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Pharmacy Y3- Mental Health > Week 8- Generalised anxiety disorder + Anxiety Overview, Prescribing and Counselling Advice > Flashcards

Week 8- Generalised anxiety disorder + Anxiety Overview, Prescribing and Counselling Advice Flashcards

1
Q

what is GAD?

A

is where the anxiety doesn’t go away, lasts for at least 6 months, and where the worry is out of proportion to the riskre the anxiety doesn’t go away, lasts for at least 6 months, and where the worry is out of proportion to the risk

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2
Q

what is the most common type of anxiety?

A

GAD

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3
Q

what type of symptoms always comes along with GAD?

A

Depression and managing this is a priority

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4
Q

what is he incidence rate for GAD?

A

5%

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5
Q

what are some serious symptoms of GAD?

A

they become desperate and suicidal

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6
Q

whats the difference between panic and GAD ANXIETY?

A

GAD- anxiety is continous but may fluctuate in intensity

Panic disorder- unrelated to any circumstance

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7
Q

when is the onset of GAD?

A

early adulthood, tends to change with age as the subject of the anxiety evolves with time

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8
Q

what are symptoms in GAD?

A
  • hyperventilation
  • palpitations
  • sweating
  • trembling
  • dry mouth
  • dyspnoea
  • chest or abdominal -discomfort
  • thinking the worst of an event e.g. any ache or pain becomes a serious illness
  • fear of losing control
  • poor concentration
  • irritability
  • disturbed sleep
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9
Q

What are some signs on presentation for GAD?

A

facial straining, restlessness and being close to tears

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10
Q

what are some major symptoms when diagnosing GAD?

A

-Excessive anxiety and worry about a number of events and activities
Difficulty controlling the worry
-MUST HAVE BOTH MAJOR SYMPTOMS, OCCURING MORE DAYS THAN NOT, FOR ATLEAST 6 MONTHS

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11
Q

what are some additional symptoms for diagnosing GAD?

A
  • Restlessness or feeling keyed up or on edge
  • Being easily fatigued
  • Difficulty concentrating or mind going blank
  • Irritability
  • Muscle tension
  • Sleep disturbance
  • MUST HAVE ATLEAST 3 OUT OF 6 ADDITIONAL SYMPTOMS
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12
Q

what other diseases are related and linked with anxiety and need to be differentiated from?

A

-Depression
-Schizophrenia
-Dementia
-Substance Misuse
-Physical Illness e.g. –Thyrotoxicosis and
hypoglycaemia (these can have tests done to differentiate.)

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13
Q

How many steps are in the stepped care model for patients with GAD?

A

4

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14
Q

what is step 1 of the stepped care model for patients with GAD?

A

STEP 1- Recognise and suspected presentations of GAD, identification and assessment, educate about GAD and look into treatment

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15
Q

what is step 2 of the stepped care model for patients with GAD?

A
  • low-intensity psychological intervention and individual guided self help and educational groups
  • diagnosed GAD that hasn’t improved after education and active monitoring in primary care.
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16
Q

what is step 3 of the stepped care model for patients with GAD?

A
  • choice of high intensity psychological intervention (CBT/applied relaxed) or drug treatment
  • GAD with an inadequate response to step 2 intervention or marked function impairment
17
Q

what is step 4 of the stepped care model for patients with GAD?

A

highly specialist treatment e.g. drug and/or psychological treatment regimens

18
Q

what are the main drugs for GAD?

A

First line
-SSRI e.g. sertraline/fluoxetine start at half normal dose then gradually increase. can take 8-12 weeks after treatment dose reached, should be used for at least 12 months, withdrawing is over weeks or months
-Venlafaxine(low dose SSRI and high SNRI)- initially 75mg increased if needed UP TO 225mg, wait 8 before response, treatment for 12 weeks withdraw gradually
-Pregabalin (Schedule 3)- initially 150mg/day in 2/3 dose if needed up to 600mg/day, unclear how long effects take, treatment should be 12months, withdrawal gradually
-

19
Q

why is pregabalin weird for treatment and where it stands in NICE guidelines?

A

-should try SSRI first if not worked use another then try SNRI then pregabalin unless patient cant tolerate SSRI

20
Q

what is the drug used for GAD short term?

A

benzodiazepines

21
Q

what is the drug used for GAD combination and treatment resistant cases?

A

beta-blocker (somatic symptoms)

buspirone

22
Q

what are two other SSRI drugs that can be used for GAD?

A

Start slowly e.g. Paroxetine 5-10mg/d or Escitalopram 5mg/d for a week or so, then increasing stepwise over several weeks as tolerated. Allow 8/52
for response.

23
Q

why is escitalopram superior over paroxetine?

A

relapse prevention has been shown

24
Q

what are some short term, adjuncts and second line drugs for GAD?

A
  • Benzodiazepines short-term
  • Beta-blockers low dose short-term
  • Antihistamines low dose short-term
  • Antipsychotics low dose short-term
  • Venlafaxine/ Mirtazapine
  • Pregabalin
  • Buspirone
25
Q

what are the different types of anxiety?

A 
• Generalised anxiety disorder (GAD)
 • Obsessive compulsive disorder (OCD) 
• Post-traumatic stress disorder (PTSD) 
• Panic disorder 
• Phobic anxiety disorders
- Specific phobia
- Social phobia (social anxiety disorder; SAD) 
-Agoraphobia
26
Q

what is the prevalence for anxiety?

A

ranged between 0.9-28.3% when looked at over 47 countries

27
Q

what is the aetiology of anxiety disorders?

A 
• Genetic factors - some individuals are resilient and
others are vulnerable
• Environmental (childhood trauma) 
• Psychosocial factors
• Relationship problems
• Unemployment
• Social isolation
• Co-morbidity (depression +substance misuse)
28
Q

what are some clinical features of anxiety?

A 
Fearful Anticipation
 Irritability 
Worrying thoughts
 Dry Mouth 
Constriction of Chest Palpitations 
Tremor Headache 
Hyperventilation Breathlessness
 Insomnia
29
Q

what are the main treatments for anxiety disorders?

A

-SSRI’s -first line for all types
-Benzodiazepines (BDZs, e.g. Lorazepam, Diazepam,
Oxazepam, Clobazam )
-Antipsychotics (e.g. Risperidone, Olanzapine, Quetiapine, Pericyazine)
-Venlafaxine and Duloxetine
-Tricyclic Antidepressants (Clomipramine, Imipramine)
-Pregabalin (controlled drug)

30
Q

what are the other treatment used for anxiety disorder?

A

-Mirtazapine (unlicensed) if they have depression/sleep issues also used for that)
-Buspirone ( not commonly used)
-Beta-Blockers (e.g. Propranolol)
-Antihistamines (e.g. Promethazine
and Hydroxyzine)

31
Q

what is the number one treatment for anxiety?

A

-SSRI (Escitalopram and Paroxetine are
licensed; other SSRIs likely to have similar
efficacy and are widely used)

32
Q

what are some counselling point for SSRIs?

A
  • reposnse is not immediate can take 12wks
  • initial worsening of symptoms is common with SSRI and venlafaxine so start low dose and increase when adverse effects subside
  • long term treatment may occur
  • stopping suddenly can give discontinuation symptoms e.g. restlessness, trouble sleeping, sweating.
  • patients under 30yrs offered SSRI or SNRI can experience increased risk of suicidal thinking and self harm
33
Q

how do you reduce the frequency of increased anxiety when starting ssri ESPEICALLY AT ANTIDEPRESSANT DOSE?

A

-start with low dose
• Escitalopram 5mg/d (can use the liquid or halved tablets)
• Fluoxetine 5-10mg/d (can use the liquid or orodispersibletablets)
• Paroxetine 5-10mg/d (can use the liquid or halved tablets)
• Sertraline 25mg/d (use half 50mg tablet)
• Citalopram 5-10mg/d (can use the liquid or halved tablets)
-then increase dose every 2 weeks
-Short-term benzodiazepines can help this initial anxiety
and if only used for a few weeks carry little if any
dependence liability

34
Q

what is the example for why withdrawal/coming off from anxiety treatment is important?

A

-must be done slowly
-Diazepam has a long half-life and so the effects of
a dose reduction have not become fully apparent
until about 4 weeks after that dose. Leave plenty
of time between dose reductions
-With Diazepam, the last few mg can be the
hardest to stop, with psychological dependence a component.

35
Q

what are some non-pharmacological interventions of anxiety?

A

-Psychotherapeutic approaches:
• Counselling
• Cognitive based therapy (CBT)
• Anxiety management

Self-help
• Dietary - caffeine avoidance or at
least reduction 
• Relaxation techniques
• Self-help groups/ books
• Lifestyle changes

Pharmacy Y3- Mental Health (16 decks)

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