Generalized Anxiety Disorder

Question 1

caused by

Answer 1

genetic & environment contributing (stressful life events, illness, parental relationships, trauma)

Question 2

other factors contributing to anxiety?

Answer 2

-positive family history of anxiety disorders
- female sex, loneliness
- low education
- adverse parenting
- chronic somatic illness (cardiovascular disease, diabetes, asthma, obesity)

Question 3

example of a screening technique

Answer 3

“During the past 2 weeks, how much have you been bothered by the following: (1) feeling nervous, anxious, frightened, worried, or on edge, (2) feeling panic or being frightened, (3) avoiding situations that make you anxious.

Question 4

important risk assessment is recommended?

Answer 4

suicide risk assessment for all anxiety disorders

Question 5

GAD abbr

Answer 5

generalized anxiety disorder

Question 6

goal of GAD

Answer 6

-acutely reduce the severity & duration of sxs
-restore overall fn

long term:
achieve and maintain remission

Question 7

general approach to tx

Answer 7

psychotherapy, pharmacotherapy, or both

Question 8

pharmacologic therapy

Answer 8

-antideprassants
-benzdodiazepines
-pregabalin
-buspirone
-hydroxyzine
-2nd generation antipsychotics (SGAs)

Question 9

antidepressants are the drug of choice for

Answer 9

chronic GAD bc of tolerable side effect profiles, no risk for dependency, and efficacy in common comorbid conditions, inc major depression, panic disorder, OCD, and SAD

Question 10

benzodiazepines remain the most effective and commonly used tx for

Answer 10

short-term management of anxiety when immediate relief of sxs is desired

Question 11

buspirone and pregabalin are alternative agents for pts w/

Answer 11

GAD without depression

Question 12

hydroxyzine use

Answer 12

adjunctive and is less desirable for long-term tx bc of s/e such as sedation and anticholinergic effects

Question 13

Guidelines vary on how long to continue treatment after remission, and the duration varies from at

Answer 13

least 6 months and up to 12 months

Question 14

antidepressants

Answer 14

reduce the psychic sxs (worry, apprehension) or somatic sxs (tremor, rapid HR, sweating)

onset: 2-4 wk

SSRIs are preferred over tricyclic antidepressants (TCAs)

Question 15

SSRIs

Answer 15

paroxetine, escitalopram, and setraline most effective

s/e: somnolence, headache, N, dry mouth (paroxetine), diarrhea (setraline), sweating (sertraline), decreased libido, ejaculation disorder, anorgasmia, and asthenia

Question 16

benefits in children and adolescents with GAD

Answer 16

Sertraline, fluoxetine, and fluvoxamine

Question 17

SNRIs

Answer 17

Venlafaxine and duloxetine alleviate anxiety with or without comorbid depression and maintain response with extended treatment

-s/e: N, somnolence, dry mouth, dizziness, sweating, constipation, and anorexia

Question 18

tricyclic antidepressants

Answer 18

limited by bothersome ADRs (sedation, orthostatic hypotension, anticholingeric effects, wt gain)
-narrow therapeutic indices & lethal in overdose due to atrioventricular block

Question 19

novel antidepressants

Answer 19

mitrazapine: not associated w/ ED
causes sedation & wt gain

Question 20

benzodiazepines

Answer 20

recommended for acute tx og GAD when short term relief is needed
-as an adjunct or when 3 tx failures
effective for somatic sxs than psychic sxs

Question 21

benzodiazepines: caution

Answer 21

-lack of effectiveness for depression; risk for withdrawal and potential need for taper; and potential interdose rebound anxiety, especially with short-acting
-older adults: due to fall and fracture risk
-risk for dependency and abuse and should be avoided in patients with current or past substance use disorder

Question 22

lorazepam and oxazepam

Answer 22

bypass hepatic oxidation and ar conjugated only
-preferred for reduced hepatic fn secondary to aging or disease (eg cirrhosis)

Question 23

benzodiazepine s/e

Answer 23

-central nervous system (CNS) depressant effects (eg, drowsiness, sedation, psychomotor impairment, and ataxia) and cognitive effects (eg, poor recall and anterograde amnesia)
-Anterograde amnesia (alprazolam)

Question 24

pregabalin

Answer 24

calcium channel modulator, and its anxiolytic properties are attributed to its selective binding to the α2-delta subunit of voltage-gated calcium channels
-reduces anxiety similar to alprozolam
-shot half-life and must be dosed 2-3 times per day
-schedule V controlled substance: caution w/ pts w a current or past history of substance abuse

Question 25

alternative agents

Answer 25

-hydroxyzine (acute reduction of anxiety)
- buspirone (no abuse potential
-SGAs

Question 26

buspirone s/e

Answer 26

dizziness, nausea, and headaches
may increase BP when coadministered with MAOI