Module 14 - Anxiety Flashcards
Anxiety disorder criteria
- be out of proportion with situation
- hinder ability to function normally
- All anxiety disorders must exhibit these two symptoms
anxiety (fear)
worry
- Leading diagnosis of anxiety disorders
Panic Disorder
GAD
Implicit neurotransmitters *
Dopamine: essential role in movement. also influences motivation and plays a role in how person perceives reality
- too much dopamine can contribute to worsening OCD
Serotonin: helps regularly mood sleep and appetite, inhibits pain
Norepinephrine: constricts blood vessels and raises BP, excess can increase anxiety
GAD-7*
ANXIETY measurement
refer 10 or greater
5=mild
10=moderate
15=severe anxiety
Management of Chronic Anxiety *
Mild: CBT first (can add pharm if doesnt work)
Mod-Sev: Use pharm with or without CBT
Buspirone *
- Effective ONLY for GAD, not indicated for anxiety subtypes
- NOT an acute drug
- Non addictive
- Does not work well for people who have had benzo exposure
- NOT FOR AS NEEDED USE
- Onset 7-10 days, (peak 3-4 weeks)
When to use Benzos *
- Primarily for acute episodes
pts acutely fearful - Patients who have panic attacks
impending doom
tachy/palps
diaphoresis
SOB - not indicated for most anxiety disorders BUT are second line option for GAD and panic disorder when appropriate
DSM5 Criteria *
- excessive anxiety and worry occuring more days than not for 6 mo
- difficult to control
- anxiety and worry associated with 3 or more of the following symptoms
(note: only 1 item required for children)
- restlessness, feeling keyed up or on edge
- being easily fatigued
- difficult concentrating or blank mind
- irritability
- muscle tension
- sleep disturbance
Response to Treatment *
- remember to follow highly anxious patients closely (higher risk of suicide)
- GAD7 score < 5 as indicator for remission
- partial response 25-75% reduction on GAD7 score
- no response < 25% reduction on GAD7 score
- AFTER ADEQUATE DOSE/TIME
(usually 4-8weeks)
Know questions on CAGE questionnaire and alcohol use disorder identification (AUDIT)
Change Theory
DSM5 diagnostic criteria and symptoms for alcohol abuse
Alcohol abuse treatment
Disfusilarm reaction (buspar?)
National Institute of alcohol abuse definition of low risk drinking
BMI
Weight loss Meds:
contraindications
precautions
AE
frequencies
phentermine
liraglutide
naltrexone-bupropion
phentermine-topiramate
orlistat
