Neuro/psych: Anxiety

Front 1

What is anxiety?

Back 1

diffuse, unpleasant, and vague sense of apprehension

Front 2

hyperhidrosis

Back 2

excessive sweating

Front 3

hyperreflexia

Back 3

overreactive reflexes

Front 4

What is the purpose of anxiety?

Back 4

warns us of internal or external threats

Front 5

List five anxiety disorders

Back 5

Panic Disorder
Obsessive Compulsive Disorder
Post Traumatic Stress Disorder
Social Phobia
Generalized Anxiety Disorder

Front 6

Define panic disorder:

Back 6

unexpected panic attacks

>4 of the following symptoms:
palpitations
sweating
trembling/shaking
sensation of SOB
choking sensation
discomfort, chest pain
GI distress/nausea/vomiting
dizziness
derealization
fear of losing control
fear of dying
paresthesias
chills or hot flashes

Front 7

List several precipitating factors for panic disorders:

Back 7

drugs/substances (stimulants)
unusual sleeping or eating patterns
specific environmental settings
emotional situations

Front 8

Are panic disorders more common in men or women?

Back 8

women (2:1)

Front 9

Which specific fear sometimes accompanies panic attacks?

Back 9

agoraphobia (fear of social situations)

Front 10

Define OCD:

Back 10

recurrent obsessions and/or compulsions
obsessions: persistent ideas, thoughts, impulses, or images
compulsions: repetitive behaviors or mental acts

must be time consuming and cause marked distress to patient
often patient recognizes this is unusual

Front 11

List five common obsessions:

Back 11

contamination
repeated doubts
need for symmetry
intrusive impulses/thoughts
sexual imagery

Front 12

List common compulsions

Back 12

hand washing
ordering
checking
symmetry and precision
hoarding

praying
counting
repeating words silently
need to ask or confess
multiple comparisons

Front 13

Is OCD more common in males or females?

Back 13

equal (happens earlier in males)

Front 14

Define PTSD:

Back 14

exposure to a traumatic life event, followed by:
--reexperiencing of the traumatic event (can be a flashback or a simple reminder)
--symptoms of increased arousal (insomnia, hyperreflexia)
--avoidance of stimuli associated with the trauma

Front 15

Is PTSD more common in women or men?

Back 15

women, 2:1

Front 16

Define social phobia:

Back 16

fear of social or performance situations
--unfamiliar people/scrutiny, embarrassment
--public speaking
--meeting new people, eating in public

Front 17

Define generalized anxiety disorder

Back 17

--excessive anxiety and worry concerning multiple things
--worry is difficult to control
--accompanied by >3 of the following:
fatigue
muscle tension
irritability
disturbed sleep
difficulty concentrating
restlessness

Front 18

What is the difference between GAD and SP?

Back 18

GAD, stress is across all areas of life

Front 19

Is GAD more common in men or women?

Back 19

women, 3:2

Front 20

List medical conditions that are common co-morbidities of anxiety disorders:

Back 20

anigna/MI
arrhythmias
anemia
electrolyte imbalances
hypoglycemia
hypo/hyperthyroidism
asthma
COPD

Front 21

List common drugs that are associated with anxiety:

Back 21

stimulants
sympathomimetics (ephedrine)
dopaminergics (levodopa)
anticholinergics
albuterol
SSRIs

Front 22

Which drugs can produce withdrawal symptoms similar to anxiety?

Back 22

barbiturates
BZDs
narcotics
alcohol
sedatives

Front 23

What are the three categories of treatment for anxiety, and what drugs are in these categories?

Back 23

short-term (BZDs)
long-term (SSRIs, SNRIs, TCAs, Buspirone)
resistant anxiety (beta blockers, mood stabilizers)

Front 24

How do BZDs work?
What are the benefits?
What are the disadvantages?

Back 24

--enhance GABA transmission
--rapid onset, can be used for bridge therapy
--tolerance, dependence, addiction potential, need for taper, cognitive impairment, symptomatic treatment only

Front 25

List adverse effects of BZDs:

Back 25

drowsiness, sedation, blurred vision, ataxia, psychomotor impairment, disorientation, aggression

Front 26

B/G: lorazepam

Back 26

Ativan

Front 27

B/G: clonazepam

Back 27

Klonopin

Front 28

B/G: chloriazepoxide

Back 28

Librium

Front 29

B/G: Oxazepam

Back 29

Serax

Front 30

B/G: diazepam

Back 30

Valium

Front 31

B/G: alprazolam

Back 31

Xanax

Front 32

What are the two ways BZDs are metabolized?

Back 32

conjugation or oxidation
(most that are oxidized have an active metabolite)

Front 33

Which BZD has the fastest onset? Paradoxically, what is its half life?

Back 33

Diazepam
100 hours
(very lipophilic so it gets into the brain very quickly)

Front 34

Which drugs are first line for anxiety?

Back 34

SSRIs
--start low, go slow
--can actually cause anxiety for the first week or so, but then it goes away

Front 35

Why are TCAs not first line for anxiety?

Back 35

equally effective but more side effects than SSRIs

Front 36

Which SNRIs are approved for anxiety?

Back 36

venlafaxine, duloxetine
--start low, go slow

Front 37

Besides BZDs, SSRIs, and TCAs, what other drugs can be used for anxiety?

Back 37

mirtazapine (can improve sleep)
buspirone (does not work that well)
prazosin (PTSD symptoms)
B-blockers (situational anxiety; propranolol)
anticonvulsant agents (not first line; CBZ, VPA, LTG, GBP, TPM, PGP)