Term
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Definition
| emotional state that causes worry, perception of danger, or feelings of threat and can lead to uncomfortable psychological and physiological symptoms |
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Term
| Goals of Tx of Anxiety Disorders |
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Definition
reduce severity, frequency, & duration of anxiety symptoms;
improve pts overall functioning |
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Term
| Nonpharm Tx for Anxiety Disorders |
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Definition
Avoidance of caffeine, drugs of abuse, and stimulants;
Psychotherapy;
Stress management;
Exercise |
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Term
| Medical Conditions that cause Anxiety |
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Definition
| angina, arrhythmias, CHF, MI, Cushing's dx, hyperthyroidism, hypoglycemia, hypokalemia, hypothyroidism, GERD, PUD, akathisia, chronic pain, seizures, Parkinsons dx, stroke, migraines, dementia, asthma, COPD, pneumonia, pulmonary embolism |
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Term
| Medications that cause Anxiety |
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Definition
| amphetamines, caffeine, cocaine, ephedrine, MDMA, methylphenidate, nicotine, PCP, phenylephrine, psuedoephedrine, barbiturates, benzodiazepines, EtOH, opiates, antipsychotics, TCAs, SSRIs, bupropion, albuterol, aminophylline, salmeterol, theophylline, corticosteroids, digoxin, levodopa, NSAIDs, thyroid supplements |
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Term
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Definition
| low cost, relatively low toxicity, easy to use, rapid onset |
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Term
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Definition
| ADRs, potential for tolerance & dependence |
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Term
| BZDs used in tx of Anxiety Disorder |
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Definition
| alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), oxazepam (Serax) |
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Term
| BZDs that form active metabolites, have long half-lives |
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Definition
| chlordiazepoxide (Librium), clorazepate (Tranxene), diazepam (Valium) |
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Term
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Definition
| more lipophilic BZDs --> rapid anxiolytic effect, shorter duration of action, provides a "rush" |
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Term
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Definition
BZDs that are less lipophilic --> slower anxiolytic effect --> longer duration of action;
L has reliable IM absorption |
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Term
| lorazepam, oxazepam, temazepam |
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Definition
| BZDs that are ONLY conjugated with NO oxidation |
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Term
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Definition
| Common: sedation, drowsiness, ataxia, lethargy, mental confusion, motor impairment, cognitive impairment, anterograde amnesia, disorientation, slurred speech, amnesia; Rare: paradoxical agitation, decreased respiration |
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Term
| Contraindications for Pts taking BZDs |
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Definition
| alcohol intoxication; chronic pulmonary insufficiency; significant hepatic dx; sleep apnea; cormorbid substance use disorders |
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Term
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Definition
| anxiety, insomnia, restlessness, irritability, muscle tension, seizures |
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Term
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Definition
BZD receptor antagonist used in tx of BZD overdose;
C/I: if TCAs used for overdose;
Will precipitate withdrawal in chronic BZD user |
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Term
| Overdose Symptoms of BZDs |
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Definition
| somnolence, confusion, slurred speech, respiratory depression, coma, hypotension |
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Term
| Decreased clearance of BZDs --> Increased BZD drug levels |
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Definition
| fluoxetine, paroxetine, fluvoxamine, itraconazole, ketoconazole, erythromycin, nefazadone |
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Term
| Increases clearance of BZDs --> decreased BZD drug levels |
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Definition
| carbamazepine, phenytoin, rifampin |
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Term
| Discontinuation of BZD therapy |
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Definition
Related to how long pt has been on med;
"reduce gradually" --> 25% reduction in dose each wk until 50% of dose is reached, then reduce by 1/8th dose per wk |
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Term
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Definition
MoA: non-BZD anxiolytic, partial 5-HT1A receptor agonist;
Dosing:
Initial - 7.5 mg BID OR 5 mg TID, increase by 5 mg every 2-3 days;
Therapeutic - 20-30 mg/day divided
Max = 60 mg/day
Onset: 1-2 wks, takes 4-6 wks for full benefit;
ADRs:
dizziness, nausea, HA
Drug Interactions:
risk of serotonin syndrome
rifampin decreases effects of drug
verapamil, diltiazem, itraconazole, erythromycin increases effects of drug; |
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Term
| Advantages of using buspirone (Buspar) |
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Definition
| no abuse potential; little/no sedation or impairment of motor activity; safe in overdose |
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Term
| Disadvantages of buspirone (Buspar) |
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Definition
| long onset of effect; previous BZD users may not feel they respond well to drug; NOT for PRN use |
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Term
| Generalized Anxiety Disorder Diagnostic Criteria |
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Definition
1) excessive anxiety & worry occurring for at least 6 months on most days;
2) Pt has difficulty controlling the worry;
3) Anxiety & worry, associated with 3 of following: restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance
4) Anxiety & worry not confined to another psychiatric illness
5) constant worrying that interferes with social or occupational functioning;
6) NOT caused by a drug, substancec, or medical condition |
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Term
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Definition
| avoid caffeine, drugs of abuse, & stimulants; Psychotherapy --> cognitive behavioral therapy; Applied relaxation therapy; Change maladaptive behaviors by substituting with other coping mechanisms |
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Term
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Definition
should be used for moderate-severe GAD only;
1st line option - SSRIs:
paroxetine 20 mg daily
escitalopram 10 mg/day
1st line option - SNRIs
duloxetine 30 mg daily x 1 wk then increase to 30 mg BID
venlafaxine 37.5-75 mg/day
2nd or 3rd line options:
TCAs, buspirone, BZDs ('bridge therapy' for time lapse of SSRI full effect) |
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Term
| Panic Disorder (PD) Diagnostic Criteria |
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Definition
begins as series of panic attacks followed by at least 1 month of peristent concern about having another panic attack; often seek med assistance for what they believe to be a medical problem; may develop agoraphobia 2ndary to panic attacks; may avoid specific situations where they feel a panic attack may occur;
Requires at 4 of following the develop abruptly and reaches a peak within 10 min:
palpitations, sweating, shaking, sensations of shortness of breath, feelings of choking, chest pain, nausea, dizziness, depersonalization, fear of losing control, fear of dying, numbness, chills or hot flashes |
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Term
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Definition
| reduce # or eliminate panic attacks; reduce duration & intensity of panic attacks; reduce or eliminate anticipatory anxiety; prevent phobic avoidance; improve social & occupational functioning |
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Term
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Definition
avoid caffeine, drugs of abuse, and stimulants;
psychotherapy - CBT that focuses on correction of pt's maladaptive behaviors & thoughts |
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Term
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Definition
SSRIs - mainstay:
start at 1/4-1/2 recommended starting dose;
sertraline 25 mg/day, paroxetine 10 mg/day IR or 12.5 mg/day CR, fluoxetine 10 mg/day
Others:
venlafaxine 37.5 mg/day
Selected BZDs - 1st line in pts requiring RAPID relief of anticipatory anxiety & those unable to tolerate antidepressants:
alprazolam - initial: 0.25-0.5 mg TIX, antipanic: 4-10 mg daily (divided doses)
clonazepam - initial: 0.25 mg BID, antipanic: 3-6 mg daily (divided doses)
Also may try TCAs (last line):
Imipramine - initial: 10 mg HS, antipanic: 150-300 mg qHS
Clomipramine - initial: 25 mg qHS, antipanic: 25-150 mg qHS
Other agents: MAO-Is, nefazodone, mirtazepine, atypical antipsychotics |
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Term
| Obsessive Compulsive Disorder (OCD) Diagnostic Criteria |
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Definition
A. Obsessions:
1) recurrent & persistent thoughts, impulses, or images that are intrusive, inappropriate, & cause marked anxiety
2) thoughts, impulses, or images are not simply excessive worries about real-life problems
3) attempts are made to ignore or suppress thoughts, impulses, or images
4) it is recognized the obessions are a product of person's own mind
Compulsions:
1) repetitive behaviors that person feels driven to perform in response to an obsession
2) behaviors are aimed at preventing or reducing distress
B. Person has recognized that obsessions or compulsions are excessive or unreasonable
C. Obsessions or compulsions cause marked distress, are time consuming, or significantly interfere with person's occupational or social functioning
D) disturbance is not due to direct physiological effects of a substance or a general medical condition |
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Term
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Definition
| recommended for mild OCD; Psychotherapy - exposure therapy, response prevention |
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Term
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Definition
recommended for pts w/ moderate-severe OCD; gradual improvement seen in 4-10 wks; pts need higher doses of antidepressants;
1st line - SSRIs:
fluoxetine 20 mg/day (max = 80 mg/day), paroxetine 20 mg/day, sertraline 50 mg daily (max = 200 mg/day), fluvoxamine 50 mg/day IR, 100 mg/day ER;
2nd line agent: Clomipramine - selected after failing 2-3 SSRIs;
Augmentation: SSRI + risperidone, olanzapine, quetiapine, venlafaxine;
*NO BZDs - NO EFFICACY to tx OCD* |
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Term
| Post Traumatic Stress Disorder (PTSD) Diagnostic Criteria |
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Definition
A) exposure to a traumatic event - witnessed event involving actual or threatened death or serious injury, person's response involved intense fear, helplessness, or horror;
B) tramautic event is persistently experienced in 1 or more of following: recurrent & intrusive distressing recollections, recurrent distressing dreams, acting or feeling as if traumatic event was recurring;
C) Persistent Avoidance of stimuli associated with trauma
D) Persistent symptoms of increased arousal
E) duration of disturbance is more than 1 month
F) Disturbance causes clinically significant distress or impairment in social or occupational functioning |
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Term
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Definition
| reduction in core symptoms; improvement in disability & QOL; long-term remission |
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Term
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Definition
| anxiety management; CBT; exposure therapy |
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Term
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Definition
1st line - SSRIs (takes up to 8 wks for response):
sertraline - 25 mg/day, increase to 50 mg/day after 1 wk, increase to 200 mg/day MAX
paroxetine - 20 mg/day
2nd line agent - mirtazapine
Other agents used:
venlafaxine
antiadrenergic: prazosin 1-4 mg daily --> decreases nightmares, sleep disturbances, also trazadone, nefazadone;
TCAs
mood stabilizers
buspirone
antipsychotics |
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Term
| Social Anxiety Disorder (SAD) Diagnostic Criteria |
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Definition
| marked, persistent fear of 1 or more social or performance situations; exposure provokes anxiety; fear is excessive or unreasonable; situations are avoided or endured with intense anxiety; it interferes with occupational or social functioning; it is NOT caused by drugs, a substance, or medical condition |
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Term
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Definition
| CBT; exposure therapy; social skills training |
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Term
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Definition
1st line - SSRIs:
onset - 4-8 wks
sertraline 25 mg/day, increase up to 50 mg/day after 1 wk (MAX = 200 mg/day)
fluvoxamine 100 mg/day
paroxetine 20 mg/day
Others:
venlafaxine 75 mg daily
BZDs
MAO-Is
Propanolol prn 1-2 hrs before presentation or performance |
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Term
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Definition
alternative herbal product;
MoA: increases GABA
ADRs: GI upset, HA, dizziness, drowsiness, dry mouth, allergic skin rxns, INCREASED LFTs
Drug interactions: CNS depressants
Dosing: 100 mg TID (70 mg lactones) |
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