Behavioral Science - Anxiety Disorders And Antiolytics

Front 1

What are the characteristics of Generalized Anxiety Disorder (GAD)?

Back 1

excessive anxiety/worry, restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance

Front 2

Posttraumatic Stress Disorder (PTSD)

Back 2

exposed to traumatic event AND event involved threatened death/serious injury AND person responded with fear

traumatic event persistently reexperienced, avoid stimuli, sx of increased arousal

Front 3

What are the characteristics of Panic Disorder (panic attack)?

Back 3

palpitations, sweating, trembling/shaking, sensation of being short of breath, feeling of choking, chest pain, nausea, dizzy/feeling faint, derealization/depersonalization, fear of losing control/going crazy, fear of dying

Front 4

What are the characteristics of Panic Disorder (agoraphobia)?

Back 4

Anxiety about being in place from which escape might be difficult and panic attack might occur -> avoid these situations

Front 5

What are the clinical features of Social Anxiety Disorder?

Back 5

self focused attention, negative self-evaluation, somatic arousal, avoidance, behavioral disruption of nL functioning, skills deficit
Can be specific or generalized

Front 6

What are complications of Social Anxiety Disorder?

Back 6

impaired social/vocational function, financial dependence, vocational underachievement, depression, substance abuse (alcohol), suicide

Front 7

What are treatment options for Social Anxiety Disorder?

Back 7

Beta blockers (only performance anxiety), SSRIs, MAOIs, Benzodiazepines, Gabapentin,
Clonazepam
Bupropion, Nefzodone, Clonidine, Pramipexole, Ondansetron

Front 8

Body Dysmorphic Disorder (BDD)

Back 8

perceive small anomalies as major defects, causes marked distress, can involve entire body or single body part
13% prevalence among psych inpatients, often underrecognized

Front 9

What are treatment options for Body Dysmorphic Disorder (BDD)?

Back 9

SSRI's and clomipramine (better than desipramine, equally effective for delusional and non-delusional BDD)

Front 10

Characteristics of Hypochondriasis

Back 10

consume vast amounts of medical resources, very debilitating, often don't seek psych help
Causes distress, latrogenic illnesses, high cost, delayed recognition of real med illnesses

Front 11

What is the treatment for hypochondriasis?

Back 11

Fluoxetine
Imipramine
Paroxetine
Also: Fluvoxamine, Clomipramine, Amitriptyline, Doxepin, MAOIs, Pimozide

Front 12

OCD: Obsessions

Back 12

Persistent thoughts, impulses, images that are experienced as intrusive, inappripriate and distressing. Recognize they are a product of his/her mind. Attepmt to ignore/suppress thoughts or neutralize them with other thoughts/actions

Front 13

OCD: Compulsions

Back 13

Repetitive behaviors or mental acts that a person feels driven to perform in response to obsession. Aimed at reducing distress, preventing dreaded situation. Unrealistic or obsessive.

Front 14

OCD: Insight

Back 14

At some point person recognizes that compulsion or obsession is excessive/unreasonable
does NOT apply to children

Front 15

What are some subtypes of OCD?

Back 15

Washers/cleaners
Checkers/harmers
Sinners/doubters
Orderers/arrangers
Hoarders
Groomers, slowness, face pickers

Front 16

What are some characteristics of OCD?

Back 16

behavior seems senseless, ego-dystonic, gives no pleasure
if resist compulsion get aniety; if yield, release tension -> stuck in this cycle

Front 17

Obsessive-Compulsive Personality Disorder (OCPD)

Back 17

Not characterized by presence of obsessions/compulsions -> instead involves pervasive pattern of preoccupation with orderliness, perfectionism, control

Front 18

What is the treatment for OCD?

Back 18

Cognitive-behavior therapy plus pharmacotherapy (SSRIs)
atypical antipsychotics sometimes exacerbate OCD sx
To augment: SSRI+clomipramine, Risperidone, Olanzapine, Quetiapine, Haloperidol

Front 19

What is treatment for Refractory OCD?

Back 19

cingulotomy and anterior capsulotomy (improve up to 50% patients, no impairment of cognitive/personality)
Deep Brain Stimulation (electrode in limbic structures, reversible/minimal side effects)

Front 20

Benzodiazepene receptor (omega) is attached to GABA receptor is attached to Cl channel that allows Cl rush into cell and hyperpolarize it.

Back 20

Alcohol and barbituates act on channel independent of GABA.
Too much = death.

Front 21

What is the mechanism of action of Barbiturates?

Back 21

bind within GABA mediated Cl channel -> stay open longer -> hyperpolarize; induce P450
INDEPENDENT of GABA (dangerous in overdose!!)
longevity determined by location of termination: kidney > liver > CNS

Front 22

What are side effects of barbiturates?

Back 22

somnolence, ataxia, REM sleep suppression, paradoxical excitation, dependence/abuse, tolerance

Front 23

What is the mechanism of action of Benzodiazepines?

Back 23

bind BZD (omega) receptors -> enhance afinity for GABA (rate limiting step). less dangerous than barbiturates. dangerous when mixed with CNS depressants (Alcohol).

Front 24

What/where are the different BZD receptors?

Back 24

BZD1 (CNS) - sleep
BZD2 (CNS) - confusion, motor control, cognition
BZD3 (peripheral) - muscle relaxation

Front 25

How is the rate of change important for different BZD's?

Back 25

Rate of change (conc/time) is proportional to initial euphoria felt after taking drug. Activates dopamine pleasure centers. Alprazolam (Xanax)>Diazepam>Clonazepam

Front 26

Which three BZDs do NOT require oxidation (hepatic metabolism) for elimination?

Back 26

lorazepam (Ativan)
temazepam (restoril)
oxazepam (serax)
Can give to chronic alcoholics, others with impaired livers

Front 27

What are the side effects of Benzodiazepines?

Back 27

somnolence, ataxia, confusion, memory impairment, paradoxical excitation, REM suppression, dependency/abuse, tolerance

Front 28

What are some BZDs and their relative potencies?

Back 28

Clonazepam (Klonopin) > Alprazolam (Xanax) > Lorazepam (Ativan) > Diazepam (Valium) > Chlordiazepoxide (Librium)

Front 29

What are the selective BZD receptor agonists?

Back 29

Zolpidem (Ambien) BZD1 > BZD2
Zaleplon (Sonata) BZD1 >> BZD2
Neither stops sz (need pure BZD)

Front 30

What are the non-BZD, non-barbiturate anxiolytics?

Back 30

SSRIs/SNRIs (Nefazodone, Trazodone, Mirtazapine)
Buspirone (Buspar) -> partial agonist at 5HT1a receptor, delayed onset (no abuse potential), limited side effect, minimal drug interactions

Front 31

Rarely used anxiolytics

Back 31

Chloral hydrate (Noctec)
Glutethamide (Doriden)
Methyprylon (Noludar)
Ethclovynol (Placidyl)
Methaqualone (Quaalude)

Front 32

Antihistamies used as anxiolytics/hypnotics

Back 32

Diphenhydramine (Benadryl)
Hydroxazine (Atarax)
Cyproheptadine (Periactin)

Front 33

Long acting barbiturates

Back 33

Half life: 12-24 hrs
Used in sz disorders
Phenobarbital (Luminal), Mephobarbital (Mebaral)

Front 34

Short and Intermediate acting barbiturates

Back 34

Half life: 3-8hrs
Used (if at all) as sedative/hypnotic
Amobarbital (Amytal), Butabarbital (Butisol), Pentobarbital (Nembutal), Secobarbital (Seconal)

Front 35

Ultrashort-acting barbiturates

Back 35

Half life: minutes
Used for induction anesthetics
Thiopental (Pentothal), Thiamylal (Surital), Hexobarbital (Sombulex)