Treatment of Anxiety Disorder

Question 1

What is the “alarm center” for anxiety that causes the symptoms (noradrenergic transmission)

Answer 1

Locus coeruleus

Question 2

How does serotonin effect anxiety

Answer 2

Serotonin in the amygdala turns on GABA, which turns off glutamate

Question 3

T/F: SSRI, SNRI and bupropion can be used to treat anxiety but does can increase anxiety initially before decreasing it

Answer 3

True

Question 4

What are the drugs associated with anxiety symptoms upon withdrawl

Answer 4

Barbiturates, benzodiazepines, ethanol, narcotics

Question 5

What is generalized anxiety disorder

Answer 5

ongoing state of excessive WORRY or anxiety lacking any clear reason

Question 6

What is the cardinal symptom of generalized anxiety disorder, how long must it last to be considered GAD

Answer 6

Excessive anxiety/worry with difficulty controlling worry, over 6 months

Question 7

What is the symptom of panic disorder

Answer 7

Discrete (short/abrupt) episode of sudden attack of overwhelming fear or terror (impending doom) with the cause not known (recurrent UNexpected attacks at least once a month)

Question 8

What is the symptoms of Obsessive-compulsive disorder (OCD)

Answer 8

obsessive or intrusive thoughts causing marked anxiety and distress, compulsions are ritualistic and repetitive

Question 9

What is Posttraumatic stress disorder

Answer 9

Anxiety triggered by the insistent recall of past stressful experiences

Question 10

T/F: Social anxiety disorder is marked by fear of being embarrassed

Answer 10

True

Question 11

What are non-pharmacological treatments of anxiety disorder

Answer 11

Education, Cognitive behavioral Therapy ( can prevent relapse)

Question 12

What are the first line drug class for anxiety disorders

Answer 12

Antidepressants: SSRIs, SNRIs, TCAs and MAOI (limited use)

Question 13

T/F: SSRIs and bupropion can be used to treat all the anxiety disorders discussed

Answer 13

False: Bupropion CAN NOT be used for panic disorder but SSRIs is effecitve for all the other anxiety disorders

Question 14

What is the best way to potentially avoid transient increases in anxiety when starting an SSRI

Answer 14

Initiate at the lowest available dose (half antidepressant doses)

Question 15

Which patients should especially receive antidepressants for their anxiety

Answer 15

Patient has a history of substance abuse or concurrent depression

Question 16

What is MOA of BZD

Answer 16

Increase the frequency of GABA-Cl channels in RESPONSE to GABA stimulation

Question 17

What is the place of therapy for anxiety

Answer 17

Can give short term to mitigate transient depression when using SSRIs

Question 18

T/F: BZDs are more effective than SSRIs in treating cognitive symptoms and less effective in treating somatic symptoms

Answer 18

False: BZDs are LESS effective than SSRIs in treating COGNITIVE symptoms and MORE effective in treating SOMATIC symtptoms

Question 19

Which anxiety disorder population are BZDs contraindicated

Answer 19

PTSD

Question 20

T/F: BDZs can interfere with CBT treatment for OCD

Answer 20

True

Question 21

What are the adverse effects of BZDs

Answer 21

Sedation/drowsiness, ataxia, visual-spatial impairment, anetograde amnesia

Question 22

What is the antidote for BZDs overdose

Answer 22

Flumazenil

Question 23

T/F: BZDs can be taking with alcohol but at low amounts only

Answer 23

False: BZDs should NEVER be used with alcohol

Question 24

When using BZDs what aspects do patients become intolerant of, where is the no intolerant

Answer 24

Sedation and euphoria, anxiolytic effects

Question 25

T/F: Relapse and rebound are common when using BZDs but must taper down so that seizures and other symptoms are less likely to occur

Answer 25

True

Question 26

What anxiety disorder is buspione approved for

Answer 26

GAD

Question 27

What is is the major drawback of buspirone use for anxiety

Answer 27

2-4 weeks for therapeutic effects

Question 28

What can be used for anxiety symptoms such as fast heart rate

Answer 28

Beta-blockers

Question 29

What drug can be use as needed for anxiety and is FDA approved

Answer 29

Hydroxyzine (H1 antagonist)

Question 30

What is the first line for GAD,Panic disorder

Answer 30

CBT and SSRI and SNRI, SSRIs and venlafaxine

Question 31

T/F: BZDs can't be used for panic disorder as needed

Answer 31

True

Question 32

What can be used to treat OCD, what type of dosing, how long

Answer 32

SSRIs and clomipramine (if SSRI ineffective), higher dose than for depression, at least 10-12 weeks

Question 33

T/F: Medications are more effective than CBT for treating OCD

Answer 33

False: CBT appears to be more effective than medications for treating OCD

Question 34

What anxiety disorders can BZDs never be used in, only time it can be used PRN

Answer 34

OCD, PTSD, social anxiety

Question 35

What lipophilic alpha-blocker can be used to elevate nightmares in someone who has nightmares due to their PTSD

Answer 35

Prazosin