Anxiety & Anxiety-Related Disorders Flashcards
(40 cards)
Noradrenergic model
- Autonomic nervous system is hypersensitive and overreactive to various stimuli
- Stimulants release of glutamate (excitatory)
GABA-receptor model
- GABA has a strong inhibitory effect on 5-HT, NE, and DA
- Proposed to be lower GABA concentrations in anxiety disorders
Serotonin (5-HT) Model
- Data suggest dysregulation of serotonin in those with anxiety disorders
- May lead to imbalance of other neurotransmitter
What is the GAD Diagnostic Criteria?
At least six months of the following:
* Excessive anxiety or worry on most days
* PLUS three of the following:
- Restlessness
- Poor concentration
- Easily fatigued
- Irritability
- Sleep changes
- Muscle tension
What is the DOC of GAD?
SSRIs
What are some adverse effects of SSRIs?
- Stomach upset
- Nausea
- Diarrhea
- Appetite changes
- Sexual dysfunction
- Weight gain
- GI bleed
- SIADH
SNRIs
- Duloxetine (Cymbalta)
- Venlafaxine (Effexor)
- Desvenlafaxine (Pristiq)
- Levomilnacipran (Fetzima)
What are the adverse effects of SNRIs?
- Increased blood pressure
- Nausea
- Constipation
- Sexual dysfunction
What is the mechanism of action benzodiazepine?
- Bind to GABA receptors in the brain which allows the opening of chloride channels and an influx of chloride into the cell
- Hyperpolarization and decreased action potentials
What is the place in therapy of benzodiazepines?
- PRN short-term relief in patients with severe anxiety that limits their ability to complete daily tasks
What are the adverse effects of benzodiazepines?
- Sedation
- Confusion
- Memory impairment
- Physical dependence
- Risk of respiratory depression
What is the discontinuation of benzodiazepines?
- May take weeks-months if done as an outpatient or if on high doses for long periods of time
- ** DECREASE dose by 10-25% every 1-3 weeks**
What is the withdrawal of benzodiazepines?
- Concern if taking for > 2 weeks
- Onset: 1-2 days if short half-life, 3-8 days if long half-life
- Symptoms usually last 1-2 weeks
What are some common symptoms of withdrawal of benzodiazepines?
- Anxiety
- Restlessness
- Insomnia
- Muscle tension
- Tremor
- Elevated BP
What are some less common symptoms of withdrawal of benzodiazepines?
- Nausea
- Blurry vision
- Diaphoresis
- Depression
- Hyperreflexia
What are some rare symptoms of withdrawal of benzodiazepines?
- Tinnitus
- Confusion
- Seizures
- Psychosis
Buspirone (Buspar)
- 5-HT-1A partial agonist
- Delayed onset of action
- No potential for dependence
- Dose: 10-60 mg/day divided BID-TID
- GAD
Hydroxyzine (Vistaril)
- H1 antagonist
- Useful for mild anxiety symptoms
- Dose: 25-100 mg as needed
- Max: 400 mg/day
- GAD
Vilazodone (Viibryd)
- SSRI/5-HT-1A partial agonist
- Useful in those with comorbid depression
- Dose: 20-40 mg/day
- GAD
Diphenhydramine (Benadryl)
- H1 antagonist
- Useful for mild anxiety symptoms
- Dose: 25-50 mg as needed
- Max: 300 mg/day
- GAD
What are the diagnostic criteria of Panic Disorder?
At least four of the following symptoms:
* Palpitations
* Sweating
* Shaking
* SOB
* Choking
* Chest pain
* Stomach upset
* Dizziness
* Chills or heat
* Sensations
* Etc.
AND
At least one month of worry about future panic attacks with maladaptive behavior changes
What is the first line of therapy for Panic Disorder?
- SSRIs
What is the second line therapy for Panic Disorders?
SNRIs
What other medications can treat panic disorder?
- Alprazolam
- Clonazepam
- Imipramine
- Clomipramine
