Week 10 - Chapter 35 Management of Anxiety Disorders Flashcards
Generalized Anxiety Disorder
chronic condition characterized by uncontrollable worrying. Of all anxiety disorders, GAD is the least likely to remit. Most patients with GAD also have another psychiatric disorder, usually depression. GAD should not be confused with situational anxiety, which is a normal response to a stressful situation (eg, family problems, exams, financial difficulties); symptoms may be intense, but they are temporary.
Obsessive-Compulsive Disorder
potentially disabling condition characterized by persistent obsessions and compulsions that cause marked distress, consume at least 1 hour a day, and significantly interfere with daily living. An obsession is defined as a recurrent, persistent thought, impulse, or mental image that is unwanted and distressing, and comes involuntarily to mind despite attempts to ignore or suppress it. Common obsessions include fear of contamination (eg, acquiring a disease by touching another person), aggressive impulses (eg, harming a family member), a need for orderliness or symmetry (eg, personal bathroom items must be arranged in a precise way), and repeated doubts (eg, did I unplug the iron?). A compulsion is a ritualized behavior or mental act that the patient is driven to perform in response to his or her obsessions. In the patient’s mind, carrying out the compulsion is essential to prevent some horrible event from occurring (eg, death of a loved one). If performing the compulsion is suppressed or postponed, the patient experiences increased anxiety. Common compulsions include hand washing, mental counting, arranging objects symmetrically, and hoarding. Patients usually understand that their compulsive behavior is excessive and senseless, but nonetheless are unable to stop.
Panic Disorder
haracterized by recurrent, intensely uncomfortable episodes known as panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort during which four or more of the following are present:
• Palpitations, pounding heart, racing heartbeat
• Sweating
• Trembling or shaking
• Sensation of shortness of breath or smothering
• Feeling of choking
• Chest pain or discomfort
• Nausea or abdominal distress
• Feeling dizzy, unsteady, lightheaded, or faint
• Chills or heat sensations
• Paresthesias (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from oneself)
• Fear of losing control or going crazy
• Fear of dying
Post-Traumatic Stress Disorder
(PTSD) develops following a traumatic event that elicited an immediate reaction of fear, helplessness, or horror. PTSD has three core symptoms: reexperiencing the event, avoiding reminders of the event (coupled with generalized emotional numbing), and a persistent state of hyperarousal. A traumatic event is one that involves a threat of injury or death, or a threat to one’s physical integrity. Many events meet this criterion. Among these are physical or sexual assault, rape, torture, combat, industrial explosions, serious accidents, natural disasters, being taken hostage, displacement as a refugee, and terrorist attacks, such as the ones that took place against the World Trade Center and the Pentagon on September 11, 2001. It should be noted that PTSD can affect persons who were only witnesses to a traumatic event—not just those who were directly involved.
Social Anxiety Disorder
formerly known as social phobia, is characterized by an intense, irrational fear of situations in which one might be scrutinized by others, or might do something that is embarrassing or humiliating. Exposure to the feared situation almost always elicits anxiety. As a result, the person avoids the situation or, if it can’t be avoided, endures it with intense anxiety (manifestations include blushing, stuttering, sweating, palpitations, dry throat, and muscle tension and twitches).
Social anxiety disorder has two principal forms: generalized and performance only. In the generalized form, the person fears nearly all social and performance situations. In the performance-only form, fear is limited to speaking or performing in public.
Social anxiety disorder can be very debilitating. In younger people, it can delay social development, inhibit participation in social activities, impair acquisition of friends, and make dating difficult or even impossible. It can also preclude pursuit of higher education. In older people, it can severely limit social and occupational options.
Social anxiety disorder is one of the most common psychiatric disorders, and the most common anxiety disorder. In the United States, 13% to 14% of the population is affected at some time in their lives. The disorder typically begins during the teenage years and, left untreated, is likely to continue lifelong.
Diazepam - use
anxiety
Diazepam - mechanism of action
enhancing responses to gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter
Diazepam - adverse effects
Principal side effects are sedation and psychomotor slowing. Patients should be warned about these effects and informed that they will subside in 7 to 10 days. Because of their abuse potential, benzodiazepines should be used with caution in patients known to abuse alcohol or other psychoactive substances.
Long-term use of benzodiazepines carries a risk of physical dependence. Withdrawal symptoms include panic, paranoia, and delirium. These can be especially troubling for patients with GAD. Furthermore, they can be confused with a return of pretreatment symptoms. Accordingly, clinicians must differentiate between a withdrawal reaction and relapse. To minimize withdrawal symptoms, benzodiazepines should be tapered gradually—over a period of several months. If relapse occurs, treatment should resume.
Diazepam - category
Benzodiazepines
Buspirone - mechanism of action
The mechanism by which buspirone relieves anxiety has not been established. The drug binds with high affinity to receptors for serotonin and with lower affinity to receptors for dopamine. Buspirone does not bind to receptors for GABA or benzodiazepines.
Buspirone - category
anxiolytic drug
Buspirone - use
anxiety
Buspirone - adverse effects
generally well tolerated. The most common reactions are dizziness, nausea, headache, nervousness, sedation, lightheadedness, and excitement. Furthermore, it poses little or no risk of suicide; huge doses (375 mg/day) have been given to healthy volunteers with only moderate adverse effects (nausea, vomiting, dizziness, drowsiness, miosis).
