anxiety disorders and insomnia therapeutics

symptoms of GAD

worry, restlessness, sleep issues

diagnostic criteria for GAD

symptoms most days for over 6 months and over 3 symptoms

first line meds for GAD

SSRI (escitalopram, paroxetine), SNRI (venlafaxine, duloxetine)

second line meds for GAD

TCA, benzodiazepines

alternative meds for GAD

buspirone, hydroxyzine, pregabalin, quetiapine

nonpharm tx for GAD

CBT

panic disorder diagnostic criteria

2 ot more unexpected panic attacks and one month concern/behavior change

symptoms of panic disorder

chest pain, SOB, fear of dying

first line meds for PD

SSRI, SNRI

medication for rapid relief of PD

BZDs

nonpharm tx for PD

CBT

symptoms of social anxiety disorder

intense fear of scrutiny, generalized or specific, blushing, sweating, GI symptoms

first line for social anxiety disorder

SSRI, SNRI

second line for social anxiety disorder

BZD, TCA, MAOI

nonpharm for social anxiety

CBT, exposure therapy

what additional class of drugs can be used for performance anxiety

beta blocker

PTSD symptoms

re-expiriencing, avoidance, mood change, hyperarousal

diagnostic criteria for PTSD

exposure to trauma and symptoms in 4 domains for over 1 month

first line med for PTSD

SSRI, SNRIa

dd-on for PTSD

prazosin for nightmares

nonpharm for PTSD

trauma-focused CBT, EMDR

obsessive compulsive disorder symptoms

time-consuming/distressing obsessions or compulsions

1st line for OCD

SSRI (fluoxetine, fluvoxamine, sertraline)

non-pharm for OCD

CBT with ERP

avoid __ in OCD

BZDs

monitor for __

efficacy, adherence, suicidality

insomnia definition

difficulty initiating/maintaining sleep with daytime impairment

__ insomnia lasts less than one week

transient

__ insomnia lasts less than 3 weeks

short term

__ insomnia lasts > 3 weeks

chronic

non BZD for insomnia include

zolpidem, zaleplon, eszopiclone

ramelteon is a __

melatonin agonist

low dose antidepressants for insomnia

trazadone, mirtazapine

suvorexant is a __

orexin antagonist

which BZD are preferred for insomnia

LOT (use with caution)

nonpharm for insomnia

CBT-I, sleep hygiene, relaxation therapy

avoid BZD in __ population

elderly, substance abuse history

good insomnia choices for elderly include

trazadone, mirtazapine, ramelteon

antidepressants may __ at first

increase anxiety

avoid __ with insomnia/anxiety medications

stimulants, alcohol

warn about complex sleep behaviors with __

Z-drugs

over the counter sleep aids include

antihistamines, alcohol, valerian and melotonin

first line for insomnia

short/intermediate BZD or nonBZD or ramelteon

second line insomnia therapy

short/intermediate BZD or non BZD or ramelteon and select alternative therapy

third line therapy for insomnia

sedating low-dose antidepressant

fourth line therapy for insomnia

combo non-BZD and AD