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Clinical 2.0 winter > Anxiety disorders > Flashcards

Anxiety disorders Flashcards

1
Q

what are compulsions

A

repetitive intentional behaviour or mental progressions
in response to an obsession
excessive

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2
Q

OCD definition

A

presence of either obsessions or compulsions
causes marked distres or anxiety
time consuming
impairment in function

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3
Q

OCD onset

A

onset around age 10 and 21

gradual

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4
Q

OCD goals of therapy

A

reduce frequency, severity, distress
improve QOL
restor function
decrease time spent in compulsive behaviour….

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5
Q

NT critical for antiobessional effects

A

serotonin

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6
Q

treatment of OCD

A

clomipramine
SSRI
CBT

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7
Q

time for response in treatment of OCD

A

onset 3 weeks

12 weeks ot see full clinical impact

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8
Q

time for ocd treatment to reach target

A

at least4-6 week at max tolerated dose

8-12 weeks total

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9
Q

if a partial response to an ocd treatment

A

push the dose if tolerated to get max dose by week 4-8

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10
Q

no response to ocd treatment after 8 weeks

A

switch to another SSRI

after 2 SSRIs try clomipramine

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11
Q

can augment SSRI with

A

CBT
clomipramine
second gen antipsychotic

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12
Q

duration of ocd treatment

A

1-2 years then gradual taper 10% every 2 months

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13
Q

AE of clomipramine

A 
antihistaminic, alpha adrenergic, and antimuscarinic side effects
serotonin side effect
increase cardiac toxicity 
seizure risk 
monitor serum levels
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14
Q

potential causes of PTSD

A

overactive alarm center may lead to prolonged excessive NE release
increase corticotropin releasing factor and decreased cortisol
NT imbalance - NE, dopammine, serotonin, GABA

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15
Q

PTSD treatmetn

A

CBT
antidepressants
psychoeducation
dont use benzos

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16
Q

goals of therapy for treatment

A

decrease hyperarousal, reexperience and avoidance

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17
Q

length of antidepressant treatment in ptsd

A

12 week trials, 12 month maintenance

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18
Q

benzos whould be what in panic disorder

A

scheduled

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19
Q

agoraphobia

A

afraid to go out in public

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20
Q

targets for long term management of panic disorder

A

worry and behaviour change

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21
Q

medical conditions associated with panic disorder

A 
thyroid prob
asthma 
arrhythmia
excesive caffiene intake 
withdrawal from alcohol 
corticosteroids 
pheuchromocytoma
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22
Q

panic attack symptoms

A 
abrupt development of at least 4 sx
peaks in 10 min and lasts 20min 
accelrated HR 
intense fear 
sweating 
trembling ....
23
Q

goals of treatment for panic disoreder

A

decrease frequency of attacks
decrease phobic avoidance
decrease physical symptoms

24
Q

substance that could precipitate panic attacks

A

caffiene
drugs f abuse
stimulants

25
Q

panic disorder treatement

A

benzos for acute relief
SSRI or venlafaxine
treat for 2 years

26
Q

benefits of benzos

A

rapid onset 1-2 weeks
no tolerance to antipanic effect
high response rate

27
Q

disadvantages of benzos

A 
sedation 
dependence
abuse 
wtihdrawal sx
reapid reemergence after abrupt discontinuation
28
Q

dose of benzos in panic disorder compared to anxiety disorder

A

increased

29
Q

SSRI advantages

A

no abuse or dependence
antidepressant
alter underlying cause

30
Q

disadantages of SSRIs

A

3-5 week onset ip to 12 weeks
mild hyperstimulation - start low go slow
sleep disturbance
sexual disturbance

31
Q

treatment duration of panic disorder

A

1-2 years then taper over 4-6 months

32
Q

combo of benzo and SSRI for panic disorder

A

rapid onset needed
greater adherance
want to take benzo off after but often hard

33
Q

medications associated with anxiety

A

CNS stimulant - caffiene, steroids, cocain
withdrawal of CNS depressant - narcotic, alcohol
anticholinergics, antidepressant, antopsychotic, thyroid supplement,

34
Q

age of onset for generalized anxiety

A

20s

gradual

35
Q

treatment of generalized anxiety

A

give benzo first and see how they respond in 2-4 weeks to make sur enot just temporary anxiety
then use antidepressant for 12 months then start tapering down *

36
Q

generalized anxiety non pharm

A 
counseling 
stress management 
meditation 
exercise 
avoid caffiene, alcohol 
CBT
37
Q

what is the basic principle of CBT

A

it is not the situation but our perception that determine feelings

38
Q

benzos more effective in treating ____ sx

A

somatic/autonomic

39
Q

which benzo has increased lipid solubility thus rapid absorption

A

diazepam

metabolit gives long half life

40
Q

length of benzo use in generalized anxiety

A

2-3 weeks should not exceed 4-6 months

if recurring 3-4 week pulses of therapy but if persistent may need continuous

41
Q

benzo DI

A

CNS depressants increase sedation
alcohol increases levels but chronic drinkers it metabolized faster
cyp 3A4 interactions
increased metabolism form smoking

42
Q

benzo withdrawal sx

A

common - anxiety, insomnia, agitation, rebound of what they were taking it for
less frequent - malaise, nightmares, ataxia
rare- tinnitus, confusion, seizures

43
Q

increased incidence of benzo withdrawal if

A 
regularly used >3month 
higher doses 
sudden cessation 
short acting benzo used - lorazepam
history of dependence
44
Q

prevention of benzo withdrawal

A

use for 3 week sonly
decrease dose 10% every week
switch to longer half life agent - diazepam

45
Q

first line treatment for anxiety

A

antidepressants - doesnt matter which one

46
Q

antidepressants better treat ___ sx than benzo in anxiety

A

psychic

worrk, apprehension

47
Q

duration of antidepressant theray in anxiety

A

response may take 6 weeks

then at least 12 months before tapering

48
Q

buspirone MOA

A

serotonin 1A partial agonist

binds to pre and post synaptic receptors to serotonergic transmission, increase serotonin

49
Q

advantages of buspirone

A

no abuse, dependence, withdrawal
no interaction with alcohol
fewer CNS effects then benzos
fewer GI than SSRI

50
Q

time for buspirone to take effect

A

max effect in 4-6 weeks

maintain for 1 year

51
Q

initiation of buspirone

A

start low dose and titrate up

52
Q

AE of buspirone

A 
dizzy 
headache
nausea
drowsy 
dysphoria
nervous
53
Q

buspirone DI

A

MAOI - hypertension
increases cyclosporin and haloperidol levels
increased by CCB, itraconazole, erythromycin

Clinical 2.0 winter (28 decks)

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