Anxiety Disorders are compromised of what 2 componenets?

psychologic

physical

~(tachycardia, dry mouth, sweating, trembling,  palpitations, weakness, fatigue, SOB)

1. generalized anxiety disorder (GAD)
2. panic disorder
3. OCD
4. phobic disorders
5. PTSD
6. acute stress disorder

with psycholtherapy (1st)

drug therapy

both

• benzodiazepines
• SSRIs

• GAD
• PD
• OCD
• SAD
• PTSD

• GAD Characteristics?
  • psychologic manifestations?
  • somatic manifestations?

• chronic characterized by uncontrollable worrying about several events or activities (work, school, family, etc)
• most have an associating disorder such as depression.
• not the same as situational worrying (normal responses to life events)
• >6months
  • vigilance, tension, apprehension, [poor], and difficulty falling or staying asleep
  • trembling, muscle tension, restlessness, autonomic hyperactivity:palpations, tachycardia, sweating, and clammy hands.

• managed with nondrug and drug therapy
• before drug therapy: is supportive therapy, cognitive behavioral therapy, biofeedback and relaxation training. (helps with coping skills)
• 1st line drugs are benzodiazepines (fast acting)
• others include antidepressants and buspirone (longer acting)
• extended treatment should last for at least 2-6 months even though treatment usually is lifelong.

Treatment of GAD

Benzodiazepines

(refer to ch 34 for pharmacology and brookes drug table)

• benefits derive from enhancing responses to GABA, which is an inhibitory neurotransmitter.
• onset immediate and highly safe
• sedation and psychomotor slowing are primary side effects
  • first 7-10 days
  • will subside
• Risk of physical dependence, withdrawal symptoms, etc.

Treatment of GAD

Buspirone

venlafaxine

Panic Disorder Characteristics

Agrophobia

• recurrent, intensely uncomfortable episodes or panic attacks.
• sudden onset, peak within 10min, these symptoms
  • racing heart, chest pain, SOB, dizzy, nausea, derealization, fear lose control, fear of death, numbing hands, flush or chills.
• daily or 1 or 2 a month.

• anxiety about being in places or situations from which escape might be difficult or embarassing, or in which help might be unavailable in the event a panic attack occurs.
• leads to avoidance or places and situations

• 70-90% effective
• drug therapy and cognitive behavioral therapy work great together.
• drug:
  • help suppress panic attacks
• CBT
  • helps pt become more comfortable with situations and places that had been avoided.
• Avoid:
  • caffeine and sympathomimetics (trigger panic attacks)
  • avoid sleep deprivation.
• exercise!

Panic Disorder Treatment

Antidepressants

• respond well to SSRIs (preferred), TCAs and MAOIs.
• refer to ch 32 for dynamics.(or brookes table)

• decrease frequency of attacks and intensity, anticipitory anxiety and avoidance behavior.
• decrease regardless if there is depression, but is great for use in depression AND panic disorder.
• nausea, headache, insomnia and sex dysfunction.

potentiall disabling condition characterized by persistent obsessions and compulsions that cause marked distress, consume at least 1 hr a day and significantly interfere with daily living.

• recurrent or persisten thought, impulse, or mental image that is unwanted or distressing and comes involuntarily to mind despite attempts to ignore or suppress it.

• fear of contamination
• aggressive impulses (family death)
• need for orderliness or symmetry
• repeated doubts

• ritualized behavior or mental act that the pt is driven to perform in response to his or her obsession.
• essential to prevent some horrible event from ocurring.
• if suppressed or postponed the pt experiences increased anxiety.

• hand washing
• mental counting
• arranging objects symmetrically
• hoarding

• responnd to both drug and behavioral therapy (prob most important).
• they are exposed to sources of their fears, while being encouraged to not act out.
• great anxiety, but success rate is high.
• 5 drugs are approved
  • 4 SSRIs (1st line), and 1 TCA (clomipramine)

SSRI for OCD

(refer to ch 32 or brookes table for further detail)

• increase serotonergic transmission.
• Nausea, HA, insomnia, sex dysfunction.
• therapy con't for at least a yr.
• slow withdrawal
• con't relapse, lifelong trx many need to occur.

Social Anxiety Disorder (social phobia)

Characteristics

• intense, irrational fear of situations in which one might be scrutinized by others, or might do something that is embarassing or humiliating.
• may avoid situation or endure with severe anxiety.
• the most common form of an anxiety disorder.

• generalized
• nongeneralized

generalized SAD is...?

What is the nongeneralized form of SAD?

• person fears nearly all social and performance situations

• fear is limited to specific situations, such as public speaking.

• retard social development
• inhibit participation in social activities
• impair acquisition of friends
• difficult to date
• inhibit education

• SSRI and benzodiazepines (rapid relief and PRN).
• behavioral and cognitive therapy are sometimes just as effective as some drugs.

PTSD Characteristics

• re-experiencing a traumatic event, avoiding reminders of event, persistent state of hyperarousal.
• interpersonal violence (rape, assault, torture) will elicit a more intense response compared to traumatic event (car accident, natural disaster)

• both therapy and drugs has not been established.