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35 Cards in this Set

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  • Back
What are the characteristics of Generalized Anxiety Disorder (GAD)?
excessive anxiety/worry, restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance
Posttraumatic Stress Disorder (PTSD)
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
What are the characteristics of Panic Disorder (panic attack)?
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
What are the characteristics of Panic Disorder (agoraphobia)?
Anxiety about being in place from which escape might be difficult and panic attack might occur -> avoid these situations
What are the clinical features of Social Anxiety Disorder?
self focused attention, negative self-evaluation, somatic arousal, avoidance, behavioral disruption of nL functioning, skills deficit
Can be specific or generalized
What are complications of Social Anxiety Disorder?
impaired social/vocational function, financial dependence, vocational underachievement, depression, substance abuse (alcohol), suicide
What are treatment options for Social Anxiety Disorder?
Beta blockers (only performance anxiety), SSRIs, MAOIs, Benzodiazepines, Gabapentin,
Bupropion, Nefzodone, Clonidine, Pramipexole, Ondansetron
Body Dysmorphic Disorder (BDD)
perceive small anomalies as major defects, causes marked distress, can involve entire body or single body part
13% prevalence among psych inpatients, often underrecognized
What are treatment options for Body Dysmorphic Disorder (BDD)?
SSRI's and clomipramine (better than desipramine, equally effective for delusional and non-delusional BDD)
Characteristics of Hypochondriasis
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
What is the treatment for hypochondriasis?
Also: Fluvoxamine, Clomipramine, Amitriptyline, Doxepin, MAOIs, Pimozide
OCD: Obsessions
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
OCD: Compulsions
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.
OCD: Insight
At some point person recognizes that compulsion or obsession is excessive/unreasonable
does NOT apply to children
What are some subtypes of OCD?
Groomers, slowness, face pickers
What are some characteristics of OCD?
behavior seems senseless, ego-dystonic, gives no pleasure
if resist compulsion get aniety; if yield, release tension -> stuck in this cycle
Obsessive-Compulsive Personality Disorder (OCPD)
Not characterized by presence of obsessions/compulsions -> instead involves pervasive pattern of preoccupation with orderliness, perfectionism, control
What is the treatment for OCD?
Cognitive-behavior therapy plus pharmacotherapy (SSRIs)
atypical antipsychotics sometimes exacerbate OCD sx
To augment: SSRI+clomipramine, Risperidone, Olanzapine, Quetiapine, Haloperidol
What is treatment for Refractory OCD?
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)
Benzodiazepene receptor (omega) is attached to GABA receptor is attached to Cl channel that allows Cl rush into cell and hyperpolarize it.
Alcohol and barbituates act on channel independent of GABA.
Too much = death.
What is the mechanism of action of Barbiturates?
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
What are side effects of barbiturates?
somnolence, ataxia, REM sleep suppression, paradoxical excitation, dependence/abuse, tolerance
What is the mechanism of action of Benzodiazepines?
bind BZD (omega) receptors -> enhance afinity for GABA (rate limiting step). less dangerous than barbiturates. dangerous when mixed with CNS depressants (Alcohol).
What/where are the different BZD receptors?
BZD1 (CNS) - sleep
BZD2 (CNS) - confusion, motor control, cognition
BZD3 (peripheral) - muscle relaxation
How is the rate of change important for different BZD's?
Rate of change (conc/time) is proportional to initial euphoria felt after taking drug. Activates dopamine pleasure centers. Alprazolam (Xanax)>Diazepam>Clonazepam
Which three BZDs do NOT require oxidation (hepatic metabolism) for elimination?
lorazepam (Ativan)
temazepam (restoril)
oxazepam (serax)
Can give to chronic alcoholics, others with impaired livers
What are the side effects of Benzodiazepines?
somnolence, ataxia, confusion, memory impairment, paradoxical excitation, REM suppression, dependency/abuse, tolerance
What are some BZDs and their relative potencies?
Clonazepam (Klonopin) > Alprazolam (Xanax) > Lorazepam (Ativan) > Diazepam (Valium) > Chlordiazepoxide (Librium)
What are the selective BZD receptor agonists?
Zolpidem (Ambien) BZD1 > BZD2
Zaleplon (Sonata) BZD1 >> BZD2
Neither stops sz (need pure BZD)
What are the non-BZD, non-barbiturate anxiolytics?
SSRIs/SNRIs (Nefazodone, Trazodone, Mirtazapine)
Buspirone (Buspar) -> partial agonist at 5HT1a receptor, delayed onset (no abuse potential), limited side effect, minimal drug interactions
Rarely used anxiolytics
Chloral hydrate (Noctec)
Glutethamide (Doriden)
Methyprylon (Noludar)
Ethclovynol (Placidyl)
Methaqualone (Quaalude)
Antihistamies used as anxiolytics/hypnotics
Diphenhydramine (Benadryl)
Hydroxazine (Atarax)
Cyproheptadine (Periactin)
Long acting barbiturates
Half life: 12-24 hrs
Used in sz disorders
Phenobarbital (Luminal), Mephobarbital (Mebaral)
Short and Intermediate acting barbiturates
Half life: 3-8hrs
Used (if at all) as sedative/hypnotic
Amobarbital (Amytal), Butabarbital (Butisol), Pentobarbital (Nembutal), Secobarbital (Seconal)
Ultrashort-acting barbiturates
Half life: minutes
Used for induction anesthetics
Thiopental (Pentothal), Thiamylal (Surital), Hexobarbital (Sombulex)