Anxiety/trauma/compulsive disorders

anxiety

emotional state commonly caused by the perceptioon of real or perceived danger that threatens the security of an individual

glutamate

the following is the noradrenergic model pathophysiology of anxiety:

- increased NE in the locus ceruleus increases ________ release and produces subjective feelings of anxiety

6 months

generalized anxiety disorder is persistent anxiety and work >/= _____ about a number of events or activities

3

for GAD, diagnosis need >/+= ___ of the following (>1 for children):

- restlessness or feeling keyed up or on edge

- easily fatigued

- difficulty concentrating or mind going blank

- irritability

- muscle tension

- sleep disturbance

GAD 7

diagnostic and monitoring tool for anxiety-related symptoms

10

a score > ___ on the GAD-7 is diagnosis for GAD

15

a GAD-7 score > ____ is considered severe

panic disorder

recurrent panic attacks and persistent concern about additional attacks or worry about consequences of attacks or change in behavior

4

symptoms of panic attack need >/= __ of the following, plus discrete period of intense fear or discomfort:

- palpitations, pounding heart, increase HR

- sweating

- trembling, shaking

- shortness of rbeath or smothering sensation

- feeling of choking

- chest pain or discomfort

- nausea or abdominal dsitress

- feeling dizzy, unsteady, lightheaded or faint

- derealization of depersonalization

- fear of losing control or going crazy

- fear of dying

- paresthesias

- chills or hot flashes

agoraphobia

anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having an unexpected or situationally predisposed panic attack

social anxiety disorder

intense, irrational, and persistent fear of being negatively evaluated, scrutinized, or embarrasses in at least 1 social or performance situation

false (classified as trauma-related disorder)

true or false: PTSD is an anxiety disorder

intrusion, avoidance of similar stimuli, negative alterations in cognitions and mood, alterations in arousal/reactivity

what are the 4 symptom clusters, (according to DSM5) that diagnose PTSD?

1

how many symptoms does someone need to have in the intrusion category for PTSD diagnosis

1

how many symptoms does someone need to have in the avoidance of similar stimuli category for PTSD diagnosis

2

how many symptoms does someone need to have in the negative alterations in cognitions and moodd category for PTSD diagnosis

2

how many symptoms does someone need to have in the alterations in arousal/reactivity category for PTSD diagnosis

intrusion

which symptom cluster is this in PTSD:

- distressing memories

- flashbacks

- dreams/nightmares

- physiological reaction to reminders of the trauma

- psychological reaction to reminders of the trauma

avoidance of similar stimuli

which symptom cluster is this in PTSD:

- avoidance of conversation about the trauma

- avoidance of thoughts or feelings about the trauma

- avoidance of activities that are reminders of the event

- avoidance of people or places that are reminders of the event

alterations in arousal/reactivity

which symptom cluster is this in PTSD:

- decreased concentration

- easily startled

- reckless or self-destructive behavior

- hypervigilance

- insomnia

- irritability or angry outbursts

true

true or false: OCD is no longer classified as an anxiety disorder

cognitive behavioral therapy

focused on overcoming fears and/or learning to manage anxiety and worry

eye movement desensitization and reprocessing (EMDR)

what nonpharmacologic therapy is more effective than fluoxetine or placebo in maintaining improvements in PTSD scores

2-4

antidepressants in the use of anxiety may have delayed benefit by atleast ______ weeks

12-24 months

what is the duration of antidepressant use in panic disorder treatment

4-6 months

how long is the taper off antidepressants if they were being used for panic disorder treatment

true

true or false: antidepressants usually use a lower starting dose in treatment of anxiety than in MDD

SSRIs

what is the first line treatment for GAD, SAD, panic disorder, PTSD, and OCD

false

true or false: SNRIs are used in the treatment of PTSD and OCD along with SSRIs

true

true or false: TCAs are NOT effective in social anxiety disorder

clomipramine

which TcA is especially effective in OCD but still only considered 2nd or 3rd line option

12 months

at least _______ (duration) of antidepressant treatment is recommended regardless of which anxiety order is being treated

PTSD

benzodiazepines are NOT effective for treatment of _______ (anxiety/trauma disorder)

benzodiazepines

which drug class potentiates inhibitory activity of GABA

during SSRI initiation to bridge and in short term GAD like reactions to stress

benzodiazepine use for short term management of acute anxiety is supported in which 2 situations

panic disorder

longer duration of use of benzodiazepines may be needed in _________

12 weeks

it is generally recommended to keep benzodiazepine duration of use under ________

true

true or false: long acting benzos have greater risk for metabolite accumulation

desmethyldiazepam

what is the primary metabolite for chlordiazepoxide, clorazepate, and diazepam

short acting

which duration of benzos is preferred in elderly

diazepam

which benzo is the most lipophilic and thus has quicker onset of action

CYP3A4 inhibitors

what may result in higher levels of parent drug and/or active metabolite

diazepam

which benzo is highly protein bound

3 months

how often is a risks vs. benefit assessment recommended for benzo use

flumazenil

what is the antidote for benzo overdose

1-4 hours

how long does flumezenil last and is the reason why a second dose mighy be needed if the benzo is longer acting then the flumazenil

2-3 weeks

if a benzo was used short term (8 weeks to 1 year) then consider taper over ____________

c-4 wrrks

if a benzo was used long term (1 year or longer), consider taper over 2-4 weeks

2-4 months

a taper of benzodiazepene includes tapering over ____________

triazolam

what is the most ultrarapid benzo

clonazepam

what is one of the longest duration benzos

propranolol

which additional option for pharm treatment of anxiety disorders is useful in performance anxiety

false

true or false: buspirone for anxiety disorders is dosed PRN

buspirone

this is a non-benzo anxiolytic that is second line agent in all anxiety disorders and max benefit is seen at 4-6 weeks

40

the following are side effects for doses of buspirone >_____ daily

gabapentin

which anticonvulsant is effective in SAD within 2 to 4 weeks

prazosin

which med is used for PTSD related nightmares and sleep disturbances

hydroxyzine

what is a good alternative to benzos for rapid anxiety relief and/or for prn use when co-morbid substance abuse is present

anxiety

quetiapine doses between 50-300mg are generally seen in ________ disorders

psychotic

quetiapine doses between 400-700mg are generally seen in _______ disorders

2nd gen antipsychotics

what are possible augmentation therapies in partial response to sSRI when treating anxiety

inositol (vitamin B8)

what CAM therapy is more effective than placebo in treatment of panic disorder and possibly OCD

saffron

what CAM therapy is shown to be more effective than palcebo in treatment of GAD