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Quiz 2 Flashcards

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1
Q

What is the DSM-5 criteria for GAD?

A

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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2
Q

What is the DSM-5 criteria for panic disorder?

A 
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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3
Q

What is the DSM-5 criteria for PTSD?

A 
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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4
Q

What events may a PTSD patient experience?

A

Directly experiences
Witnessing
Learning
Repeated/extreme exposure

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5
Q

What are ways PTSD patients may re-experience events?

A 
Memories
Dreams
Flashbacks
Psychological distress
Reactivity
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6
Q

What are events PTSD patients may experience persistent avoidance?

A

Memories

External reminders

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7
Q

When might PTSD patients experience alterations in cognition and mood?

A 
Inability to remember 
Exaggerated beliefs
Distorted cognitions
Negative emotional state
Diminished interest
Detachment
Persistent inability to experience positive emotions
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8
Q

When might PTSD patients experience arousal and reactivity?

A 
Irritability/outbursts of anger
Recklessness/self-destructive behavior
Hypervigilance
Exaggerated startle response
Difficulty concentrating
Difficulty falling or staying asleep
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9
Q

What is the duration for PTSD diagnosis?

A

1+ month

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10
Q

What is the first line treatment of GAD?

A

Most SSRIs and SNRIs

Sx may worsen initially with SSRI tx

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11
Q

What are first line treatments for Panic Disorders?

A

SSRIs

SNRIs

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12
Q

What are the first line treatments of OCD?

A

CBT

SSRIs

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13
Q

What are the first line treatments for PTSD?

A

SSRIs

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14
Q

What is the treatment of GAD in non-response?

A

Try a different 1st line agent

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15
Q

What is the treatment of OCD in partial response?

A

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

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16
Q

What is the role of SSRIs in treatment of anxiety?

A

First line because they treat related/core symptoms

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17
Q

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

A

6+ months

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18
Q

What is the onset of SSRIs?

A

4-8 weeks

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19
Q

How long until a response is seen in SSRIs?

A

~12 weeks

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20
Q

What is the DOT of GAD and Panic Disoder?

A

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

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21
Q

What is the DOT for PTSD?

A

12+ months

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22
Q

What is the DOT for OCD?

A

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

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23
Q

What is the general rule for MTM in PTSD?

A

Start low, go slow

Titrate over weeks to months

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24
Q

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

A

SRI first

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

25
Q

What is the benzo place in therapy for GAD?

A

2nd line therapy

26
Q

How long are benzos used in GAD?

A

4 weeks or less

27
Q

Why are short-term adjunctive benzos used for GAD?

A

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

28
Q

Why are benzos used short term in GAD?

A

SEs (dependence, WD, abuse)

29
Q

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

A 
2nd line (if not SUD/mood disorder) or
Adjunctive
30
Q

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

A

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

31
Q

What are benzo’s place in therapy for PTSD?

A

Do not target core sx

Should be avoided (safer agents for sleep and anxiety)

32
Q

What is CBT’s place in therapy for GAD?

A

CBT is effective first line option for the treatment of GAD

CBT + meds is better than either alone

33
Q

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

A

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

34
Q

What is CBT’s place in therapy for PTSD?

A

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

35
Q

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

A

Can decrease dose, and titrate more slowly

36
Q

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

A

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

37
Q

What is the DSM-5 criteria for insomnia diagnosis?

A

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

38
Q

What is the definition of chronic persistent insomnia?

A

3+ nights/week 3+ months

39
Q

What is the onset of Ambien?

A

30 minutes

40
Q

What is the onset of zaleplon?

A

15-20 minutes

41
Q

What is the onset of Lunesta?

A

30-45 minutes

42
Q

What is the maintenance dose of Ambien?

A

5-10mg QHS PRN

43
Q

What is the maintenance dose of zaleplon?

A

5-20mg QHS PRN

44
Q

What is the maintenance dose of Lunesta?

A

1-3mg QHS PRN

45
Q

What is the role of Ambien?

A 
IR = as needed for sleep onset
CR = Sleep onset and/or maintenance (up to 6 months)
46
Q

What is the role of zaleplon?

A

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

47
Q

What is the role of Lunesta?

A

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

48
Q

What is a weird side effect of Lunesta?

A

Unpleasant taste

49
Q

What disorders may cause insomnia?

A 
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
50
Q

What medications may cause insomnia?

A

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

51
Q

What is the MOA of NBRAs?

A

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

52
Q

What are the NBRAs?

A

Ambien
Zaleplon
Lunesta

53
Q

What is the DORAS?

A

Belsomra (suvorexant)

54
Q

What is the DORAS MOA?

A

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

55
Q

What is the MT1+2 MOA?

A

Ramelteon (rozerem)

56
Q

What is the MOA of MT1+2?

A

Melatonin receptor agonist selective for MT1 and MT2 receptors

57
Q

What is the MOA for TCAs in insomnia?

A

Doxepin selective antagonism for H1 receptor at low dose

58
Q

What are the consequences of insomnia?

A

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

Psych (9 decks)

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