Chapter 30: Anxiety Disorders

Question 1

anxiety

Answer 1

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

Question 2

types of anxiety disorders

Answer 2

Generalized anxiety disorder​

Panic disorder​

Obsessive-compulsive disorder​

Social anxiety disorder (social phobia)​

Posttraumatic stress disorder​

Question 3

GAD characteristics

Answer 3

Uncontrollable worrying that lasts 6 months or longer​

Not situational anxiety

have sleep issues, poor concentration, palpitations, sweaty palsm

tx for more than 12m

Question 4

GAD tx non drug

Answer 4

Supportive therapy​
Cognitive behavioral therapy​
Biofeedback​
Relaxation training​

Question 5

GAD drug therapy: benzo

Answer 5

valium

Question 6

GAD: Buspirone [BuSpar]

Answer 6

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​

Question 7

buspaur ADR

Answer 7

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

​

Question 8

buspar drug and food interactions

Answer 8

Erythromycin and ketoconazole​

Grapefruit juice (cyp enzymes )​

Question 9

GAD drug therapy

Answer 9

first line is SSRI
second line is SNRI

Question 10

GAD AD Venlafaxine [Effexor XR]

Answer 10

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​

Question 11

GAD other AD

Answer 11

Duloxetine [Cymbalta]​

Paroxetine [Paxil]​
Short- and long-term use​

Escitalopram [Lexapro]

Question 12

panic disorder characteristics

Answer 12

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

Question 13

panic dz tx

Answer 13

Cognitive behavioral therapy​

Drug therapy​

Question 14

panic dz drug therapy

Answer 14

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

Question 15

OCD characteristics

Answer 15

Potentially disabling condition​

Persistent obsessions and compulsions

Spend an hour a day doing them ​

obsessions: Recurrent persistent thought

Compulsion: is ritualistic behavior

Question 16

OCD SSRIs

Answer 16

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

Question 17

OCD: Clomipramine [Anafranil]

Answer 17

Less tolerated​

Second-line drug
TCA

Question 18

social anxiety dz (social phobia) characteristics

Answer 18

Intense and irrational fear that one will be scrutinized by others​
Generalized​
Nongeneralized​

Very debilitating​

One of the most common psychiatric disorders

Question 19

social phobia tx

Answer 19

Psychotherapy​

Drug therapy: SSRIs, paroxetine [Paxil], and sertraline [Zoloft]​

See improvement in 3-4 wk ​

Optimal effects 8-12 weeks

Question 20

PTSD characteristics

Answer 20

Develops after a traumatic event​:

Reexperiencing the event​

Avoiding reminders of the event​

Persistent state of hyperarousal

Question 21

PTSD tx

Answer 21

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