Flashcards in Anxiety and Schizophrenia Deck (275)
What are some acute signs of anxiety?
Shortness of breath
What are some chronic signs of anxiety?
What is Globus hystericus?
Feeling of a lump in your throat
When does anxiety become a problem?
If it results in isolation
Under what heading does ICD-10 classify anxiety disorders? What does this include?
- Adjustment disorder
- Hoarding disorder
How are PTSD and Adjustment disorder classed in DSM-V?
Under trauma and stressor-related disorders
How are OCD and Hoarding disorder classed in DSM-V?
OCD and Related Disorders (OCARD)
Under ICD-10, what does F40 describe?
Phobic anxiety disorders:
- Agoraphobia (F40.0)
- Social phobia (F40.1)
- Specific phobies (F40.2)
Under ICD-10, what does F41 describe?
Other anxiety disorders:
- Panic disorder (F41.0)
- Generalised Anxiety Disorder (GAD) (F41.1)
Under ICD-10, what does F42 describe?
Under ICD-10, what does F43 describe?
Reaction to severe stress and adjustment disorders:
- PTSD (F43.1)
- Adjustment disorder (F43.2)
What is the full ICD-10 range which describes 'Neurotic, Stress-Related and Somatoform Disorders'?
Under the proposed ICD-11, what does OCARD also include?
Olfactory reference disorder
What are the key features of Generalised Anxiety Disorder?
Excessive and inappropriate woryring that is persistent
Not restricted to certain circumstances
- Autonomic arousal (eg. palpitations, sweating)
- Thorax symptoms (eg. SoB0
- Brain/Mind symptoms (eg. Dizziness)
- General symptoms (eg. Hot flushes)
- Symptoms of tension (eg. Aches and pains)
What ICD-10 number is Generalised Anxiety Disorder?
How is a panic attack defined?
Discrete periods of intense fear alongside physical and psychological anxiety symptoms
Reach peak within 10 minutes
Last around 30-45 minutes
What fraction of people with panic disorder develop agoraphobia?
What is the other name for social phobia?
Social anxiety disorder
What is agoraphobia?
Fear in places/situations in which:
- Escape might be difficult
- Help might not be available
How is social phobia characterised?
A persistent and unreasonable fear of being evaluated negatively by others
This fear is in social/performance situations
What are common physical symptoms of social phobia?
Fear of vomiting
Urgency/Fear of micturition/defaecation
What sort of history is present in PTSD?
Exposure to trauma:
- Actual/Threatened death
- Serious injury
- Threats to physical integrity of self/others
What symptoms develop later in PTSD?
Intrusive symptoms (eg. Flashbacks)
Negative alterations in cognitions and mood
What are the features of hyperarousal?
Exaggerated startle response
How is OCD characterised?
Recurrent obsessive ruminations/images/impulses
+/or recurrent rituals
- Time consuming
- Interfering with social and occupational function
How is an obsession described?
Intrusive and inappropriate
Excess and unreasonable (not in kids)
How is an obsession ego-dystonic?
Product of own mind but experienced as alien
Outwith own control
What is a compulsion?
Repetitive behaviour/mental act
Aim to reduce anxiety
Not pleasurable in themselves
What is F40.00?
Agoraphobia without panic disorder
What if F40.01?
Agoraphobia with panic disorder
What is F40.8?
Other phobic anxiety disorders
What is F40.9?
Phobic anxiety disorder, unspecified
Marked and consistently manifested fear/avoidance of how many places is needed to diagnose agoraphobia? What sort of places?
>=2 of the following:
- Public spaces
- Travelling alone
- Travelling away from home
Apart from fear/avoidance of certain situations in agoraphobia, what other two features must be present?
- Anxiety in a situation with >=2 symptoms on >1 occasion from the key features symptoms of GAD
- Significant emotional distress due to avoidance/anxiety
To diagnose a social phobia, what insight should the patient have?
Recognising that the symptoms and avoidance are excessive or unreasonable
What percentage of patients with social phobia with abuse alcohol?
How many symptoms of generalised anxiety disorder must be present for a panic attack to be classed as such?
At least one from each of:
- Autonomic symptoms
- Thorax symptoms
- Brain/Mind symptoms
- General symptoms
How is general anxiety disorder diagnosed?
>=6 months with prominent tension/worry/feeling of apprehension about every-day events
At least one from each of:
- Autonomic symptoms
- Thorax symptoms
- Brain/Mind symptoms
- General symptoms
How is OCD diagnosed?
Obsessions +/or compulsions present on most days for >=2 weeks
In OCD, what features of obsessions and compulsions MUST be present to be diagnosed as such?
Acknowledged as originating from patient's mind
Repetitive and unpleasant
Subject tries to resist
Carrying out a compulsion is not pleasurable
In diagnosing PTSD, following an initial stressor event, when must criteria 2-4 be met?
Within 6 months of:
- Event OR
- The end of a period of stress
What kind of stressor event is associated with the highest incidence of PTSD?
When is the 'freeze' response initiated?
When limbic system judges that neither fight nor flight is possible and death/severe injury is inevitable
What happens during a 'freeze' response?
Altered state of reality
Body becomes immobile
Pain responses reduced
What are the types of trauma?
Type 1 = Simple
Type 2 = Complex
What symptoms can run alongside typical PTSD symptoms to classify it as complex PTSD?
Chronic interpersonal difficulties
Tension reductive activities
How is the stress response resolved?
PNS kicks in:
- Muscles relax
- Skin warms
- Pupils constrict to normal (SNS dilates them)
- HR slows
- BP reduces
- Eat, digest and rest
What part of the brain is responsible for locating memories in the right time, place and context?
What part of the brain stores emotionally charged memories?
Where does the limbic brain connect to?
Medial prefrontal cortext
What to the limbic connections enable it to do?
Regulate emotional and fear responses
How many connections are there from limbic brain to medial prefrontal cortex?
How many connections are there from the medial prefrontal cortex to the limbic brain?
How do sense of danger and logic interact?
Sense of danger overrides logic
What can potentially trigger flashbacks in PTSD?
Why can nightmares result in insomnia?
Delay in going to sleep
Bedroom associated with nightmares:
- Bedroom avoidance
- Poor sleep hygeine
When is dissociation more likely to occur in PTSD?
If trauma is:
- Affecting a very young victim
How does dissociation present in PTSD?
Patient may feel like they're watching themselves
May feel like it isn't happening
Dissociative Identity Disorders
What can indicate dissociation?
Things look strange
Changes in sound
Feel like a robot/observer
When does an acute stress reaction occur following trauma?
48 hours after
When does an acute stress disorder occur following trauma?
Up to 4 weeks
When does acute PTSD occur following trauma?
Up to 3 months
When does chronic PTSD occur following trauma?
Over 3 months
How can acute stress disorder be diagnosed?
The following symptoms occurring within 1 months of the trauma and lasting at least 2 days:
- Dissociative symptoms
- Persistent re-experiencing
- Increased arousal
What treatment should not be undertaken in acute stress disorder?
When is watchful waiting and monthly reviewing appropriate in an acute stress disorder?
If symptoms are mild and present for <4 weeks
What psychotherapeutic models can be employed in the treatment of acute stress disorder/PTSD?
Trauma focused CBT
Eye Movement Desensitisation and Re-Programming
Cognitive processing therapy
What drugs are licensed for use in PTSD?
- Other classes if SSRIs don't work
What specialist alternative drugs can be used in PTSD?
Under DSM-V, what is included under OCARD?
Body dysmorphic disorder
What is the most common comorbid condition in OCD?
What is the mean age of onset of OCD?
What is the median age of onset of OCD?
When is the peak incidence of OCD in males?
When is the peak incidence of OCD in females?
What populations have an increased incidence of OCD?
General hospital populations
What autoimmune conditions may contribute to developing OCD?
Beta-Haemolytic Strep. infection (PANDAS)
Autoantibodies to basal ganglia
What does neuroimaging show in OCD?
Increased metabolism and blood flow in:
- Orbitofrontal cortex
- Caudate nucleus
- Cingulate cortex
What five screening questions can be used for OCD?
1. Do you wash or clean a lot?
2. Do you check things a lot?
3. Is there any thought that keeps bothering you that you wanna get rid of but can't?
4. Do your daily activities take a long time to finish?
5. Are you concerned about orderliness/symmetry?
When would benzodiazepines be used in anxiety disorders?
Specific occasions (eg. flights)
What anxiety disorders can graded exposure be used to treat?
Simple phobias (eg. spiders)
How would the exposure in graded exposure be described?
Gradual and progressive
What is flooding?
Full exposure to feared stimulus and staying with it until fear reduces
What are the issues with flooding?
Generally less popular
Fear may spontaneously reoccur
What are the principles of CBT?
Suggest that underlying thoughts affect emotions which then affect behaviour
Involve patient in questioning/testing their thoughts
What BZDs can be used in PTSD?
What anticonvulsants can be used in PTSD?
What form of CBT is used in PTSD?
What are the typical first line medications used in OCD?
- Clomipramine (TCA)
What antipsychotics can be used to augment treatment in OCD?
What anticonvulsant might be used in OCD?
What psychological therapies are very frequently employed in OCD?
Exposure and Response Prevention >=20 hours
- Heavy emphasis on exposure
How would OCD with mild functional impairment be treated?
Brief CBT (+ERP); <10 therapist hours
How would OCD with moderate-severe functional impairment OR when patients with mild impairment cannot engage with CBT/it fails, be treated?
Offer choice of:
- More intensive CBT (+ERP); >10 therapist hours
- Course of SSRI
Following treatment of OCD with moderate-severe functional impairment, when would it be upgraded to definite severe impairment?
If there is inadequate response at 12 weeks an MDT review is carried out
How is OCD with severe functional impairment treated?
Offer combo of:
- CBT (+ERP) AND
If first line treated of OCD with severe functional impairment fails, how can it be treated?
- Different SSRI
(Continue CBT [+ERP])
If second line treated of OCD with severe functional impairment fails, how can it be treated?
Refer to MDT with OCD experience
If third line treated of OCD with severe functional impairment fails, how can it be treated?
Additional CBT (+ERP) or cognitive therapy
Add antipsychotic to SSRI/Clomipramine; combine clomipramine and citalopram
What dose of fluoxetine is used in OCD?
What dose of paroxetine is used in OCD?
What dose of citalopram is used in OCD?
What dose of sertraline is used in OCD?
What dose of fluvoxamine is used in OCD?
What dose of escitalopram is used in OCD?
What dose of clomipramine is used in OCD?
How does ERP work?
Repeatedly keeping anxiety in check:
- Provides powerful reinforcement for avoidance
- Sustains avoidance
- Increase exposure to feared stimulus
- Develops habituation to anxiety
What is the first line pharmacological treatment for Generalised Anxiety Disorder?
What is the second line pharmacological treatment for Generalised Anxiety Disorder?
What is the third line pharmacological treatment for Generalised Anxiety Disorder?
What psychological therapies can be used in Generalised Anxiety Disorder?
Guided self-help (if mild)
Relaxation (usually short-term)
What medications can be used to treat social phobia?
Some BZDs (Bromazepam, Clonazepam)
Anticonvulsants (Gabapentin, Pregabalin)
What psychological therapies can be used to treat social phobia?
CBT with emphasis on exposure
Social skills training
When would an SSRI be used in management of a specific phobia?
If anxiety is moderate-severe and hasn't responded to behavioural therapy
What psychological therapies are used frequently in management of a specific phobia?
- Graded exposure
What medications can be used to treat panic disorder +/- agoraphobia?
Some TCS (Clomipramine, Imipramine)
Some anticonvulsants (Gabapentin, Pregabalin)
What psychological therapies are used frequently in management of panic disorder +/- agoraphobia??
Graded exposure therapy if agoraphobia present
How long is maintenance treatment continued for in responders in GAD?
How long is maintenance treatment continued for in responders in panic disorder?
How long is maintenance treatment continued for in responders in social phobia?
How long is maintenance treatment continued for in responders in PTSD?
How long is maintenance treatment continued for in responders in OCD?
What are the worldwide suicide rates?
15 per 100,000 per annum
What are the suicide incidence rates in England and Wales?
15.9/100,000 in men
4.5/100,000 in women
What are the suicide incidence rates in Scotland?
26.8/100,000 in men
7.4/100,000 in women
Levels of what are lower in patients with a history of deliberate self-harm?
CSF 5-HIAA (5-Hydroxyindoleacetic acid)
There is reduced binding of 5-HT transporter sites in deliberate self-harm; where in the brain does this occur?
Ventral Prefrontal Cortex-PM
In the PM there is an increase in what receptors in deliberate self-harm?
What does neuroimaging show in deliberate self-harm patients?
In high lethality patients:
- Different prefrontal cortex activity
SPECTs of recent deliberate self-harm patients showed reduced frontal activity
In what populations is deliberate self-harm more common?
Low socio-economic status
How do deliberate self-harm patients die prematurely?
In what European country is deliberate self-harm more common in males?
What is the initial stage of managing deliberate self-harm?
Calm the patient; emotional release is good:
- Crying is good; Aggression is not
- Be supportive but firm
- Deep breathing
What is it important to ask about in deliberate self-harm?
The episode of DSH
Mental state then and now
How can self-esteem be bolstered and problem-solving be initiated in deliberate self-harm?
Tell patient that discussing personal matters is brave
Any relief indicates more discussions needed
Look at what resolved past episodes
Use family or friends
What may a manipulative patient use as a threat?
Threat of suicide to change environment:
What are the types of manipulative patients?
1. Dependent clingers
2. Entitled demanders
3. Manipulative help-rejecters
4. Self-destructive deniers
How else can deliberate self-harm be referred?
Passive death wish
Suicidal ideation vs. Suicidal intention
What are the positive symptoms of Schizophrenia?
What are the negative symptoms of Schizophrenia?
Lack of volition
When are negative symptoms in Schizophrenia prominent?
Prior to illness atrting
What symptoms in Schizophrenia respond better to treatment?
What symptoms in Schizophrenia have more impact on functioning and QoL?
Schizophrenia can be diagnosed by ONE of what symptoms (according to ICD-10)?
- Running commentary OR
- Third person
Impossible, persistent delusions
Schizophrenia can also be diagnosed by TWO of what symptoms (according to ICD-10)?
Formal thought disorder
Loss of interest/Idleness/Self-absorbed/Social withdrawal
How long must either of the ONE symptoms or the TWO symptoms last to diagnose Schizophrenia?
What are Schneider's First Rank Symptoms of Schizophrenia?
- Thoughts spoken aloud
- Third person voices
- Running commentary
- ?Explained by delusions
- Experience that acts are imposed by an outsider
Though broadcasting, withdrawal and insertion
What is the typical kind of delusion in Schizophrenia?
Are delusions in Schizophrenia mood-congruent or mood-incongruent?
What are delusions often related to in Schizophrenia?
Hallucinations in Schizophrenia are often believed to be public (ie. others can perceive them too). If a patient with Schizophrenia realises that others can't perceive them, what might happen?
Development of new delusions
How can flow of thought be affected in Schizophrenia?
Disruption of association
Crowding (Flight of ideas with passivity)
What sort of affect is seen in Schizophrenia?
- Limited range of emotion
- Lack of sensitivity/connection to surroundings
Is the affect of a patient with Schizophrenia congruent or incongruent with surroundings?
What is catatonia (as seen in Schizophrenia)?
Increased tone at rest (abolished by voluntary movement)
Other motor activity and posture abnormalities:
- Waxy flexibility
What is the peak incidence of onset of Schizophrenia in men?
What is the peak incidence of onset of Schizophrenia in women?
What is the incidence of Schizophrenia?
What is the suicide rate in Schizophrenia?
What factors contribute to a good prognosis in Schizophrenia?
Marked mood disturbance (esp. elation)
FHx of mood disorder
What factors contribute to a poor prognosis in Schizophrenia?
Longer duration of untreated psychosis
Poor premorbid adjustment
What does psychosis involve?
Inability to distinguish between subjective experience and reality
What is psychosis characterised by?
Lack of insight
Why is it important to recognise the importance of the experience in consulting with a psychotic patient?
Don't give the impression that it is "All in your head."
Try and understand:
- "I want to check that I understand, I think what you're saying is that..."
In consulting with a psychotic patient, it is important to think of creative ways to challenge their beliefs. How can this be done?
"What would you say if someone said to you that [these beliefs] weren't true?"
"Can you just explain to me how this is possible?"
If it is clear that a psychotic patient will not accept that the delusions/hallucinations are not real (and they are becoming agressive/stubborn), what might it be necessary to say?
"I think this is evidence that you are unwell and I think you need to be in hospital and receive treatment - although I recognise you disagree with this."
What is Schizophrenia typified by?
Prodromal symptoms and gradual functional decline
How present are depressive and manic symptoms in Schizophrenia?
Absent or minimal
What is F20.0?
What is F20.1?
What is F20.2?
Catatonic Schizophrenia (catalepsy catatonia)
What is F20.3?
What is F20.4?
What is F20.5?
What is F20.6?
What is F20.8?
What is F20.9?
What is Simple Schizophrenia?
Insidious progressive development of:
- Oddities of conduct
- Inability to meet societal demands
- Decline in total performance
Negative features develop without being preceded by overt psychotic symptoms
What is F10?
Mental and behavioural disorders due to the use of alcohol
What is F11?
Mental and behavioural disorders due to the use of opioids
What is F12?
Mental and behavioural disorders due to the use of cannabinoids
What is F13?
Mental and behavioural disorders due to the use of sedatives or hypnotics
What is F14?
Mental and behavioural disorders due to the use of cocaine
What is F15?
Mental and behavioural disorders due to the use of other stimulants (including caffeine)
What is F16?
Mental and behavioural disorders due to the use of hallucinogens
What is F17?
Mental and behavioural disorders due to the use of tobacco
What is F18?
Mental and behavioural disorders due to the use of volatile substances
What is F19?
Mental and behavioural disorders due to the use of multiple drug use and use of other psychoactive substances
When any disorder under F10-F19 is followed by a .0, what does this indicate?
When any disorder under F10-F19 is followed by a .1, what does this indicate?
When any disorder under F10-F19 is followed by a .2, what does this indicate?
When any disorder under F10-F19 is followed by a .3, what does this indicate?
When any disorder under F10-F19 is followed by a .4, what does this indicate?
Withdrawal with delirium
When any disorder under F10-F19 is followed by a .5, what does this indicate?
When any disorder under F10-F19 is followed by a .6, what does this indicate?
When any disorder under F10-F19 is followed by a .7, what does this indicate?
Residual and late-onset psychotic disorder
What delusions are seen in depressive psychosis?
What hallucinations are present in depressive psychosis?
2nd person (usually)
What is F32.2?
Severe depressive episode with psychotic symptoms
How is F32.3 defined?
An episode as described in F32.2
- Psychomotor retardation
What may the symptoms of F32.3 result in that can be life-threatening?
Are psychotic symptoms in depressive psychosis congruent or incongruent?
Are psychotic symptoms in mania with psychosis congruent or incongruent?
What kind of delusions are seen in mania with psychosis?
What sort of hallucinations are seen in mania with psychosis?
How is F30.2 (mania with psychosis) described according to ICD-10?
An episode as in F30.1
- Delusions (usually grandiose)
- Flight of ideas
- Excessive motor activity
What is Schizoaffective Disorder?
Presence of both symptoms typical of:
- Schizophrenia AND
- Affective disorder
Can mood-incongruent psychotic symptoms in an affective disorder justify a diagnosis of Schizoaffective Disorder?
What is F25.0?
Schizoaffective Disorder, manic type
What is F25.1?
Schizoaffective Disorder, depressive type
What is F25.2?
Schizoaffective Disorder, mixed type
What is F25.3?
Other Schizoaffective Disorder
What is F25.9?
Schizoaffective Disorder, unspecified
What are affective symptoms superimposed on a pre-exisiting schizophrenic illness classified under in ICD-10?
Somewhere else in F20-F29
What sort of delusions are seen in delirium?
When is clouding of consciousness worse in delirium?
What hallucinations are seen in delirium?
+/- auditory (often threatening)
What is the ICD-10 for delirium (not induced by alcohol/psychoactive substances)?
Delirium can also include acute or subacute conditions. Give examples.
Brain syndrome confusional state (non-alcoholic)
What is the ICD-10 for delirium tremens?
What is F05.0?
Delirium not superimposed on dementia
Delirium superimposed on dementia
What is F05.8?
- Of mixed origin
- Postoperative delirium
What are functional disorders?
Symptoms unexplained by conventional physical disease processes
Under ICD-10 and DSM-IV, what are functional disorders called?
What is the conversion process to a functional disorder referred to under ICD-10 and DSM-IV?
What dissociative disorders exist under ICD-10?
Trance and possession disorders
Dissociative disorders of movement and sensation
How do dissociative disorders of movement and sensation present?
Like a physical disorder:
- Doesn't explain symptoms
- Can represent patient's concept of physical disorder
What are somatoform disorders? What is their ICD-10 number?
Repeated presentation of physical symptoms WITH
Persistent requests for medical investigations:
- In spite of repeated negative findings
Usually resist attempts to discuss psychological basis
Any physical disorder present:
- Do not explain patient's distress
What is F45.0?
- Repeated and changing physical symptoms
- Present over >=2 years
- Long + complicated Hx of medical contact
- Any body part affected
- Disruption of social and family functioning
What GI symptoms can somatisation present with?
- Low mood
- Abdominal pain
What neurological symptoms can somatisation present with?
Non-epileptic attack disorder
Weakness +/- sensory disturbance
What rheumatological symptoms can somatisation present with?
Chronic fatigue syndrome
What other symptoms can somatisation present with?
Cardiology - Atypical chest pain
Dermatology - Chronic vulval pain
Gynaecology - Chronic pelvic pain
Orthopaedics - Chronic lower back pain
What percentage of somatisation patients present with apparent status epilepticus?
What impact do chronic somatisers have?
Spend an average 7 days/month in bed
Use 9 times more healthcare resources
Have ~22 abortive/unnecessary lifetime hospital admissions
In what populations is somatisation most common?
F > M
3rd to 6th decade
FHx of functional disorders
Allied Health Professionals
Patients with learning difficulties
What indicates poor prognosis in somatisation?
What is the biopsychological perspective of how IBS can result in symptoms?
1. Psychological distress
2. Stimulation of ANS
3. GI motility changes
What biological changes occur in chronic pain syndromes?
Adaptive changes in nervous system:
- eg. Arborisation of dorsal horn cells
What psychosocial symptoms can occur in chronic pain syndromes?
What childhood experiences can predispose to somatisation?
Exposure to excessive family illness
Exaggerated family health concers
Exposure to 'figure of identity'
What stressful life events can precipitate somatisation?
Major threats to health
What secondary gains can perpetuate somatisation?
Illness accrued benefits
Exemption from work
Manipulation of others
What SPECT abnormalities are seen in functional disorders?
Increased activity in rCBF (when resting) bilaterally in:
- Frontal cortex
- Parietal cortex
Reduced rCBF to contralateral:
- Basal ganglia
Hypoactivation resolved with recovery
What is Hoover's sign?
1. Ask patient to push their "weak" heel down against hand -> No effect
2. Do straight leg raise of "normal" leg against resistance -> "Weak" heel will press into hand as "weak" hip extends
What does Hoover's sign indicate?
Inconsistency of examination
What external inconsistency may be seen in functional disorders?
Tubular field defect:
- Inconsistent with laws of optics
What percentage of patients with Non-Epileptic Attack Disorder also have epilepsy?
What can predispose to Non-Epileptic Attack Disorder?
Traumatic experiences (in 90%):
- Esp. childhood abuse/neglect
What is Non-Epileptic Attack Disorder often comorbid with?
How can Non-Epileptic Attack Disorder be differentiated from epilepsy?
How can functional disorders be treated?
Positive diagnosis and explanation
Physical rehab (physio and OT)
Treat any anxiety/depression/PTSD
What symptoms can antidepressant treatment improvement in functional disorders?
Diarrhoea in IBS
Insomnia in chronic pain
What is hypochondriasis?
Often called "health anxiety"
Focuses on diagnosis of serious and progressive physical disorders
What is Munchausen's Syndrome?
Factitious disorder (F68.1):
- Feigning symptoms for no reasons
- May self-harm to produce signs/symptoms
What is malingering?
Feigning illness for secondary aim:
- Often there is some actual structural/functional symptoms
What is the first line drug for severe anxiety for short-term use?
What pharmacological effects do BZDs have in anxiety?
Reduce anxiety and aggression
When are BZDs used?
Acute treatment of severe anxiety
- During minor procedures
What substances all exhibit anxiolytic properties?
What drugs can have anxiogenic properties?
Inverse BDZ agonists:
How can BZD overdose be treated?
What are some side effects of BZD treatment?
Anterograde amnesia and reduced coordination (beware Rohypnol)
Tolerance and dependence
What can happen on BZD withdrawal?
- Toxic psychosis
Why do the effects of BZD withdrawal occur?
Neuroadaptation of GABA response:
- Treatment reduces response to GABA
- Withdrawal results in anxiety/convulsions due to decreased density of BZD receptors
What is the process by with BZDs are withdrawn?
1. Transfer to equivalent dose of diazepam/chlordiazepam (take at night)
2. Reduce dose every 2-3 weeks in steps of 2 or 2.5mg (maintain dose until symptoms improve)
3. Reduce dose further in smaller steps if necessary
4. Stop completely
When can BZD withdrawal occur?
From ~4 weeks to >=1 year
In what anxiety disorders are SSRIs used?
Panic disorder, OCD, PTSD, phobias
In what anxiety disorders are TCAs used?
2nd line for panic disorder
What TCAs are usually used in anxiety disroders?
In what anxiety disorder is Venlafaxine used?
In what anxiety disorder is Moclobemide?
What acute affect can SSRIs have in anxiety?