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neurology/psychiatry > Anxiety & Related Disorders > Flashcards

Anxiety & Related Disorders Flashcards

(75 cards)

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1
Q

what are some drugs that may cause anxiety

A

steroids
dopamine agonists
stimulants
thyroid hormones
sympathomimetics
antidepressants

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2
Q

what are some disease states that may cause anxiety

A

angina
arrhythmias
hyperthyroidism
asthma
COPD
IBS
Crohn’s
PUD

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3
Q

what are some pathophysiology models that are hypothesized to cause anxiety disorders

A

noradrenergic model
GABA receptor model
serotonin model

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4
Q

noradrenergic model

A

autonomic nervous system is hypersensitive & overreactive to various stimuli

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5
Q

GABA receptor model

A

GABA has a strong inhibitory effect on 5HT, NE, DA

proposed to be lower GABA in anxiety disorders

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6
Q

serotonin model

A

dysregulation of serotonin in those with anxiety disorders

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7
Q

which gender is more common to have GAD

A

female

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8
Q

median age of onset for GAD

A

30 years
peaks in middle age

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9
Q

which ethnicity is more common to have GAD

A

european

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10
Q

DSM-V criteria for GAD

A

at least 6 months of:
-excessive anxiety or worry on most days
PLUS at least 3 of the following
-restlessness, poor concentration, easily fatigued, irritability, sleep changes, muscle tension

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11
Q

how long should GAD be treated

A

at least 12 months

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12
Q

nonpharmacological treatments for GAD

A

CBT, stress management, exercise, support groups

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13
Q

SSRI doses for GAD

A

generally need higher doses for anxiety than for depression

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14
Q

1st line drugs for GAD

A

SSRIs:
escitalopram, sertraline, fluoxetine, paroxetine, citalopram, fluvoxamine

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15
Q

SSRI side effects

A

upset stomach, appetite changes, sexual dysfunction, weight gain, GI bleed, SIADH

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16
Q

SNRIs

A

Duloxetine, venlafaxine, desvenlafaxine, levomilnacipran

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17
Q

SNRI side effects

A

increased blood pressure, nausea, constipation, sexual dysfunction

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18
Q

when are benzos indicated for GAD

A

for prn short term relief

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19
Q

how to dc benzos

A

decrease dose by 10-25% every 1-3 weeks

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20
Q

which benzo is more lipophilic and accumulates in tissues

A

diazepam

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21
Q

do not take benzos in combination with ___

A

alcohol

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22
Q

which populations are we cautious with benzos

A

history of substance use disorder
elderly (kidney/liver, fall risk, ADEs)
pregnancy & lactation

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23
Q

what are some antidepressants that are INEFFECTIVE in anxiety

A

bupropion & mirtazapine

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24
Q

clinical pearl when using antidepressants initially for GAD

A

they can initially increase anxiety. may take 2-4 weeks to see an improvement

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25
buspirone class
5HT1 partial agonist
26
hydroxyzine and diphenhydramine class
H1 antagonist, useful for mild anxiety
27
vilazodone class and when is it used
SSRI/5HT-1a partial agonist useful for comorbid depression
28
which gender more commonly has panic disorder
females
29
median age for panic disorder
20-24 years peaks in young adulthood
30
which race/ethnicity more common for panic disorder
non-hispanic white, indigenous
31
DSM-V criteria for panic disorder
at least 4 symptoms of panic attack (ie palpitations, shaking, swearing, SOB, fear of dying, etc) AND at least one month of worry about future panic attacks with maladaptive behavior changes
32
1st line for panic disorder
SSRIs
33
2nd line for panic disorder
SNRIs: venlafaxine most studied
34
note when dosing for panic disorder
higher doses are necessary and adequate trial duration is 6 weeks. increase dose every 1-2 weeks
35
other agents that may be used for panic disorder
benzos-- alprazolam & clonazepam for short term use only TCAs-- imipramine & clomipramine may reduce panic attacks but side effects are bad
36
duration of treatment for panic disorder
at least 12 months after symptoms resolve
37
gender more common for SAD
females
38
median age for SAD
13 years, peaks in adolescence
39
race/ethnicity more common for SAD
indigenous
40
DSM-V criteria for SAD
at least 6 months of: -marked fear about social situations -fear of others causes avoidance out of proportion to the actual threat
41
first line for SAD
SSRIs
42
second line for SAD
SNRIs (venlafaxine)
43
third line for SAD
MAOIs
44
short term use for SAD
benzos: alprazolam & clonazepam
45
drug that can be used for performance-based situations in SAD
propranolol
46
nonpharm for SAD
CBT
47
treatment duration for SAD
6-12 months, adequate trial is 8-12 weeks
48
gender more common in OCD
females
49
median age for OCD
19.5 years, peaks in adolescence to young adulthood
50
OCD DSM-V criteria
time consuming obsessions, compulsions, or both (defined as 1 hour time consuming)
51
1st line for OCD
SSRIs (not citalopram/escitalopram)
52
adequate trial for OCD for pharm therapy
12 weeks
53
adequate trial in OCD for CBT
3-5 months of weekly sessions or 3 weeks of daily sessions
54
1st line in OCD for SEVERE or comorbid conditions
CBT + SSRI
55
agents that are not first line for OCD
TCAs (clomipramine)-- only after failure of 2 SSRIs (bad side effects) 3rd line would be to augment with haloperidol/SGAs
56
options for refractory cases of OCD
dual therapy: SSRI + clomipramine can also try venlafaxine, mirtazapine, deep brain stimulation
57
treatment duration for OCD
at least 1-2 years for medicine then slow taper 10-25% decrease every 1-2 months for therapy: should have quarterly or biannual booster CBT sessions
58
OCD options for pregnant/lactating patients
consider CBT avoid clomipramine, paroxetine
59
OCD options for elders
avoid clomipramine start low and go slow
60
OCD options for children
CBT first line CBT+SSRI second line if ineffective, can switch to another SSRI or clomipramine
61
who is more likely to develop civilian PTSD
females
62
what are some causes of civilian PTSD
sexual violence, interpersonal network trauma, interpersonal violence, organized violence
63
DSM-V criteria for PTSD
exposure to ACTUAL or THREATENED death, serious injury, etc that leads to at least one of the following: intrusive memories, dreams, flashbacks, distress and at least one: avoidance of thoughts/feelings/convos or avoidance of external reminders and 2 impairments in mood or cognition (ie blame, diminished interest) and 2 evidences of arousal such as aggressive behavior, self destructive, or sleep disturbance symptoms must occur for more than one month and cause significant distress/impairment
64
what are some PHYSICAL symptoms of PTSD
pain, sweating, tachycardia, hypertension, weakness, dizziness, dyspnea
65
what are some BEHAVIORAL symptoms of PTSD
guilt, fear, denial, depression, anxiety, social withdrawal
66
difference between PTSD and acute distress disorder
PTSD is for one month acute distress disorder is for at least 2 days but less than a month
67
benzos for PTSD
NO all guidelines recommend against
68
what can we use for nightmares in PTSD
prazosin (alpha1 antagonist)
69
prazosin side effects
dizziness, hypotension, orthostasis, fatigue, headache
70
which drug has evidence in pediatrics for PTSD
clonidine
71
first line for PTSD
CBT
72
drug options for PTSD
SSRIs: sertraline, paroxetine (fluoxetine off label) SNRI: venlafaxine off label adequate trial 8 weeks less ideal options: TCAs, mirtazapine, phenelzine, mood stabilizers, antipsychotics
73
when to start meds for PTSD
3-4 weeks after trauma experienced
74
_______ reduce the 3 PTSD symptom clusters & treat comorbid anxiety/depression, reduce suicidal behaviors, with minimal side effects
SSRIs and SNRIs
75

neurology/psychiatry (22 decks)

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