Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
71 Cards in this Set
- Front
- Back
|
Autonomic symptoms of anxiety
|
Inc. BP, HR, RR, muscle tension
Inc. levels of Epi, NE, GH, Cortisol, Prolactin |
|
|
BDZs mechanism of action
|
Positive allosteric modulators of GABA
|
|
|
General effects of BDZs (5)
|
Anti-convulsant
Muscle relaxant Sedative-hypnotic Amnestic Anxiolytic |
|
|
Flumazenil
|
BDZ-receptor antagonist
Block effects of BDZs Used to reverse anesthesia and in cases of OD |
|
|
BZ-1 Receptor location & effect
|
Cerebellum
Sedative |
|
|
BZ-2 Receptor locations & effect
|
Hippocampus, Striatum, SC
Anti-convulsant Muscle relaxant |
|
|
Zolpidem (Ambien)
|
BZ-1 selective agonist
Causes sedation NO disruption of normal REM sleep pattern |
|
|
This is especially dangerous when mixed with BDZs
|
Alcohol
|
|
|
BDZs that are reliably absorbed IM (2)
|
Lorazepam
Midazolam |
|
|
BDZ w/ the shortest half-life and thus most amnestic effect
|
Midazolam
|
|
|
Lorazepam key points
|
Given acutely to agitated pts.
Helps combat EPS from antipsychotics NOTE: when given in combos, sedative effects are synergistic |
|
|
Flurazepam key points
|
LONG half-life
Good for middle insomnia NOTE: can cause some daytime sedation |
|
|
Triazolam key points
|
SHORT half-life
Better for initial insomnia Rarely assoc. w/ amnesia or behavior changes |
|
|
Side effect of ALL BDZs except Zolpidem
|
Suppression of REM sleep and stages 3 and 4
|
|
|
BDZ side effects (4)
|
Sedation
Dizziness/Ataxia Mild cognitive impairment Greater rate of falls (elderly) |
|
|
When is it good to use BDZs that don't have active metabolites?
Which BDZs don't have them? |
In liver disease
Lorazepam, Oxazepam, Temazepam |
|
|
Risk factors for BDZ dependence (5)
|
History of alcohol dependence
Potency of medication Duration of treatment Rapidity of onset of CNS effects Agents with shorter-effects |
|
|
Most reasonable BDZs for routine use (2)
|
Lorazepam
Clonazepam |
|
|
What are beta-blockers good for treating (2)?
|
Performance anxiety
Tremor NOTE: LESS effective for cognitive symptoms (ie worry, expectation) |
|
|
What is clonidine used to treat (2)?
|
Autonomic arousal in opiate withdrawal
MILDLY effective in anxiety disorders (NOT 1st choice) |
|
|
5-HT's effects on NE and DA
|
@ Locus Ceruleus - 5HT --> DECREASED NE
@ Nigrostriatum - 5HT --> DECREASED DA |
|
|
What part of the brain do SSRIs enhance 5HT activity in?
|
ALL areas of the brain
|
|
|
Generalized Anxiety Disorder requires 3 or more of the following
|
Restlessness (feeling "keyed up")
Being easily fatigued Difficulty concentrating ("mind going blank") Irritability Muscle tension Sleep disturbance |
|
|
Behaviorist theory about anxiety
|
Anxiety is a conditioned behavior
|
|
|
Psychoanalytic theory on anxiety
|
Sign of some unconscious conflict
"Signal anxiety" is a sign that repression is failing |
|
|
Cognitive behavioral theory on anxiety
|
Pt. is anxious due to characteristic cognitive distortions
|
|
|
Characteristics common to BOTH depression and anxiety (5)
|
Demoralization
Self-absorption Heightened automatic info. processing Maladaptive Schemas Reduced capacity for problem solving |
|
|
Drug of choice for Generalized Anxiety Disorder
|
Buspirone or SSRI
NOTE: TCAs and venlafaxine will also work NOTE: BDZs used to be DOC |
|
|
Panic attack
|
Discrete period of intense fear or discomfort
4 or more symptoms from the list Develop abruptly, reach a peak WITHIN 10 MINUTES |
|
|
Within what time do panic attacks reach their peak?
|
TEN MINUTES
|
|
|
Panic Disorder
|
Recurrent unexpected Panic Attacks
At least one of the attacks followed by 1 or more of: Persistent concern about additional attacks Worry about the implications Significant change in behavior |
|
|
Most common comorbid condition w/ Panic Disorder
|
Major Depressive Disorder (50-65%)
Comorbidity has poorer prognosis |
|
|
Prevalence of other comorbid anxiety disorders
|
Social phobia (15-30%)
OCD (10%) GAD (25%) |
|
|
Most common age of onset for Panic Disorder
|
Mid 20s
|
|
|
Is Panic Disorder more common in men or women?
|
Women (2-3x)
|
|
|
% of panic disorder pts. who attempt suicide
|
7%
Compared to 8% with MDD |
|
|
Ablation of what in animals blocks the fear response?
|
Locus Ceruleus
|
|
|
These triggers true Panic Attacks in panic pts. but NOT in normals (2)
|
Sodium lactate infusion
NOTE: does NOT cross BBB CO2 Inhalation NOTE: lactate is metabolized into CO2 |
|
|
False Suffocation theory
|
Pts. have overly sensitive chemoreceptors
Mild increase in CO2 triggers a smothering sensation |
|
|
Treatment of Panic Attacks
|
Education and support
Cognitive techniques BDZs can be used acutely (usually not monotherapy) SSRIs or TCAs can be used for prophylaxis ("Start low, go slow") |
|
|
Treatments for Phobic Disorders (3)
|
BDZs for acute anxiety or panic
Beta-blockers for specific phobias or performance anxiety SSRIs and MAO-Is for worry in Generalized Social Phobia |
|
|
Main criteria for PTSD (4)
|
Exposure to traumatic event
Persistent re-experiencing of traumatic event Avoidance of stimuli assoc. w/ event and numbing of responsiveness Persistent symptoms of increased arousal |
|
|
In children, recollections of a traumatic event may present as this
|
Repetitive play in which themes of the trauma are expressed
|
|
|
% of people exposed to traumatic stressor that get Acute Stress Disorder
|
50%
|
|
|
% of people who get Acute Stress Disorder that develop PTSD
|
50%
SO, of those who have traumatic stressor, 25% get PTSD |
|
|
% of women who report childhood sexual abuse
|
30%
|
|
|
Learned Helplessness
|
Similar to PTSD
Responds to TCAs |
|
|
With chronic stress, what happens to cortisol system?
|
Cortisol system responsiveness DECLINES
|
|
|
Type of treatment required for PTSD
|
Multimodal (psychotherapy + meds)
Meds alone are not especially helpful |
|
|
Effects of TCAs and MAO-Is in PTSD treatment
|
Treat mood and anxiety symptoms
Treat hypervigilance Treat re-experiencing phenomena MUCH LESS effect on withdrawal and numbing |
|
|
Effects of clonidine, naltrexone, and propranolol in PTSD treatment
|
Similar results to TCAs/MAO-Is
|
|
|
Effects of Li and Carbamazepine in PTSD treatment
|
Help only w/ anger outbursts
"anti-kindling" |
|
|
Effects of BDZs in PTSD treatment
|
May help w/ anxiety
(Use w/ caution) LITTLE EFFECT on numbing/re-experiencing |
|
|
Effects of SSRIs in PTSD treatment
|
Treat depression and anxiety
Treat re-experiencing and numbing BUT, many pts. can't tolerate SSRI side effects (esp. anxiety) |
|
|
Link between Tourette's and OCD
|
5% of OCD pts. have Tourette's
2/3 of Tourette's pts. have OCD |
|
|
Is psychoanalysis effective for OCD?
|
NO
|
|
|
OCD responds preferentially to what types of drugs?
|
SSRIs
BUT, up to 40% of pts. don't respond Addition of D2-blocker helps |
|
|
Functional neuroimaging in OCD shows what?
|
INCREASED activity in:
Orbitofrontal lobes Caudate nucleus Anterior cingulate gyrus Pts. w/ OCD appear to have TOO MUCH executive function |
|
|
OCD pts. have loss of volume in what part of their brains?
|
Caudate nucleus
This could be involved in feedback loop that relates to Tourette's |
|
|
What effect do cocaine/stimulants have in OCD?
|
Worsen the behaviors
Can bring out motor tics in Tourette's |
|
|
How do atypical anti-psychotics effect OCD?
|
They can make it worse
They further increase DA activity in the frontal lobe |
|
|
PANDAS
|
Pediatric
Autoimmune Neuropsychiatric Disorders Associated w/ Strep infection |
|
|
In PANDAS, what does an initial negative swab test mean?
|
NOTHING
Pt. should be retested in 72 hours |
|
|
How is PANDAS treated?
|
10 day course of antibiotics
OCD symptoms dissipate in about 14 days |
|
|
Treatment for OCD
|
SSRIs (60% response rate)
-- Higher doses/trial than with depression -- Effect is via downregulation of receptors Behavior Therapy Neurosurgery (90% response rate) |
|
|
What happens in OCD when you stop SSRI treatment?
|
Symptoms return
|
|
|
The fear circuit centers on what?
|
The Amygdala
|
|
|
The pleasure circuit centers on what?
|
The nucleus accumbens
|
|
|
Tiazolam
|
Shortest 1/2 life
Short duration of effect Good for INITIAL insomnia |
|
|
Clonazepam
|
Long half life
Slow onset of effects Can aid in smoothly detoxifying a pt. from BDZs |
|
|
Alprazolam
|
Rapid onset of effects
Short duration of effect Great risk of addiction |
