Chapter 5- GAD- Stahl and Moore book

Question 1

GAD

Answer 1

1. Includes a combination of somatic and psychological complaints.
2. Prevalence: 12 month = 3.1% and lifetime - 5.7; 2;1 emale to male
3. Relatively uncommon before age 20
4. Medical disorders associated with GAD involve the adrenal systems (pain, arthritis, migraine, GI, ulcers, back pain, CAD, DM, asthma, COPD
5. GAD folks use GI and primary care doctors more often than those without GAD.

Question 2

Pharmacological treatments

Answer 2

1. benzodiazepines
   a. short latency to response (15-60 minutes)
   b can be used PRN
   c. not recommended when GAD present with hostility, impatience, irritability, and impulsivity
   d. side effects: sedation, motor impairment, cognitive disturbance
   e. if chronic use can have dependence in two weeks
2. Azapirones: buspirone
   a. 5HT1a partial agonist
   b. not addictive
   c. often used as an augmenting agent
3. Antidepressants
   a. Paxil - first SSRI approved for GAD
   b. sertraline- sexual side effects
   c. escitalopram- enantiomer of citalopram
   d. SNRIs
   i. venlafaxine
   II. duloxetine (not as much sexual dysfunction; more increases in HR and blood pressure
   iii. agomelatine- agonist at melatonergic (MT1, MT2) receptors and antagonist at 5HT2c receptors.
4. Anticonvulsants
   a. pregabalin- inhibits release of glutamate, noradrenaline, and substance P
   b. tiagabine- inhibits reuptake of GBA
   c. valproate- increases GABA concentration by increasing its synthesis or inhibiting its metabolism and possibly decreasing excitatory neurotransmission.
   d. zonisamide- reduces neuronal firing by clocking voltage-sensitive ion channels and reducing glutamatergic excitation.
   e. riluzole- glutamate presyaptic release modulator
5. atypical antipsychotics (SGAs)- used as augmenting agents mostly
   a. Risperidone
   b. olanzapine
   c. abilify
   d. ziprasidone
6. Hydroxyzine- antihistamine
7. Nutritional and herbal supplements
   a. Kava Kava- GABAa receptor binding and blockade of sodium and calcium voltage-gated ion channels.
   i. concerns about liver failure
   ii. inhibits P450 metabolic enzymes
   b. St. John’s Wort-
   c. PAssionflower-
   d. l-Theanine- amino acid in green tea

Question 3

Non-pharmacological treatments of GAD

Answer 3

1. CBT- psychoeducation, self-monitoring, relaxation training, cognitive restructuring
2. relaxation training, biofeedback, mediation
3. Coordinated Anxiety Learning and Management (CALM)
   a. Individuals choose either pharmacotherapy, CBT, or both
4. Cognitive bias modification (CBM)
   a. attention and interpretation biases serve as cognitive indices of anxious behavior
   b, manipulations of these behaviors can be used to treat excessive anxiety.
5. Mindfulness based therapy