Chapter 30: Anxiety Disorders Flashcards
anxiety
An uncomfortable state with psychologic and physical components
Characterized by fear, apprehension, dread, and uneasiness
Among the most common psychiatric illnesses
25% will experience in lifetime
Women more than men
types of anxiety disorders
Generalized anxiety disorder
Panic disorder
Obsessive-compulsive disorder
Social anxiety disorder (social phobia)
Posttraumatic stress disorder
GAD characteristics
Uncontrollable worrying that lasts 6 months or longer
Not situational anxiety
have sleep issues, poor concentration, palpitations, sweaty palsm
tx for more than 12m
GAD tx non drug
Supportive therapy
Cognitive behavioral therapy
Biofeedback
Relaxation training
GAD drug therapy: benzo
valium
GAD: Buspirone [BuSpar]
Not a central nervous system depressant
Non benzo non barb
Has no abuse potential
Does not intensify the effects of central nervous system depressants
Anxiolytic effects develop slowly –takes several weeks
Pharmacokinetics
Well absorbed after oral administration
buspaur ADR
Dizziness
Nausea
Headache
Nervousness
Sedation
Lightheadedness
Excitement
Labeled short term but has been effective for up to a year
If switching from benzo to bus –taper benzo slowly. Bus takes 2-4 weeks to be active, than can withdrawal other med
buspar drug and food interactions
Erythromycin and ketoconazole
Grapefruit juice (cyp enzymes )
GAD drug therapy
first line is SSRI
second line is SNRI
GAD AD Venlafaxine [Effexor XR]
First antidepressant approved for generalized anxiety disorder
Proved effective for both short- and long-term use
Nausea: Most common side effect
Other common reactions: Headache, anorexia, nervousness, sweating, daytime somnolence, insomnia, and hypertension
GAD other AD
Duloxetine [Cymbalta]
Paroxetine [Paxil]
Short- and long-term use
Escitalopram [Lexapro]
panic disorder characteristics
Palpitations, pounding heart, and racing heartbeat
Chest pain or discomfort
Sensation of shortness of breath
Feeling of choking
Dizziness and lightheadedness
Nausea or abdominal discomfort
Derealization or depersonalization
Fear of losing control
Fear of dying
Tingling or numbness in the hands
Flushes or chills
4 or more characterics to be panic dz
Peaks in min , Gone in 30 min
Less than 2% of pop have this
Daily or 1-2 month panic attacks
Onset is late teens to early 20s
panic dz tx
Cognitive behavioral therapy
Drug therapy
panic dz drug therapy
Antidepressants
Selective serotonin reuptake inhibitors -prozac, zoloft, paxil
Tricyclic antidepressants
Monoamine oxidase inhibitors
Benzodiazepines
First-line drugs for panic disorder
70-90 respond to tx
Cont for 3-9 m if not there is a relapse
See benefits in 6-12 wk
OCD characteristics
Potentially disabling condition
Persistent obsessions and compulsions
Spend an hour a day doing them
obsessions: Recurrent persistent thought
Compulsion: is ritualistic behavior
OCD SSRIs
First-line drugs for obsessive-compulsive disorder
Citalopram
Escitalopram
Fluoxetine -approved
Fluvoxamine -approved
Paroxetine -approved
Sertraline -approved
Tx for 1 yr then try to dc by withdrawing it slowly
~ 25 % dose reduction every 1-2 month
23 to 90% will relapse
If relapse occurs 3-4x after trying to withdrawal –life long med
OCD: Clomipramine [Anafranil]
Less tolerated
Second-line drug
TCA
social anxiety dz (social phobia) characteristics
Intense and irrational fear that one will be scrutinized by others
Generalized
Nongeneralized
Very debilitating
One of the most common psychiatric disorders
social phobia tx
Psychotherapy
Drug therapy: SSRIs, paroxetine [Paxil], and sertraline [Zoloft]
See improvement in 3-4 wk
Optimal effects 8-12 weeks
PTSD characteristics
Develops after a traumatic event:
Reexperiencing the event
Avoiding reminders of the event
Persistent state of hyperarousal
PTSD tx
Psychotherapy with drugs
Evidence of efficacy is strongest for three SSRIs (fluoxetine, paroxetine, and sertraline) and one serotonin/norepinephrine reuptake inhibitor (venlafaxine)
Psychotherapy alone
Before any kind of long term med -get therapy as well
Want med shortest time possible