Generalized Anxiety Disorder Flashcards
caused by
genetic & environment contributing (stressful life events, illness, parental relationships, trauma)
other factors contributing to anxiety?
-positive family history of anxiety disorders
- female sex, loneliness
- low education
- adverse parenting
- chronic somatic illness (cardiovascular disease, diabetes, asthma, obesity)
example of a screening technique
“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.
important risk assessment is recommended?
suicide risk assessment for all anxiety disorders
GAD abbr
generalized anxiety disorder
goal of GAD
-acutely reduce the severity & duration of sxs
-restore overall fn
long term:
achieve and maintain remission
general approach to tx
psychotherapy, pharmacotherapy, or both
pharmacologic therapy
-antideprassants
-benzdodiazepines
-pregabalin
-buspirone
-hydroxyzine
-2nd generation antipsychotics (SGAs)
antidepressants are the drug of choice for
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
benzodiazepines remain the most effective and commonly used tx for
short-term management of anxiety when immediate relief of sxs is desired
buspirone and pregabalin are alternative agents for pts w/
GAD without depression
hydroxyzine use
adjunctive and is less desirable for long-term tx bc of s/e such as sedation and anticholinergic effects
Guidelines vary on how long to continue treatment after remission, and the duration varies from at
least 6 months and up to 12 months
antidepressants
reduce the psychic sxs (worry, apprehension) or somatic sxs (tremor, rapid HR, sweating)
onset: 2-4 wk
SSRIs are preferred over tricyclic antidepressants (TCAs)
SSRIs
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
benefits in children and adolescents with GAD
Sertraline, fluoxetine, and fluvoxamine
SNRIs
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
tricyclic antidepressants
limited by bothersome ADRs (sedation, orthostatic hypotension, anticholingeric effects, wt gain)
-narrow therapeutic indices & lethal in overdose due to atrioventricular block
novel antidepressants
mitrazapine: not associated w/ ED
causes sedation & wt gain
benzodiazepines
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
benzodiazepines: caution
-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
lorazepam and oxazepam
bypass hepatic oxidation and ar conjugated only
-preferred for reduced hepatic fn secondary to aging or disease (eg cirrhosis)
benzodiazepine s/e
-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)
pregabalin
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
