Lecture 3 - Anxiety Flashcards
General Anxiety Disorder Risk factors
Women = 2 X
economically disadvantaged
stressful event
Chronic physical or mental illness
Low support in childhood
Genetics = FH, if parents have it
What classifies as General Anxiety
excessive anxiety or worry every day > 6 months
presence of > 3 of the following( 1 if child)….
on edge, restless
easily fatigued
mind going blank, cant concentrate
irritability
tense muscles
sleep disturbances
not caused by a specific substance or other condition
enough distress to interfere with normal activity
Labs to run to rule out other causes?
CBC, Chem 7, Thyroid studies
Urine analysis, EKG, urine tox
Initial Treatment options for General Anxiety
- Psychotherapy (CBT or IPT)
- Pharm ( SSRI or SNRI)
- Combo of 1 n 2
panic disorder risk factors
FH
life stressor
child abuse
smoking as child
anxious trait
behavioral inhibition = separation anxiety
Panic attack vs Disorder
Attack: period of intense fear or discomfort with > 4 of the following symptoms and develop suddenly and peak within 10min
Disorder = recurrent, unexpected panic attacks with > 1 attack being followed by > 1 month of constant concern over att, being anxious, change in behavior designs to avoid having panic attacks
How to Treat panic attacks?
no urgent = SSRI or Venlafaxine 12 weeks
Urgent, no abuse history = short term BZD 2-4wk and SSRI/venlafaxine
usually therapy is 12-24 months
Social anxiety disorder risk factors
Female
FH
shyness
maternal stress
early childhood abuse, neglect, teasing, etc
Social Anxiety Disorder definition
mixed fear or anxiety about > 1 social situation where individual is exposed to possible scrutiny by others
usualy lasts > 6 months, cause significant impairment and social distress, not related to conditions or substance abuse
Social anxiety disorder treatment
SSRI or Venlafaxine for 12 months
Check and see if works, or inc dose if some response or switch med if no response
BB for performance anxiety
FDA off label
propranolol 10-60mg for 30-60min prior to performance
obsessive compulsive disorder risk factors
Males> females (kids), opposite in adults
FH
stress or hormonal changes
PANDAS
1st line OCD
CBT alone
SSRI alone, 8-12 wk
CBT + SSRI
2nd line OCD
switch to another SSRI or clomipramine
Augmentation with 2nd gen antipsychotic (aripip or risperidone)
Switch to venlafaxine
3rd line OCD
Switch to other SGA augmenting agent
Switch to duloxetine or mirtazapine
Augmentation of SSRI w/ clomipramine
Maintenance and continuation phase OCD
after 1-2yrs, gradually taper
Periodic CBT booster sessions for 3-6 months
OCD therapies
fluoetine
fluvaxamine
paroxetine
sertraline
citalopram/escitalopram = off-label
PTSD overview defintion
Traumatic event
Intrusive symptoms
Avoidance
Negative cognition/mood
Hyper-arousal
PTSD criteria A
exposure to threatened or acute death, violence or serious injury in >1 in the following.
PTSD criteria B
presence of > 1 of the following intrusive symptoms associated with traumatic events, starting after traumatic event occurred
PTSD criteria C
ongoing avoidance of stimuli associated with traumatic events demonstrated b >1 of the following
PTSD criteria D
negative alterations in mood or cognition associated with traumatic events
PTSD criteria E
Marked changes in reactivity and arousal associated with traumatic events
PTSD treatment
SSRI = 8-12 weeks, maximize dose and wait for effect.
switch or venlafaxine if no response
mirtazapine or TCA if still nothing
can augment based on symptoms
