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PR3136 > Treatment of Anxiety > Flashcards

Treatment of Anxiety Flashcards

1
Q

Long term treatment goal for GAD, PD, SAD and PTSD (2)

A
  • remission of core anxiety symptoms

- recovery of function

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2
Q

Long term treatment goal for OCD (2)

A
  • complete resolution of symptoms is often difficult to achieve
  • relapse rate very high with poor medication adherence
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3
Q

Objective assessment of outcomes (3)

A
  • Psychiatric rating scales
    eg Hamilton Anxiety Scale
  • identify target symptoms for each type of anxiety disorders (classify which type of anxiety disorders the patient have)
  • keep detailed diary to record fear levels, physical symptoms, cognition and anxious behaviours
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4
Q

Non-pharmacological management

A
  • recommended in combination to medication treatment
  • cognitive behavioural therapy
    eg OCD = CBT + SSRI/Clomipramine
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5
Q

Duration of medication treatment

A

GAD, SAD, PD & PTSD
- 1 year
OCD
- 1-2 years

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6
Q

What type of antidepressants good for anxiety disorders & why

A

All serotonergic agents
eg SSRI, SNRI
- promote 5-HT transmissions have efficacy for anxiety disorders
- 5-HT inhibit amygdala output

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7
Q

Antidepressants efficacy & dosing features for anxiety (3)

A
  • effective for worrying/apprehension type of symptoms
  • initiate at low dose then gradually titrate up to maximum dose range
  • maintenance dose usually will be at high end of therapeutic range
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8
Q

Time to respond for antidepressants

A
  • 6-12 weeks

- maximum response may take 3 months

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9
Q

Discontinuation of antidepressants in anxiety

A
  • gradually taper dose to avoid discontinuation syndrome (FINISH)
    eg 10-25% reduction in dose every 1-2 weeks
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10
Q

What type of benzodiazepines good for anxiety disorders (4)

A
  1. Diazepam
  2. Lorazepam
  3. Clonazepam
  4. Alprazolam
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11
Q

Benzodiazepines efficacy in anxiety (4)

A
  • not recommended for monotherapy
  • short course PRN (3-4 months)
  • quick onset of effects (~30min)
  • effective for physical/somatic symptoms
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12
Q

Discontinuation of benzodiazepines in anxiety

A
  • gradual taper to avoid rebound anxiety
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13
Q

Abrupt discontinuation with antidepressants vs benzodiazepines

A

Abrupt discontinuation with antidepressants
- Serotonin Withdrawal Symptoms (FINISH)

Abrupt discontinuation with benzodiazepines
- rebound anxiety

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14
Q

Significant DDI with benzodiazepines

A
  • CNS depressants

eg benzodiazepines & opioids = increased risk of mortality

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15
Q

Early ADR of anxiety treatment

A
  • possible increased anxiety (transient jitteriness) with antidepressants during 1-2 weeks
  • N/V, insomnia/sedation, headache (usually subsides 2-3 weeks of continued treatment)
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16
Q

Long term ADR of anxiety treatment

A
  • SD
  • weight gain
    may lead to discontinuation of treatment
17
Q

Types of anxiety disorders (5)

A
  1. General Anxiety Disorder (GAD)
  2. Social Anxiety Disorder (SAD)
  3. Panic Disorder (PD)
  4. Post Traumatic Stress Disorder (PTSD)
  5. Obsessive Compulsive Disorder (OCD)
18
Q

Anxiety disorders (3)

A
  • severe, excessive, persistent anxiety
  • irrational fears that impairs functioning with everyday living (severe)
  • anxiety is out of proportion to the actual danger or threat (excessive)
  • persists long even after original trigger disappeared (persistant)
19
Q

Prevalence of OCD in Singapore

A

3.6%

20
Q

Generalised Anxiety Disorder (GAD)

A
  • excessive anxiety & worries

- at least 6 months

21
Q

Panic Disorder (PD)

A
  • anticipatory anxiety of recurrent panic attacks
22
Q

Social Anxiety Disorder (SAD)

A
  • fear of being scrutinised or humiliated by others in public
23
Q

Obsessive Compulsive Disorder (OCD)

A
  • obsessional thoughts/impulses that causes anxiety
  • patient is aware that thoughts are product of their own mind
  • followed by compulsive behaviours to relieve that anxiety that is excessive & repetitive
24
Q

Post-Traumatic Stress Disorder (PTSD) (3)

A
  • re-experiencing of trauma
  • persistent avoidance
  • increased arousal
25
Q

Etiology of anxiety disorders

A
  • imbalance of excitatory and inhibitory neurotransmitters
  • 5-HT can inhibit amygdala output
  • GABA (inhibitory neurotransmitter)
26
Q

GAD antidepressant treatment (3)

A
  1. SSRI
  2. Venlafaxine XR (SNRI)
  3. Pregabalin
27
Q

PD antidepressant treatment (1)

A

SSRI

28
Q

SAD treatment (1)

A

SSRI

29
Q

OCD treatment (3)

A

SSRI
> Clomipramine
> SNRI

30
Q

PTSD treatment (1)

A

SSRI

31
Q

Approach to dosing antidepressants in anxiety

A
  • start low

- titrate to high end of the range

32
Q

High potency benzodiazepines (3)

A
  1. Clonazepam
  2. Alprazolam XR
  3. Lorazepam (short acting)
33
Q

OCD vs Schizophrenia (2)

A

OCD

  • patient know the irrational of their behaviours but still cannot stop themselves from doing it
  • patient in reality

Schizophrenia

  • patient can tell you that they got bizarre ideas and they believe in it
  • patient not in reality
34
Q

Serotonin Syndrome symptoms (8)

A

RDTSMCCD

  1. restlessness
  2. diaphoresis (excessive, abnormal sweating)
  3. tremor
  4. shivering
  5. myoclonus
  6. confusion
  7. convulsions
  8. death
35
Q

Method to reduce the risk of initial increased anxiety (jitteriness) when first initiated on serotonergic agents?

A

Reduce the dose of serotonergic agents

PR3136 (19 decks)

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