Canadian Clinical Practice Guidelines for Treatment of Anxiety, OCD, and PTSD: Part 2 (Special Populations) Flashcards
are anxiety and related disorders more prevalent in the peripartum period
some studies say yes, some say no
maternal anxiety disorders are associated with which 3 adverse pregnancy outcomes
elective c section
premature delivery
shorter gestational age
*however, a meta analysis found no relationship between anxiety symptoms per se and adverse pregnancy outcomes
maternal anxiety and related disorders have been associated with what challenges/adverse outcomes with regard to parenting
mothers with anxiety and related disorders may be:
-less promoting of psychological autonomy
-associated with behavioural/emotional problems in kids
-subsequent development of anxiety in the kid
which antidepressant in particular appears to have risk of congenital cardiac malformations in exposued fetuses
paroxetine
fetal exposure to what antidepressant has been linked to childhood ADHD
buproprion (needs more study)
prenatal antidepressant exposure has been linked to what neurodevelopmental disorder
autism spectrum disorder (needs more study)
which antidepressants are preferred if mother must use while breastfeeding
sertraline or paroxetine
what is the risk associated with prenatal benzo exposure
oral cleft increased risk (absolute risk is small… another case control study did not find this association)
there is risk of neonatal withdrawal or toxicity syndrome
*no increased risk found of major malformations or cardiac defects
what are the risks associated with exposure to antipsychotics in pregnancy (for the infant)
potential risk for abnormal muscle movements and withdrawal symptoms in infants exposure to APs during 3rd trimester
what are the most common phobias reported in pediatric populations
blood/injury/injection and animal fears
anxiety and related disorders among younger patients are associated with high rates of what issues/disorders in addition
comorbid psych conditions
SUD
sleep problems
somatic symptoms
suicidality
problems with cognition/attention
problems with academic performance
problems with peer relationships
is there a benefit to universal anxiety prevention programs for preventing childhood anxiety and related disorders? what about indicated prevention programs (targeted to children demonstrating highly anxious symptoms)?
both have evidence of benefit–> indicated programs have larger effect sizes than universal programs
is CBT effective for treatment of pediatric anxiety
yes, across symptom/dx clusters
name a commonly used pediatric CBT protocol
“coping cat” program–> was as effective as pharmacotherapy with SSRI but less effective than combo therapy
list some other psychological approaches that have been effective in treating anxiety in kids and teens
attention bias modification, social effectiveness therapy, MBCT–> for social anxiety disorder
ERP, family based CBT, meta cognitive therapy–> for OCD
cognitive behavioural writing therapy, spiritual hypnosis assisted therapy, emotion regulation therapy, exposure therapy, EMDR–> for PTSD
exposure therapy–> specific phobias
is there benefit to parental training only in managing pediatric anxiety disorders
yes
name 6 ADs with evidence for treatment of OCD in kids and teens
fluoxetine + clomipramine = level 1
citalopram, fluvoxamine, paroxetine, sertraline = level 2
name 3 ADs with evidence for treatment of GAD in kids and teens
fluoxetine
fluvoxamine
sertraline
all level 2
name two medications with evidence for treatment of school refusal in kdis
citalopram = level 4
adjunctive imipramine = level 2
list two medications with evidence in kids for separation anxiety disorder
fluoxetine
fluvoxamine
both level 2
list 7 medications with evidence in kids/teens for social anxiety disorder
fluoxetine = level 1
fluvoxamine, paroxetine, venlafaxine XR = level 2
escitalopram, sertraline, mirtazapine = level 3
name 2 medications for treatment of panic disorder in kids and teens
clonazepam and alprazolam have level 4 evidence
name a medication that can be used adjunctively in treatment of pediatric OCD
abilify (level 3)
is sertraline helpful in pediatric PTSD
seems to have level 2 NEGATIVE evidence
what two disorders have decent evidence for use of SSRIs in kids and teens
most evidence is in OCD and social anxiety disorder
what is the perspective of the canadian guidelines on the use of benzos in youth with anxiety and related disorders
“benzos have limited utility in youth”
may be useful for short term therapy in specific situations where there is a need to achieve rapid reduction in severe anxiety symptoms to allow exposure related psychotherapy i.e panic disorder, school refusal disorder
what type of medication is riluzole
glutamate antagonist (may have some efficacy in pediatric OCD, not alot of evidence)
what are the most common antidepressant adverse events in children
activation
vomiting
somnolence in adolescents
how do the prevalence rates of anxiety and related disorders generalyl change as progress into old age
generally decrease prevalence rates
may be related to age biases in the assessment of anxiety and the masking effect of other risk factors that increase with aging
under diagnosis is common
how does having an anxiety or related disorder affect elderly populations compared to those elderly who do not have an anxiety disorder
those with anxiety disorders have higher rates of SLEEP DISTURBANCE and greater IMPAIRMENT in COGNITIVE FUNCTIONING compared to those without anxiety disorders
also impacts physical functioning and mobility and health related QoL
older patients with anxiety and related disorders report higher rates of which medical problems
diabetes
GI conditions
dementia
what medical problems were associated with elevated rates of anxiety and related disorders in the elderly (i.e risk factors for anxiety in the elderly)
chronic urinary incontinence
hearing impairment
HTN
resp disease
poor sleep
how does comorbid anxiety affect outcomes in cardiovascular disease in the elderly
increased risk of mortality
is CBT as effective for anxiety symptoms in older adults compared to younger adults?
may be slightly less effective in older adults –> may benefit from inclusion of learning and memory aids with standard CBT
CBT has evidence for efficacy for treatment of which anxiety and related disorders in older adults
GAD and panic disorder
is pharmacotherapy for anxiety and related disorders as effective in older adults as it is in working age adults
yes it appears it is as effective
what medication for GAD has the most robust evidence in older adults
pregabalin
also good evidence for velafaxine and duloxetine (and citalopram and escitalopram)
what is the most common comorbidity in bipolar disorder
anxiety and related disorders
name a medication with evidence for improving both ADHD symptoms and social anxiety symptoms in kids
atomoxetine
