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Generalized Anxiety Disorder Flashcards

1
Q

What is generalized anxiety disorder (GAD)?

A

Excessive and persistent worrying that is hard to control, causes significant distress or impairment, and occurs on more days than not for at least six months.

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2
Q

What are common predictors (risk factors) of incident GAD?

A
  • Female sex
  • Poverty
  • Recent adverse life events
  • Unmarried status
  • Chronic physical illness (respiratory, cardiovascular, metabolic, cognitive)
  • Chronic mental disorder (depression, phobia, past GAD)
  • Parental loss or separation
  • Low affective support during childhood
  • History of mental problems in parents
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3
Q

What screening tool is used for generalized anxiety disorder?

A

The generalized anxiety disorder seven-item (GAD-7) scale.

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4
Q

What is the significance of a GAD-7 score of 10 or more?

A

It has good diagnostic sensitivity and specificity.

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5
Q

How are greater GAD-7 scores related to functional impairment?

A

Greater GAD-7 scores correlate with more functional impairment.

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6
Q

On what criteria was the GAD-7 scale developed and validated?

A

Based on DSM-IV criteria.

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7
Q

How often have you been bothered by feeling nervous, anxious, or on edge? (GAD-7)

A

Respond with: Not at all, Several days, More than half the days, Nearly every day.

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8
Q

What is the total score range for the GAD-7?

A

0 to 21.

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9
Q

What do scores of 5, 10, and 15 represent in the GAD-7?

A
  • 5 - Mild anxiety
  • 10 - Moderate anxiety
  • 15 - Severe anxiety
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10
Q

Does the GAD-7 have utility for disorders other than GAD?

A

Yes, it has moderately good operating characteristics for panic disorder, social anxiety disorder, and posttraumatic stress disorder.

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11
Q

What is the recommended cutoff for further evaluation when screening for anxiety disorders using the GAD-7?

A

A score of 10 or greater.

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12
Q
A
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13
Q

What is the primary characteristic of generalized anxiety disorder (GAD)?

A

Presence of generalized, persistent, and excessive anxiety.

GAD involves a combination of psychological and somatic complaints.

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14
Q

How long must excessive anxiety and worry occur to meet the DSM-5 criteria for GAD?

A

More days than not for at least six months.

This anxiety must be about a number of events or activities.

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15
Q

What does criterion B of the DSM-5 for GAD state?

A

Difficult to control the worry.

This reflects the uncontrollable nature of the anxiety experienced.

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16
Q

What are the six symptoms associated with anxiety and worry in GAD, represented by I CREST?

A
  • Restlessness or feeling keyed up or on edge (R)
  • Being easily fatigued or loss of energy (E)
  • Difficulty concentrating or mind going blank (C)
  • Irritability (I)
  • Muscle tension (T)
  • Sleep disturbance (S)

Only one symptom is required in children.

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17
Q

What is criterion D of the DSM-5 for GAD?

A

Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

This highlights the impact of GAD on daily life.

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18
Q

What must be excluded to diagnose GAD according to criterion E?

A

Not attributable to the physiological effects of a substance or another medical condition.

Examples include drug abuse, hyperthyroidism, etc.

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19
Q

What does criterion F of the DSM-5 for GAD specify?

A

Not better explained by another mental disorder.

This ensures that GAD is diagnosed independently.

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20
Q

What are some clinical manifestations of GAD?

A
  • Difficulty relaxing
  • Headaches and pain in the neck, shoulders, and back
  • GIT symptoms

These manifestations can vary among individuals.

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21
Q

What percentage of individuals with current GAD had at least one concurrent disorder?

A

66%.

Common concurrent disorders include social phobia, panic disorder, and substance abuse.

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22
Q

What are some health risks associated with GAD?

A
  • Poor cardiovascular health
  • Coronary heart disease
  • Increased blood pressure

These risks highlight the physical health implications of GAD.

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23
Q

What medical conditions must be excluded when diagnosing GAD?

A
  • Endocrine conditions (e.g., hyperthyroidism)
  • Cardiopulmonary conditions (e.g., arrhythmia)
  • Neurologic diseases (e.g., temporal lobe epilepsy)
  • Other psychiatric disorders
  • Substance effects (e.g., caffeine)

This ensures that the symptoms are not due to other medical issues.

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24
Q
A
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25
Q

What role does patient education play in anxiety treatment?

A

It can help reduce anxiety by identifying and removing possible triggers, improving sleep quality/quantity, and increasing physical activity.

Triggers include caffeine, stimulants, nicotine, dietary factors, and stress.

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26
Q

What is the recommended exercise regimen for reducing anxiety?

A

Exercising at 60% to 90% of maximal heart rate for 20 minutes three times weekly.

Yoga is also effective for anxiety reduction.

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27
Q

How long should SSRIs or SNRIs be continued for anxiety treatment?

A

At least 12 months rather than the standard 6 months.

This duration helps limit relapse.

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28
Q

How should medications for anxiety be titrated?

A

Slowly, once every week or twice, and not considered ineffective until titrated to the high end of the dose range and continued for at least 4 weeks.

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29
Q

What should be done if there is no response after 4-6 weeks on maximum dose of an SRI?

A

The medication should be tapered off and another medication, typically a different SRI, should be considered.

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30
Q

What should patients who experience a partial response to an SRI receive?

A

Adjunctive treatment with one of the second-line medications or with cognitive behavioral therapy (CBT).

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31
Q

List common side effects (S/E) of anxiety medications.

A
  • Sexual dysfunction
  • GI abnormalities (nausea and diarrhea)
  • Insomnia
  • Withdrawal on discontinuation
  • Drug interactions
  • Weight gain
  • Agitation and/or hyperactivation
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32
Q

What is the recommended duration for psychotherapy or CBT for GAD?

A

Weekly for at least 8 weeks to assess its effect.

Can include 10 to 15 60-minute sessions, with additional sessions if necessary.

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33
Q

What is the impact of combined treatment with medications and psychotherapy?

A

It reduces relapse.

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34
Q

What are second-line treatment options for generalized anxiety disorder?

A
  • Tricyclic antidepressants (ICAs)
  • Benzodiazepines (e.g., lorazepam 1 to 2 mg/day in divided doses)
  • Pregabalin
  • Buspiron
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35
Q

What are the limitations of benzodiazepines in anxiety treatment?

A

Dependence and tolerance have limited their use.

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36
Q

When might a psychiatric referral be indicated?

A

If there is poor response to treatment, atypical presentation, or concern for significant comorbid psychiatric illness.

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37
Q

What is the focus of pharmacology in treating adults with GAD?

A

Understanding the medications used for treatment.

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38
Q

What role does patient education play in anxiety treatment?

A

It can help reduce anxiety by identifying and removing possible triggers, improving sleep quality/quantity, and increasing physical activity.

Triggers include caffeine, stimulants, nicotine, dietary factors, and stress.

How well did you know this?
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39
Q

What is the recommended exercise regimen for reducing anxiety?

A

Exercising at 60% to 90% of maximal heart rate for 20 minutes three times weekly.

Yoga is also effective for anxiety reduction.

How well did you know this?
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40
Q

How long should SSRIs or SNRIs be continued for anxiety treatment?

A

At least 12 months rather than the standard 6 months.

This duration helps limit relapse.

How well did you know this?
1
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2
3
4
5
Perfectly
41
Q

How should medications for anxiety be titrated?

A

Slowly, once every week or twice, and not considered ineffective until titrated to the high end of the dose range and continued for at least 4 weeks.

How well did you know this?
1
Not at all
2
3
4
5
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42
Q

What should be done if there is no response after 4-6 weeks on maximum dose of an SRI?

A

The medication should be tapered off and another medication, typically a different SRI, should be considered.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What should patients who experience a partial response to an SRI receive?

A

Adjunctive treatment with one of the second-line medications or with cognitive behavioral therapy (CBT).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

List common side effects (S/E) of anxiety medications.

A
  • Sexual dysfunction
  • GI abnormalities (nausea and diarrhea)
  • Insomnia
  • Withdrawal on discontinuation
  • Drug interactions
  • Weight gain
  • Agitation and/or hyperactivation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is the recommended duration for psychotherapy or CBT for GAD?

A

Weekly for at least 8 weeks to assess its effect.

Can include 10 to 15 60-minute sessions, with additional sessions if necessary.

46
Q

What is the impact of combined treatment with medications and psychotherapy?

A

It reduces relapse.

47
Q

What are second-line treatment options for generalized anxiety disorder?

A
  • Tricyclic antidepressants (ICAs)
  • Benzodiazepines (e.g., lorazepam 1 to 2 mg/day in divided doses)
  • Pregabalin
  • Buspiron
48
Q

What are the limitations of benzodiazepines in anxiety treatment?

A

Dependence and tolerance have limited their use.

49
Q

When might a psychiatric referral be indicated?

A

If there is poor response to treatment, atypical presentation, or concern for significant comorbid psychiatric illness.

50
Q

What is the focus of pharmacology in treating adults with GAD?

A

Understanding the medications used for treatment.

52
Q

What does SSRI stand for?

A

Selective Serotonin Reuptake Inhibitor

53
Q

Name three SSRIs

A
  • Citalopram
  • Escitalopram
  • Sertraline
54
Q

What is the initial daily oral dose of Citalopram in mg?

55
Q

What is the initial daily oral dose range for Sertraline?

A

25 to 50 mg

56
Q

What is the initial daily oral dose of Paroxetine in mg?

A

10 to 20 mg

57
Q

What is the initial daily oral dose of Fluoxetine in mg?

A

10 to 60 mg in divided doses

58
Q

What does SNRI stand for?

A

Serotonin-Norepinephrine Reuptake Inhibitor

59
Q

Name two SNRIs

A
  • Duloxetine
  • Venlafaxine (extended-release)
60
Q

What is the initial daily oral dose of Duloxetine in mg?

61
Q

What is the daily oral dose range for Venlafaxine?

A

75 to 225 mg in divided doses

62
Q

What is a characteristic of SSRIs relevant to GAD treatment?

A

Lower risk of insomnia/agitation

63
Q

What is a common side effect associated with Paroxetine?

A

Greater risk of insomnia/agitation

64
Q

What type of drug is Buspirone?

A

A nonbenzodiazepine anxiolytic

65
Q

What is a key feature of Pregabalin?

A

A GABA analog calcium-channel modulator anticonvulsant

66
Q

What is the initial daily oral dose of Mirtazapine?

67
Q

What is a potential side effect of Quetiapine?

A

Sedation, extrapyramidal effects, weight gain, and metabolic side effects

68
Q

What is the initial daily oral dose of Imipramine in mg?

A

75 mg in divided doses

69
Q

What is a notable risk of using tricyclic antidepressants?

A

Cardiotoxic in overdose

70
Q

True or False: Withdrawal symptoms are present if Buspirone is not tapered.

71
Q

Fill in the blank: Venlafaxine can lead to increased _______ and heart rate with increasing doses.

A

blood pressure

72
Q

What is a characteristic of Duloxetine in relation to painful conditions?

A

Useful for treatment of comorbid painful conditions

73
Q

What is a side effect associated with the use of SSRIs?

A

Can prolong QT interval with increasing blood levels

74
Q

Fill in the blank: Mirtazapine is noted for being _______.

75
Q

What is a common side effect of Fluoxetine?

A

Greater risk of insomnia/agitation

76
Q

What is the initial daily oral dose of Quetiapine?

A

25 to 50 mg

77
Q

What is the onset time for Pregabalin when starting treatment?

A

Onset within days of starting treatment

78
Q

What is the maximum daily dose many patients require for Pregabalin?

A

Up to 300 mg/day

79
Q

What is a major concern with the use of Quetiapine?

A

Rarely tardive dyskinesia

80
Q

What is a significant characteristic of SNRIs?

A

Greater risk of gastrointestinal complaints

81
Q

What is the classification of Imipramine?

A

A tricyclic antidepressant

82
Q

What does SSRI stand for?

A

Selective Serotonin Reuptake Inhibitor

83
Q

Name three SSRIs

A
  • Citalopram
  • Escitalopram
  • Sertraline
84
Q

What is the initial daily oral dose of Citalopram in mg?

85
Q

What is the initial daily oral dose range for Sertraline?

A

25 to 50 mg

86
Q

What is the initial daily oral dose of Paroxetine in mg?

A

10 to 20 mg

87
Q

What is the initial daily oral dose of Fluoxetine in mg?

A

10 to 60 mg in divided doses

88
Q

What does SNRI stand for?

A

Serotonin-Norepinephrine Reuptake Inhibitor

89
Q

Name two SNRIs

A
  • Duloxetine
  • Venlafaxine (extended-release)
90
Q

What is the initial daily oral dose of Duloxetine in mg?

91
Q

What is the daily oral dose range for Venlafaxine?

A

75 to 225 mg in divided doses

92
Q

What is a characteristic of SSRIs relevant to GAD treatment?

A

Lower risk of insomnia/agitation

93
Q

What is a common side effect associated with Paroxetine?

A

Greater risk of insomnia/agitation

94
Q

What type of drug is Buspirone?

A

A nonbenzodiazepine anxiolytic

95
Q

What is a key feature of Pregabalin?

A

A GABA analog calcium-channel modulator anticonvulsant

96
Q

What is the initial daily oral dose of Mirtazapine?

97
Q

What is a potential side effect of Quetiapine?

A

Sedation, extrapyramidal effects, weight gain, and metabolic side effects

98
Q

What is the initial daily oral dose of Imipramine in mg?

A

75 mg in divided doses

99
Q

What is a notable risk of using tricyclic antidepressants?

A

Cardiotoxic in overdose

100
Q

True or False: Withdrawal symptoms are present if Buspirone is not tapered.

101
Q

Fill in the blank: Venlafaxine can lead to increased _______ and heart rate with increasing doses.

A

blood pressure

102
Q

What is a characteristic of Duloxetine in relation to painful conditions?

A

Useful for treatment of comorbid painful conditions

103
Q

What is a side effect associated with the use of SSRIs?

A

Can prolong QT interval with increasing blood levels

104
Q

Fill in the blank: Mirtazapine is noted for being _______.

105
Q

What is a common side effect of Fluoxetine?

A

Greater risk of insomnia/agitation

106
Q

What is the initial daily oral dose of Quetiapine?

A

25 to 50 mg

107
Q

What is the onset time for Pregabalin when starting treatment?

A

Onset within days of starting treatment

108
Q

What is the maximum daily dose many patients require for Pregabalin?

A

Up to 300 mg/day

109
Q

What is a major concern with the use of Quetiapine?

A

Rarely tardive dyskinesia

110
Q

What is a significant characteristic of SNRIs?

A

Greater risk of gastrointestinal complaints

111
Q

What is the classification of Imipramine?

A

A tricyclic antidepressant

Psychiatry (3 decks)

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