intrusions that must be neutralized or suppressed, e.g., obscene or blasphemous thoughts, repugnant sexual images, and unrealistic doubts about whether something has been done correctly
- Compulsions are repetitive, purposeful behaviors performed in response to an obsession or according to certain rules.
abnormal brain structure and activity in patients with OCD, the abnormality apparently lies
mainly in a pathway that links the frontal lobes of the cerebral cortex with the basal ganglia.
MRI suggests a loss of tissue in the caudate nuclei, areas in the basal ganglia that filter messages, fails to dampen the obsessional thinking.
treatments for obsessive-compulsive disorder are
behavior therapy and medications
behavior therapy for OCD
Therapists may train the patient in “thought stopping” therapy (when the obsessive thought encroaches, the patient says “stop”) or saturation therapy (in which the client concentrates so intensely on the obsessive thought that it loses its compelling quality).
Unfortunately, patients usually relapse unless they go on taking the drug indefinitely. Compliance by patients can be a problem in that many patients with OCD are also reluctant to take drugs
patient with OCD will fare better if those surrounding them or their family do not tell them “just stop this behavior.” An expectation or statement about simply stopping the behavior usually only increases the anxiety for those with OCD.
medications 4 OCD
standard approach is to start treatment with a SSRI or clomipramine and then move to other pharmacological strategies if the serotonin-specific drugs are not effective. The serotonergic drugs have increased the percentage of patients with OCD who are likely to respond to treatment to the range of 50 to 70 percent.
specific drugs 4 OCD
fluoxetine/Prozac, fluvoxamine/Luvox, sertraline/Zoloft or paroxetine/Paxil.
PTSD
Often PTSD does not overtly present itself in patients who seek help.
Typically complaints are of a somatic nature or are comorbid with major depression or substance abuse.
In fact, PTSD is comorbid with another condition 80% of the time.
PTSD is
the injury that results from a traumatic event that overwhelms a person’s coping mechanisms. This event must meet two criterion: that the person has directly experienced the potentially life-threatening event and the person must have experienced extreme distress through fear, helplessness and/or horror
patient with PTSD re-experiences the event avoids situations that may cause a re-experiencing of the event and hyperarousal or hypervigilance related to the event.
treatments for PTSD,
sertraline (Zoloft) and paroxetine (Paxil), are considered first-line treatments due to their efficacy, tolerability, and safety ratings. SSRIs reduce symptoms from all PTSD symptom clusters and are effective in improving symptoms unique to PTSD, not just symptoms similar to those of depression or other anxiety disorders
Buspirone (BuSpar) is serotonergic and may also be of use.
efficacy of imipramine (Tofranil) and amitriptyline (Elavil), two tricyclic drugs, in the treatment of PTSD is supported by a number of well-controlled clinical trials
PTSD Nightmares:
Prazosin is used in psychiatry to suppress nightmares, particularly those associated with PTSD. In patients w/ PTSD, excessive adrenaline can cause nightmares. Prazosin blocks some of the effects of adrenaline. Prazosin is recommended as a first-line for nighttime PTSD symptoms like nightmares or sleep disturbances.
Benzodiazepines
- the name is derived from their molecular structure.
- Share a common effect on receptors that have been termed benzodiazepine receptors, which in turn modulate GABA activity.
- GABA binds to GABAa receptor -> Increase of influx of CL-ions (Chloride) -> Hyperpolarization of neuronal cell membrane -> Decreased excitability
Pharmacological Effects Benzodiazepine
All benzodiazepines have anxiolytic effects
Can cause paradoxical hyperexcitability
Induction of sleep
Anterograde amnesia
Anticonvulsant Effect (Clonazepam as an antiepileptic / Diazepam in acute seizures)
Reduces muscle tone by a central action on GABAa receptors primarily in the spinal cord
In pre-anesthetic doses, decreases blood pressure and increases heart rate
Tolerance occurs with all benzodiazepines
Benzodiazepines vary greatly in the duration of action
Short-acting - better hypnotics with reduced hang-over effect upon wakening
Long-acting - better anxiolytics and anticonvulsant drugs
Withdrawal symptoms typically mimic those of anxiety disorders
“Z” compounds e.g. Zolpidem (Ambien), Eszopiclone (Lunesta)
Structurally unrelated to benzodiazepines
Act as agonists on the benzodiazepine site of the GABAa receptor
Tolerance and physical dependence are not as common as seen in benzodiazepine use
Lunesta is approved for long term use
