Generalized Anxiety Disorder Treatment Notes

A set of flashcards focused on the treatment and management strategies for Generalized Anxiety Disorder based on lecture notes.

What is Generalized Anxiety Disorder (GAD)?

A mental health condition characterized by excessive and uncontrollable worry about various aspects of life.

What are the initial steps in managing GAD?

Identify + assess including about GAD, and treatment optionS

What psychological interventions are recommended for GAD?

Low intensity psychological interventions or individual non-facilitated self-help.

What are the treatment choices for GAD?

Patients can choose between cognitive behavioral therapy or drug treatment.

What is included in highly specialist treatment for GAD?

Complex drug and/or psychological treatment regimens.

What is the role of benzodiazepines in GAD treatment?

Benzodiazepines are used only as a short-term measure during crises.

What are the first-line pharmacological treatments for chronic GAD?

SSRIs such as sertraline, citalopram, escitalopram, fluoxetine, and paroxetine.

What are some second-line treatments for GAD?

Alternative SSRIs or SNRIs like duloxetine and venlafaxine.

What is a third-line treatment option for GAD?

Pregabalin.

Why can't benzodiazepines be used long-term?

They can be addictive and cause higher development of anxiety.

What are short-acting benzodiazepines?

Alprazolam, lorazepam, oxazepam, and remifentanil.

What are the risks/ characteristics with short acting benzos

Little to no hangover effect, likely to experience withdrawal symptoms, higher risk of falls in elderly

What are long-acting benzodiazepines?

Chlordiazepoxide, clonazepam, diazepam, and nitrazepam.

Name some paradoxical effects of benzos

Restlessness, agitation, aggressiveness, rages, nightmares, hallucinations

What are some side effects associated with benzodiazepines?

Cognitive impairment, drowsiness, risk of respiratory depression, and paradoxical effects.

What would increase risk of respiratory depression with benzos

Concomitant use with alcohol/ CNS depressants

What warnings are associated with benzodiazepine use?

Risk of fatal respiratory depression - MHRA warning, especially in hepatic impairment - can lead to coma, and increased risk of toxicity symptoms.

What is the antidote for benzodiazepine toxicity?

Flumazenil.

What is the process for withdrawal from benzodiazepines?

Gradual reduction over months up to 1 year to avoid severe withdrawal symptoms.

What is the preferred benzodiazepine used to withdraw use

Diazepam - should convert dose to this

What is a commonly used method to taper benzodiazepine dosage?

Reduce dose by 2-4 mg every 1-2 weeks until reaching 20mg/ day then 1-2mg until 10mg/day, then 1mg until 5mg/day then 0.5mg until stopped

What benzodiazepines have a limit for driving

Clonazepam, oxazepam, lorazepam, diazepam, flunitrazepam, temazepam - COLDFT

What should be assessed before reducing benzodiazepine doses?

Check if the patient is stable before making further dose reductions.