Anxiety

patho and therapy

Anxiety is the activation of what nervous system

sympathetic

In a GAD patient there is an increase in _____ and a decrease in _____

cortical activity, basal ganglia activity

duration of GAD diagnostic criteria

6 months or more

mean age of onset for SAD

14—16 y.o

about 20% of SAD patients have what other issue

SUD

Diagnostic duration for SAD

6 months or greater

Women are 2x more likely than men to have what 

PD

In PD, remission is achieved in only _____ of patients

1/3

how is the rate of suicide related to PD

there is an increased rate of attempts and ideation

pathophysiology of PD

decrease in serotonin and benzo receptors which affects GABA and serotonin

Diagnostic crieteria of PD

• recurrent, unexpected panic attacks

• more than 1 attack that has been followed by more than 1 month of 

  • persistent worry

  • maladaptive changes in behaviors

Causes of PTSD

unknown

3 subsets of PTSD

pre-trauma, peri-trauma, post-trauma

In what subset of PTSD is there an emotional response; dissociation

peri-trauma

What part of the brain is influencial in PTSD

the amygdala

what sends the stress response

amygdala

In PTSD, there is low _____ release

cortisol

alpha 1 postsynaptic receptors cause

startle response, sleep (PFC)

alpha 2 postsynaptic receptors cause what

cognition and normal response to emotional stimuli

causes of OCD is likely

genetic

mean age of onset of OCD

20 y.o

good prognostic factors of OCD

symptoms are:

• episodic

• precipitated by an event

• The patient adjusts well occupationally and socially

define obessions

recurrent, persistent thoughts, urges and images

define complusions

Repetitive behavior or mental act in response to obsessions

examples of obessions

• contamination

• symmetry

• aggressive, sexual images or thoughts

• discarding something valuable 

• doubts

examples of compulsions

• cleaning

• ordering, arranging

• praying, checking, reassurance

• hoarding

• repeated checking

what are common OCD themes or dimensions

• cleaning

• symmetry

• forbidden thoughts

• harm

• discarding (hoarding)

true or false: duration of action is the same thing as onset of action

false

rapid onset benzos

alprazolam, diazepam, clorazepate

BZD in elderly has a higher risks of

falls and fractures

what is a big interaction with benzos

alcohol

absolute/relative CI in benzos 

• SUD

• respiratory disorders

• pregnancy, labor, lactation

• hepatic disease

• M. gravis

• acute narrow angle glaucoma 

Which benzos do not undergo extensive hepatic metabolism

lorazepam, oxazepam, temazepam (LOTe)

which benzo has the longest half life

lorazepam

weekly dose reduction for tapering in benzos

25%

First line agents in GAD

SSRIs

2nd line tx of GAD

switching out antidepressants

follow up for GAD

2-4 weeks for the first 3 months

1st line for SAD

CBT

Most used SSRIs used for SAD

zoloft, escitalopram 

2nd line for SAD

CBT + SSRI

3rd line for SAD

SSRI + buspirone

true or false: buspirone has to be scheduled

true 

what is usually given for performance anxiety

propranolol, atenolol

tx duration of SAD

about 9 months

1st line for PD

SSRIs, SNRI, psychotherapy, TCAs or BZDs

2nd line agents for PD

TCAS or BZDs

1st line for PTSD

prolonged exposure therapy

avoid what medication class in PTSD

benzos

nightmares associated with PTSD

prazosin

1st line OCD

CBT and SSRIs

true or false: benzos are effective in OCD

false