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PHA333 > Wk 27 - Anxiety 2 > Flashcards

Wk 27 - Anxiety 2 Flashcards

1
Q

Outline the important points for pharmacotherapy

A
  • SSRI = 1st line
  • Benzodiazepines effective in anxiety but ST
  • SSRI + venlafaxine: initial worsening or emergence of suicidal ideation
  • Benzodiazepines: discontinuation symptoms, rebound anxiety + w/drawal
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2
Q

Outline the detection + diagnosis of GAD treatment

A
  • Symptoms + signs
  • Asses level of disability to help determine threshold for treatment
  • Ask bout long-standing anxiety symptoms when presenting w/ depression or unexplained physical symptoms
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3
Q

Outline the acute treatment of GAD

A
  • SSRI, venlafaxine, benzodiazepines, imipramine, buspirone, hydroxyzine
  • Higher dose of SSRI or venlafaxine = greater response
  • CBT
  • 12 wks needed to asses efficacy
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4
Q

Outline the long term treatment of GAD

A
  • Continue drug treatment for 6 months for those responding at 12 wks
  • SSRI (escitalopram, paroxetine) to prevent relapse
  • CBT
  • Monitor efficacy + tolerability regularly
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5
Q

Is combining drugs + psychological approaches recommended for treating GAD?

A

No

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6
Q

What do you do when initial treatment of GAD fails?

A
  • Venlafaxine/imipramine after non-response to acute treatment to SSRI
  • Benzodiazepine after non-response to SSRI + SNRI
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7
Q

Outline the detection + diagnosis of panic disorder treatment

A
  • Familiarise diagnostic criteria for panic disorder
  • Asses agoraphobia avoidance
  • Ask about panic attacks + agoraphobia when presenting w/ depression or medically unexplained physical symptoms
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8
Q

Outline the acute treatment of Panic disorder

A
  • All SSRI, TCAs, benzodiazepine, venlafaxine + reboxetine
  • CBT
  • Inc dose if insufficient response
  • Initial s/e minimised by slowly inc dose
  • 12 wks needed to assess efficacy
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9
Q

Outline the long term treatment of panic disorder

A
  • Cognitive therapy w/ exposure - red relapse rates
  • Continue drug treatment for 6 months for those responding at 12 wks
  • 1st line: SSRI
  • 2nd line: imipramine

Monitor efficacy + tolerability

  • 3 months for taper period
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10
Q

What do you do when initial treatment of panic disorder fails?

A
  • Combination if no contraindications
  • Add paroxetine or buspirone to psychological treatment after partial response
  • Add paroxetine whilst continuing CBT
  • Add group CBT in non-pharmacological response
  • Refer to specialist in refractory patients
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11
Q

Outline the detection + diagnosis of social phobia treatment

A
  • Familiarise diagnostic criteria for social phobia
  • Asses disability to distinguish social phobia from shyness
  • Ask bout social anxiety symptoms when presenting w/ depression, panic attack in social situations or alcohol misuse
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12
Q

Outline the acute treatment of social phobia

A
  • Most SSRI, venlafaxine, phenelzine, moclobemide, some benzo, anticonvulsants + olanzapine
  • CBT
  • high dose of SSRI not recommended
  • 12 wks to assess efficacy
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13
Q

Outline the long term treatment of social phobia

A
  • Continue drug treatment for 6 months for those responding at 12 wks
  • Cognitive therapy w/ exposure as red relapse
  • Prevent relapse: SSRI + CBT
  • Clonazepam 2nd line
  • Monitor efficacy + tolerability
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14
Q

What do you do when initial treatment of social phobia fails?

A
  • Switch to venlafaxine after non-response to acute treatment
  • Add buspirone after partial response to SSRI
  • Benzo: haven’t responded
  • Combine when no contraindications
  • Combine + CBT
  • Refer to specialist in refractory patient
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15
Q

Outline the detection + diagnosis of simple phobia treatment

A
  • Asses no. fears, impairment + comorbidity to judge severity
  • Ask bout anxiety symptoms when present w/ specific fears or phobias
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16
Q

Whats is the treatment for simple phobia?

A
  • 1st line: exposure technique

- Paroxetine/benzo when patient w/ distressing + impairing phobia have not responded to psychological approach

17
Q

Outline the prevention of post-traumatic symptoms

A
  • After major trauma + no contraindications, consider preventative treatment w/ propranolol
  • Trauma focused CBT prevent chronic PTSD in patients w/ post-traumatic symptoms lasting 1 month
18
Q

Outline the acute treatment of chronic PTSD

A
  • Some SSRI, phenelzine, mirtazapine, venlafaxine, lamotrigine
  • Trauma focused CBT + EMDR
  • 12 wks to assess efficacy
19
Q

What is the long term treatment for PTSD?

A
  • Continue drug treatment for 12 months for those responding at 12 wks
  • SSRI to prevent relapse
  • Monitor efficacy + tolerability
20
Q

What do you do when initial treatment of PTSD fails?

A
  • Combine when no contraindications
  • Combine drugs + psychological treatment
  • Augmentation of antidepressants w/ atypical antipsychotic after initial non-response
  • Refer to specialist in refractory patients
21
Q

Outline the detection + diagnosis of OCD treatment

A
  • Familiarise w/ criteria for OCD
  • Assess time engaged in OCD behaviour, associated distress + impairment + degree of attempted resistance to confirm diagnostic
  • Ask about OCD symptom when presenting w/ depression
22
Q

Outline the acute treatment for OCD

A
  • Clomipramine + SSRI
  • Exposure therapy + CBT
  • Inc SSRI dose
  • 12 wks needed to assess efficacy
23
Q

Outline the long term treatment for OCD

A
  • Continue drug treatment for 12 months for those responding at 12 wks
  • SSRI prevent relapse
  • Monitor efficacy + tolerability
24
Q

What do you do when initial treatment of OCD fails?

A
  • Inc dose
  • Switch btw other treatments
  • Combine when no contraindications
  • Combine drug treatment + exposure therapy/CBT
  • Augmentation w/ antipsychotic or pindolol after initial SSRI non-response
  • Refer to specialist in refractory patients
25
Q

Outline the considerations made when treating children + adolescents

A
  • Reserve pharmacological treatment when no response to psychological treatment
  • SSRI 1st line but avoid benzodiazepines + tricyclic
  • Monitor adverse effects
26
Q

Outline the considerations made when treating someone with cardiac disease + epilepsy

A
  • Avoid tricyclic antidepressants in cardiac disease
  • QT prolongation w/ venlafaxine, predisposes to cardiac arrhythmias tf avoid
  • Avoid antidepressants that lower seizure threshold
27
Q

Outline the considerations made when treating someone who is pregnant + breastfeeding

A
  • Fluoxetine or tricyclic antidepressants: 1st line in pregnancy
  • SSRI + tricyclic antidepressant when breastfeeding
28
Q

When should patients be referred to secondary care mental health services?

A
  • Primary care practitioner feels insufficiently experienced
  • 2/more attempts at treatment have no improvement
  • Severe coexisting depressive symptoms or risk of suicide
  • Comorbid physical illness + prescribed treatment could interact
  • Proposed interventions not available w/in primary care service

PHA333 (35 decks)

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