Anxiety

Question 1

what is a common feature of anxiety disroders

Answer 1

presence of excessive fear and anxiety related to behavioural disturbances

Question 2

what are panic attacks

Answer 2

a specific type of fear response

Question 3

those with anxiety have higher prevalence of

Answer 3

CVD, GID, HPTN, arthritis, IBS< thyroid disease, respiratory disease, migraines and allergic conditions

Question 4

emdian age of onset for anxiety is

Answer 4

30yrs

Question 5

GAD peaks in _______ and declines with _____

Answer 5

middle age and declines with age

Question 6

the excessive worry in GAB results in ________ and the expense of ____________

Answer 6

↓capacity to quickly + efficiently complete required tasks = expense of energy and time in state of worry

Question 7

many pts with GAD say they have felt anxious and nervous _______

Answer 7

their whole lives- manifests into anxious temperment over time

Question 8

course of GAD sx

Answer 8

wax and wane over lifespan- v low rates of full remission

Question 9

which of the following is false about GAD
1. onset is rarely before adolescence
2. sx are chronic and wax and wane over lifetime
3. have low rates of full remission
4. most are on medication for short period of time to get over difficult situation

Answer 9

4

Question 10

describe criteria A-C in GAD

Answer 10

excessive worry and anxiety, more days than not for 6mths about many things
finds it difficult to manage the worry
anxiety and worry associated with 3 or more of MRS.FICs (or 1 sx in children)

Question 11

describe criteria D-F in GAD

Answer 11

anxiety causes clinically significant distress or impairment in social, occupational, or other important areas of funtioning
disturbance not due to something else
not better explained by another mental disorder

Question 12

list 3 RF for anxiety

Answer 12

famHx for anxiety, personal hx of anxiety/ mood disorder, childhood stressful life events or trauma, female, chronic medical illness, behavioral inhibition

Question 13

2 factors associated with GAD

Answer 13

childhood adversities, overprotective parenting

Question 14

3 questions in GAD screening

Answer 14

In the past 4 weeks, are u bothered by feeling worried, tense, or anxious most of the time

Are you frequently tense, irritable, and having trouble sleeping

During the last 2 weeks, how much have you been bothered by: feeling nervous/ anxious/ frightened/ on edge, feeling panic/ benign frightened, avoiding situations that make you anxious

Question 15

2 clinician rated anxiety rating scales

Answer 15

HAM-A
CGI scale

Question 16

and increase on CGI-S and CGI-I means

Answer 16

worsening

Question 17

2 pt rated anxiety scales

Answer 17

PHQ-9
GAD-7

Question 18

what is the first line nonpharm option for GAD

Answer 18

psychotherapy

Question 19

Evidence shows that_______________ have a benefit years later + continuous therapy can help maintain control of GAD

Answer 19

LT psychotherapy sessions

Question 20

T or F: bright light therapy has some evidence of benefits in GAD

Answer 20

F

Question 21

T or F: 1st line tx in GAD is combo psychotherapy + pharmacotherapy

Answer 21

F- financial strain
try monotx initially

Question 22

which is true
1. psychotx > pharmacotx in GAD
2. psychotx = pharmacotx in GAD
3. psychotx < pharmaco tx in GAD

Answer 22

2

Question 23

name the 1st line GAD pharmacotx

Answer 23

duloxetine, escitalopram, paroxetine, pregabalin, sertraline, venlafaxine

Question 24

anxiolytisc bind _____ to various subtypes of ______

Answer 24

nonselectively
GABAa

Question 25

a1 subunit binding =

Answer 25

sedation, ataxia, amnesia

Question 26

which GABA subunit binding results in anxiolytic activity

Answer 26

a2 or a3

Question 27

what is a major pathway of metabolism for anxiolytics

Answer 27

phase 1

Question 28

in elderly pts with GAD, anxiolytics should be selected to

Answer 28

go through phase 2 metabolism

Question 29

whcih 3 anxiolytics go through phase 2 metabolism more than 1

Answer 29

lorazepam, oxazepam, temazepam

Question 30

phase 1 metabolism may be compromised by

Answer 30

disease states, age, CYPi

Question 31

a shorter half life of anxiolytics results in (SEs)

Answer 31

interdose withdrawal, anterograde amnesia, increased abuse potential

Question 32

longer anxiolytic half life SEs

Answer 32

handover effect

Question 33

Older adults have ↑ _________ + ↓ ________ of BZDs

Answer 33

sensitivity to metabolism

Question 34

anxiolytics should be reserved for _____________ in older populations

Answer 34

severe GAD

Question 35

4 long acting anxiolytics

Answer 35

chlordiazepoxide, clorazepate, diazepam, flurazepam

Question 36

2 short acting anxiolytics

Answer 36

midazolam, triazolam

Question 37

T or F: PRN use of BZDs in GAD is preferred to avoid withdrawal/rebound effects

Answer 37

F- Short term, regular use may be better than PRN to avoid withdrawal/ rebound effects

Question 38

BZDs are associated with _______, _____,. ____________, and _______ anxiety between doses

Answer 38

dependence tolerance withdrawal rxns rebound anxiety

Question 39

there is a greater rsk of sedation, dependence, memory impairment, rebound anxiety with _________ acting BZDs

Answer 39

short/ intermediate

Question 40

what is rebound after BZDs

Answer 40

occurs hrs-days after d/c where anxiety is similar or more intense than before

Question 41

describe the dependence/ tolerance effect of using BZDs- what kind of tolerance develops rapidly? what doesn't?

Answer 41

rapidly = toelrance to sedative eff does not occur, even after long usage = anxiolytic effect

Question 42

T or F: use of BZDs in GAD should be limited to avoid rapid development to anxiolytic effect

Answer 42

F- doesn't develop tolerance to anxiolytic effect even after prolonged use more common tolerance to hypnotic/ sedative

Question 43

when does withdrawal occur with SA and LA BZDs

Answer 43

SA = 1-2d LA = 5-10d

Question 44

BZD withdrawal sx

Answer 44

insomnia, agitation, anxiety, perceptual changes, dysphoria, headaches, muscle aches, twitches, tremors, loss of appetite, diaphoresis, tachycardia, and GI distress

Question 45

dosage of BZDs should be gradually decreased over ______

Answer 45

6-12wks

Question 46

decrease BZDs by _____% of current dose q___d

Answer 46

10-20% q3-7d

Question 47

in tapering down BZDs 1. we can use a LA BZD if patient was on SA to minimize withdrawal sx 2. the last 50% can be decreased faster than the first 50% 3. should be decreased gradually even if using low dose for short duration 4. may see withdrawal with LA at 1-2d

Answer 47

1

Question 48

buspirone MOA

Answer 48

central D2 agonist/ ant 5HT1A partial agonist metabolite can increase NE release

Question 49

buspirone SEs

Answer 49

dizziness, lightheadedness, HA, nausea, sweating, nervousness

Question 50

T or F: buspirone causes lots of sedation

Answer 50

F- well tolerated, little sedation

Question 51

buspirone is a ____ substrate, and the metabolite is a _____ substrate

Answer 51

3A4 2D6

Question 52

the effect of buspirone may be seen ____ after taking routinely

Answer 52

2-4wks

Question 53

hydroxyzine's activity at __, ___, ____ receptors in the brain produce the anxiolytic effects

Answer 53

M, 5HT, D

Question 54

hydroxyzine SEs

Answer 54

significant sedation, dizziness, QTc prolongation

Question 55

what is the active metabolite of hydroxyzine

Answer 55

cetirizine

Question 56

MAD medications should be titrated up in ___ intervals

Answer 56

1-2wk

Question 57

pharm tx is often associated with a delay of ____ in onset of sx relief, with full response taking up to ___wks or more

Answer 57

2-8wks 12wks or more

Question 58

what is considered remission in GAD

Answer 58

loss of dx, prespecified score on scale, no functional impairment

Question 59

what is considered response in GAD

Answer 59

25-50% reduction of sx on an appropriate scale

Question 60

T or F: there is no guideline algorithm for GAD

Answer 60

T

Question 61

how long to see full effect of pharm tx on GAD

Answer 61

8-12wks

Question 62

when should adjunctive agents be trialed for GAD

Answer 62

tx resistant GAD- trialed at least 2 1st line agents + failed

Question 63

what are 4 typical combos used with SSRIs/SNRIs in GAD

Answer 63

short term/ PRN BZDs anticonvulsants atypical antipsychotics psychotx

Question 64

LT therapy is associated with continued symptomatic improvement + prevention of relapse = therapy should continue for at least _____ for most GAD pts

Answer 64

12-24mths