Anxiety + insomnia

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18 Terms

1

What are the key differences between GAD and phobias?

GAD is a constant feeling of anxiety, while phobias are often triggered by external situations or objects.

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2

What conditions can mimic the symptoms of anxiety?

hypothyroidism, substance misuse, and alcohol withdrawal can mimic anxiety symptoms.

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3

What is the GAD-2 screening tool, and what score indicates further investigation?

GAD-2 is a two-question tool assessing nervousness and uncontrollable worrying. A score of 3 or more indicates the need for further investigation using GAD-7.

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4

What is the first-line pharmacological treatment for GAD?

SSRIs (e.g., sertraline) are first-line for moderate-severe GAD.

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5

How long does it take for sertraline to show full effect in anxiety?

Sertraline may take 8-12 weeks to show full effect in anxiety, longer than in depression.

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6

What is the mechanism of action of pregabalin?

Pregabalin is a voltage-gated calcium channel blocker.

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7

When are benzodiazepines used in anxiety?

Benzodiazepines are used short-term in severe anxiety states (crisis) but are not recommended for panic disorder or social anxiety.

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8

What are the withdrawal symptoms of benzodiazepines?

Withdrawal symptoms include irritability, increased anxiety, panic attacks, sweating, nausea, and headaches.

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9

What is the Heimberg model for social anxiety?

The Heimberg model involves exposure therapy, gradually exposing individuals to social situations that cause anxiety.

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10

What is the Clark and Wells model for social anxiety?

The Clark and Wells model focuses on education and feedback to break down barriers to confidence in social situations.

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11

What are the key characteristics of chronic insomnia?

  • Chronic insomnia involves difficulty initiating or maintaining sleep

  • poor sleep despite adequate opportunity

  • daytime consequences like tiredness and cognitive impairment.

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12

What is the first-line treatment for insomnia?

Non-pharmacological treatments like sleep hygiene and CBT-I (Cognitive Behavioral Therapy for Insomnia) are first-line.

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13

What are the risks of long-term benzodiazepine use in the elderly?

Risks include falls, cognitive impairment, and a 50% increased risk of hip fractures.

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14

What is the difference between short-acting and long-acting benzodiazepines?

  • Short-acting benzodiazepines (e.g., temazepam) are used for difficulty falling asleep

  • long-acting ones (e.g., nitrazepam) are used for frequent nighttime awakenings but carry a higher risk of next-day sedation.

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15

What is the Sleepio app, and how does it help with insomnia?

Sleepio is a digital CBT-I program recommended by NICE for insomnia. It provides a six-week self-help program based on CBT principles.

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16

What are the risks of Z-drugs like zolpidem?

Risks include tolerance, dependence, rebound insomnia, and neuropsychiatric reactions. Zolpidem can work within 15 minutes but has a high risk of addiction.

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17

How does alcohol affect sleep?

Alcohol interferes with REM sleep, leading to more time spent in REM and less in slow-wave sleep (non-REM 3 and 4), resulting in poorer sleep quality.

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18

What are the key considerations when prescribing hypnotics for insomnia?

Hypnotics should be used for the shortest time possible (2-4 weeks), at the lowest effective dose, and only for severe insomnia. Non-pharmacological options should be tried first.

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