4. Generalized Anxiety Disorder

Question 1

this is known as apprehension, uncertainty, or anticipations of a future events, which can be a normal emotion under circumstances of threat

Answer 1

anxiety

Question 2

what are the three types of symptoms that someone may experience in anxiety

Answer 2

physical, cognitive and behavioural symptoms

physical - getting sick
cognitive - difficulty concentrating
behavioural - substance abuse, agoraphobia, avoidance

Question 3

true or false: anxiety disorders are more prevalent in men

Answer 3

false - more prevalent in females

Question 4

true or false: anxiety disorders can be med induced

Answer 4

true
by anti-depressants, bronchodilators, steroids, stimulants, sympathomimetics, thyroid hormones, alcohol and sedative withdrawal sx’s

Question 5

this anxiety disorder is a fearful separation from something or someone

Answer 5

separation anxiety disorder

Question 6

this anxiety disorder is known as a failure to speak in social situations

Answer 6

selective mutism

Question 7

this anxiety disorder is an avoidance of social or performance situations

Answer 7

social anxiety disorder

Question 8

this anxiety disorder is avoidance of objects or situations (e.g. needles, flying on airplanes, spiders, etc.)

Answer 8

specific phobia

Question 9

this anxiety disorder is fear of 2 or more of the following situations: being in open or closed spaces, public transport, away from home, etc. because you are afraid if you have a panic attack you won’t be able to get help

Answer 9

agoraphobia

Question 10

true or false: GAD tends to run an acute course

Answer 10

false - chronic

Question 11

what are some non-charm tx options for GAD

Answer 11

• psychoeduation / reassurance (e.g. help getting over a fear)
• lifestyle changes (e.g. avoiding substances such as caffeine, etoh, nicotine, stimulants), healthy eating, exercise, sleep hygiene
• mobilization of family/social supports
• counselling/CBT

Question 12

what is the onset of action for antidepressants in GAD

Answer 12

2-6/52, and may not see maximal effect until 12 week period

Question 13

what is the onset of action for pregabalin in GAD

Answer 13

1-2/52?

Question 14

what is the onset of action for buspirone in GAD

Answer 14

2-4/52, and may not see maximal effect until 4-6 weeks

Question 15

true or false: after taking a benzodiazepine for GAD, some effect may be seen after the first dose

Answer 15

true

Question 16

true or false: benzodiazepines and anti-depressants cannot be taken together since benzodiazepines have a quick onset whereas anti-depressants have a delayed onset

Answer 16

false
if a patient is started on an antidepressant, they may also be started on a benzo to get some immediate relief until the effects of the antidepressant may be seen at the 2-6/52 week mark

Question 17

true or false: hydroxyzine has a quick onset

Answer 17

true - may see some effect after the first dose

Question 18

what agents should you avoid in patients with substance abuse

Answer 18

benzodiazepines

Question 19

what agents should you avoid in patients with dementia

Answer 19

avoid benzodiazepines, hydroxyzine and paroxetine (paroxetine is VERY anticholinergic)

Question 20

what agents should you avoid in patients with sleep apnea

Answer 20

avoid benzodiazepines, hydroxyzine and pregabalin

Question 21

what agents should you avoid in patients with risk of Qt prolongation

Answer 21

avoid hydroxyzine, citalopram and escitalopram

Question 22

what agents may be beneficial for someone who also have chronic pain

Answer 22

SNRI or pregabalin

Question 23

what agents may be beneficial for someone who also has depression

Answer 23

SSRI or SNRI

Question 24

what agents should you avoid in patients with bipolar disorder

Answer 24

antidepressants

Question 25

what agent may be beneficial for someone who also has a seizure disorder

Answer 25

benzodiazepines and pregabalin (raise seizure threshold)

Question 26

what are the main s/e of pregabalin

Answer 26

sedation, dizziness, weight gain and sexual dysfunction

Question 27

what are the main s/e of hydroxyzine

Answer 27

sedation, anticholinergic effects, Qt prolongation

Question 28

what are the main s/e of benzodiazepines

Answer 28

sedation, ataxia, memory loss

Question 29

true or false: SSRI's are considered safe in pregnancy and lactation

Answer 29

true - sertraline seems to be a favourite

Question 30

true or false: when starting a patient on an antidepressant, they should be started on a high dose to optimize therapy

Answer 30

false - start w/ low dose so you don't precipitate an anxiety attack

Question 31

what is the suggested follow up for GAD treatment

Answer 31

follow up q 2 weeks for the first 6 weeks then monthly

Question 32

this medication used for GAD can cause paradoxical reactions where the patient experiences irritability, agitation, hallucinations

Answer 32

benzo's

Question 33

true or false: cognitive impairment and anterograde amnesia is seen with all benzo's

Answer 33

false - most common with highly lipophilic benzo's (alpraz, diazepam)

Question 34

true or false: benzo's can cause respiratory depression at therapeutic doses

Answer 34

false - won't cause respiratory depression on their own usually see if take in excess quantities with etoh or other sedative. avoid in patients with sig. compromised respiratory. function and sleep apnea

Question 35

what is a risk factor for abuse potential with benzo's

Answer 35

highly lipophilic benzo such as diazepam has a higher abuse potential because it gets into the brain quicker

Question 36

what the an adequate duration on treatment for GAD

Answer 36

not clear! recommended 1 year minimum some patients will relapse after tx d/c and long-term tx may be required

Question 37

what should you do if the first treatment chosen for a patients GAD does not work?

Answer 37

step 1: switch to another first line agent; if this doesn't work step 2: add adjunct/combination therapy; if this doesn't work step 3: switch to second line tx