Quiz 2 Flashcards by Nicole Gaudreau

What is the DSM-5 criteria for GAD?

Occurring more days than not for 6+ months
Finds it difficult to control the worry
Has 3+ of the following: arousal, fatigued, concentrating, irritability, muscle tension, insomnia
Causes clinically significant distress

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What is the DSM-5 criteria for panic disorder?

4+ sx w/abrupt onset and reaches a peak within 10 minutes
Palpitations, pounding heart, or accelerated HR
Sweating
Trembling/shaking
Sensations of SOB or smothering
Feeling of choking
Chest pain/discomfort
Nausea/abdominal distress
Feeling dizzy, unsteady, lightheaded, or faint
De-realization or depersonalization
Fear of losing control or going crazy
Fear of dying
Paresthesias
Chills or hot flushes

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What is the DSM-5 criteria for PTSD?

The individual experienced events
Persistently re-experienced in 1+ ways
Persistent avoidance
Alteration in cognition and mood
Arousal and reactivity
Duration > 1 month
Clinically significant distress/impairment

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What events may a PTSD patient experience?

Directly experiences
Witnessing
Learning
Repeated/extreme exposure

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What are ways PTSD patients may re-experience events?

Memories
Dreams
Flashbacks
Psychological distress
Reactivity

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What are events PTSD patients may experience persistent avoidance?

Memories

External reminders

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When might PTSD patients experience alterations in cognition and mood?

Inability to remember 
Exaggerated beliefs
Distorted cognitions
Negative emotional state
Diminished interest
Detachment
Persistent inability to experience positive emotions

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When might PTSD patients experience arousal and reactivity?

Irritability/outbursts of anger
Recklessness/self-destructive behavior
Hypervigilance
Exaggerated startle response
Difficulty concentrating
Difficulty falling or staying asleep

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What is the duration for PTSD diagnosis?

1+ month

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What is the first line treatment of GAD?

Most SSRIs and SNRIs

Sx may worsen initially with SSRI tx

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What are first line treatments for Panic Disorders?

SSRIs

SNRIs

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What are the first line treatments of OCD?

CBT

SSRIs

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What are the first line treatments for PTSD?

SSRIs

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What is the treatment of GAD in non-response?

Try a different 1st line agent

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What is the treatment of OCD in partial response?

Titrate to max SRI dose before adding to changing to another SRI

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What is the role of SSRIs in treatment of anxiety?

First line because they treat related/core symptoms

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What is the length of maintenance tx for SSRIs in the treatment of anxiety?

6+ months

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What is the onset of SSRIs?

4-8 weeks

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How long until a response is seen in SSRIs?

~12 weeks

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What is the DOT of GAD and Panic Disoder?

General rule: therapy should be continued for at least 12 months after remission/response for most patients

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What is the DOT for PTSD?

12+ months

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What is the DOT for OCD?

Successful medication treatment should be continued for 1-2 years before considering a gradual taper

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What is the general rule for MTM in PTSD?

Start low, go slow

Titrate over weeks to months

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What is the step-wise approach to adjusting therapy in PTSD?

Study These Flashcards

SRI first

Then augment with: AAP, benzo, gaba, mirtaz, buspar, or b-blocker

What is the benzo place in therapy for GAD?

2nd line therapy

How long are benzos used in GAD?

4 weeks or less

Why are short-term adjunctive benzos used for GAD?

Short course, low dose, until SSRI has time to work

Why are benzos used short term in GAD?

SEs (dependence, WD, abuse)

What is benzo's place in therapy for panic disorder?

``` 2nd line (if not SUD/mood disorder) or Adjunctive ```

How are benzo's used as adjunctive therapy in panic disorder?

Short term (< 8 weeks including taper) can lead to a more rapid response to SSRIs

What are benzo's place in therapy for PTSD?

Do not target core sx | Should be avoided (safer agents for sleep and anxiety)

What is CBT's place in therapy for GAD?

CBT is effective first line option for the treatment of GAD | CBT + meds is better than either alone

What is CBT's place in therapy for panic disorder?

Extensively studied and is an appropriate and efficacious treatment for acute PD 1st line alone or with pharmacotherapy

What is CBT's place in therapy for PTSD?

2nd line is effective and should be continued along with medications for 6-12 months, maybe indefinitely

What do we do to treatment of GAD when there are SEs?

Can decrease dose, and titrate more slowly

What do we do to treatment of GAD when there is intolerance?

AAPs (quetiapine) - should be reserved for antidepressant intolerant or use as adjunct

What is the DSM-5 criteria for insomnia diagnosis?

1+ complaints related to: Difficulty initiating sleep Difficulty maintaining sleep with frequent awakenings or difficulty returning to sleep Early morning awakenings with inability to return to sleep Occurs at least 3 nights/week, lasting at least 3 months

What is the definition of chronic persistent insomnia?

3+ nights/week 3+ months

What is the onset of Ambien?

30 minutes

What is the onset of zaleplon?

15-20 minutes

What is the onset of Lunesta?

30-45 minutes

What is the maintenance dose of Ambien?

5-10mg QHS PRN

What is the maintenance dose of zaleplon?

5-20mg QHS PRN

What is the maintenance dose of Lunesta?

1-3mg QHS PRN

What is the role of Ambien?

``` IR = as needed for sleep onset CR = Sleep onset and/or maintenance (up to 6 months) ```

What is the role of zaleplon?

As needed for: sleep onset and/or (2nd dose for frequent awakenings) *** less tolerance, rebound insomnia WD sx, daytime sedation and dependence vs other z-hypnotics

What is the role of Lunesta?

As needed for: sleep onset and/or maintenance up to 6 months

What is a weird side effect of Lunesta?

Unpleasant taste

What disorders may cause insomnia?

``` COPD, asthma CHF, angina, s/p MI GERD Musculoskeletal, osteoarthritis, RA Parkinson's dz, dementia, alzheimer's dz, RLS MDD, anxiety, psychotic do, akathisia Narcolepsy, EtOH, cocaine, opioid use, sedative/anxiolytic Advancing age (elderly), female ```

What medications may cause insomnia?

Beta2 agonist, ipatropium, oral steroids, theophylline BBs, diuretics, clonidine Oral steroids, caffeine containing analgesics SSRIs, SNRIs Amphetamines, pseudoephedrine

What is the MOA of NBRAs?

Possessing selectivity for BZ-1 receptor on the alpha-subunit of the GABA-A receptor

What are the NBRAs?

Ambien Zaleplon Lunesta

What is the DORAS?

Belsomra (suvorexant)

What is the DORAS MOA?

Inhibits the binding of the wake-promoting neuropeptides orexin-A and orexin-B to the receptors orexin-1 receptor and orexin-2 receptor -> reducing wakefulness and providing a sleep-enhancing effect

What is the MT1+2 MOA?

Ramelteon (rozerem)

What is the MOA of MT1+2?

Melatonin receptor agonist selective for MT1 and MT2 receptors

What is the MOA for TCAs in insomnia?

Doxepin selective antagonism for H1 receptor at low dose

What are the consequences of insomnia?

Deficit of REM sleep results in psychological and behavioral changes Psychiatric disorders may lead to insomnia; insomnia may lead to psychiatric disorders (MDD)

Quiz 2 Flashcards

(58 cards)