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25 Cards in this Set
- Front
- Back
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what do comorbid psychiatric disorders cause? when does anxiety become and anxiety disorder? |
decrease in remission rates and increase in relapse rates when the fear response system leads to maladaptive behavior or distress |
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what does an increase of NE activity in the brain usually cause?
what are some symptoms of GAD?
What is a great way to think of GAD? R |
arousal, anxiety, and panic
excessive anxiety or worry involving multiple events or activities occurring more days than not for at least 6 months and have at least 3 of the following: reslessness, fatigue, poor concentration, irritability, muscle tension, insomnia RIM FIC
chronic anxiety |
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what non-pharm things should patients be avoiding if they have anxiety? what are the psychic symptoms of anxiety? the somatic symptoms? |
caffeine, decongestants, diet pills, excessive alcohol worry, apprehension tachycardia, sweating, tremor |
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how long is treatment for anxiety usually? what are first line treatments for anxiety? what symptoms do they help with? how long till benefit? |
a full year antidepressants psychic and indirectly somatic 2-4 weeks |
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when are benzos recommend in GAD? what symptoms do the treat? why do we taper benzos? |
acute treatment of GAD when short term relief is needed, to improve sleep, or as an adjuvanct to antidepressant therapy only somatic, doesnt fix pathophsy withdrawal, return of symptoms/relaspe, rebound anxiety, seizure |
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what are the disadvatages of benzos? what benzos are diretly glucuronidated? who are these good in? |
only somatic symptoms, risk for abuse/dependency, rebound anxiety lorazepam, oxazepam, tamzepam good for elderly and hepatic issues |
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what are the pros of a long lasting benzo?
what are the cons?
what are the cns depressive effects of benzos? |
long relief, less risk of rebound anxiety, fewer doses
more interactions, not for elderly, hepatic impairment
drowsiness, sedation, ataxia, psychomotor impairtment, poor recall, amnesia CALL AMYS PYCHOTIC TAX LADY B4 SHE SLEEPS |
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what drugs can interact with benzos? what is a good indication when to switch to a long acting benzo? what benzos will this usually occur with ? which of these should you NOT give with liver impairment? |
alcohol, opioids, sedatives, antidepressants rebound anxiety alprazolam, lorazepam, oxazepam alprazolam |
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is there a relationship between half life and duration of action? what two drugs are used in GAD but are not yet recognized as having an off label indication? |
not really, half life does not tell us the duration of action of a drug pregagalin and gabapentin |
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when would hydroxzine be apporpriate? what type of symptoms does it improve? what type of symptoms does buspirone treat? when is it appropriate to use? when is it inappropirate to use? |
to treat anxiety when patient has a substance abuse disorder, extremely sedative somatic only somatic and psychic if patient has a substance abuse disorder, depression with anxiety (no affect on sex function) for acute anxiety relief, needs 2 weeks to work |
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would we ever consider SGA's for treatment? what is important to remember when using benzos? how are antianxiety drugs taken? |
for now no, but can be used in those with severe paranoid or delsuional behavior always look to titrate down PRN |
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what is a good way to define/think about panic disorder? how long is the acute treatment phase of a panic disorder? how long should therapy be continued after the acute phase? |
unpredictable, acute, severe form of anxiety 12 months an additional 12-18 months |
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what nonpharm thing can be done to help in PD? what drugs are used to treat PD? what is the issue in using longterm benzo in this population? what can be done to prevent this? |
avoid the stimulants antidepressant, benzos, BB more severe rebound anxiety and relapse use benzos prn at the onset of a panic attack, use it for breakthrough attacks only |
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what symptoms to BB treat? when are they good to use? what population should you not use BB in? |
only somatic patients with substance abuse, those with partial remission that need a chronic adjunctive medication younger population and athletes |
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how can you think of/define social anxiety disorder? how long is treatment? what is the backbone of treatment? what should you do if the patient is going to run into a known trigger of SAD? |
panic attacks caused by social triggers which cause patient to become fearful and avoidant of social situations 1 year antidepressants +/- benzos use benzo or BB before experiencing known trigger |
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what is the pathophysiology of OCD? what are obsessions? what are compulsions? |
dysfunction in GABA/inhibitory output, results in increased excitation of the thalamus and frontal cortex recurrent/persistent thoughts/urges/images that cause anxiety or distress, individual has compuslions to neutrilze these issues repetitive behaviors that the individual feels drive to perform in response to obsessioin, aim to prevent or reduce anxietyu |
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what are the first line treatments for OCD? what other drug can be used as montherapy/adjunctive? what other therapy can be used as adjunctive? how long is treatment |
ssris, or velaflaxine clomipramine risperadone/aripiprazole 1-2 years |
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what is the pathophysiology of PTSD? what happens before PTSD? |
increase NE, and structureal changes in the brain traumatic event leads to acute stress reaction, this can last a few weeks and is then called acute stress disorder, after a month it is called acute ptsd, after 3 months it is called chronic PTSD |
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what are the four main symptoms of ptsd?
describe them |
intrusion-flashbacks, cant keep memories from returning avoidance- avoiding situation that remind you of the event negative mood- cant trust people hyperarousal- on the lookout for danger HI NA |
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what are the first line treatments for ptsd? what is second line? could benzos work? |
setraline, paroxetine, fluoxetine, venlafaxine mirtazapine, amitriptyline, imipramine, phenelzine no, they cause harm, more rebound and abuse |
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what is prazosin useful for? is this ever used as montherapy? when is it better to use antidepressants? |
somatic symptoms, nightmares, used before bed yes, especially for vets, with intrusion and hyperarousal for negative mood and avoidance sympotoms |
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describe the alogrithm for GAD |
determine if severe/urgent symptoms, if so, use a benzo for 2-4 weeks, if not use an ssri or snri (duloxetine/venlafaxine), if that doesnt work switch to another ssri/snri, if that doesnt work switch to PHIBS (pregagalin, hydrozyzine, imipramine, busiprone ssri/snri/, if that doesnt work augment with sga, antidepressant, or benzo |
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describe the pd algorithm. |
determine if severe/urgent, if so use benzo +ssri/venflax, if not go to a ssri/venlaf, if that doesnt work switch to another ssri/venla, if that doesnt work try ssri/velaf or imipramine, if that doesnt work add bz or BB to antidepressant, if that doesnt work try phenelezine |
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describe the algorithm for SAD |
determine if severe/urgent if so do bz+ssri/venlaf if not, just do ssri/venlaf, if you get a partial response then add buspirone, if no response try another ssri/venlaf, if that doesnt work use phenelezine |
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