Untitled Flashcards Set

Generalized Anxiety Disorder (GAD):

• Know core symptoms

  • Usually characterized by an incessant feeling of anxiety that impedes your day-to-day functioning––-GAD is different from agoraphobia because this anxiety expands to everything and is not specific to a situation

  • Restlessness, fatigue, insomnia, irritability, concentration difficulties, muscle tension

  • Uncertainty intolerance

  • Core DSM Diagnostic Criteria

    • High anxiety & excessive worry for over 6 months

• 90% meet DSM criteria for another disorder (co-morbidity), major overlap with depression

  • People with depression will usually have GAD, people with GAD are basically guaranteed a clinical diagnosis depression diagnosis at some point in their lives

• Uncertainty intolerance

  • Not being able to accept that you don’t know the outcome (being anxious about the lack of predictability)

  • This uncertainty intolerance will lead to people with GAD to try and control the situation or leave it entirely

• Error detection (anterior cingulate cortex)

  • I need to double check my notes but people with GAD have super twitch ACCs because anything that their brain deems “wrong” or “out of place” sets off the error detection circuits in their brain (like a Christmas tree) and tells them that they need to fix it (it’s highly related to control)

  • Explains why some people with GAD can be control freaks or really particular or bossy––they like the predictability of things and if they’re the ones controlling it, there’s no way that things can go wrong (in their mind)

  • The brain notices when they’re having trouble walking itself through a situation, this creates a prediction error that then sets it off (so I was basically right above :P)

• Sex ratio = 2:1, female:male (similar for other anxiety disorders)

  • I’ll have to check my notes for this one but I think he was saying something about how men and women are socialized…

  • This also goes to the amount of testosterone and estrogen in our systems (he talked more about this with panic disorder so see below ig)

• Basic facts about use of SSRIs/SNRIs & benzos in GAD (no need to know specific numbers or %)

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Benzodiazepines:

• Short-term (versus long-term) efficacy in treatment of panic, GAD

  • Benzos work super quickly (which is why they’re party drugs)

• Work via GABA (brain’s major inhibitory neurotransmitter) receptors

  • I don’t have any other notes about this so I guess just remember this part? (remember GABA = inhibitory transmitter receptors)

• Know Xanax, Ativan, Klonopin, Valium

• Major their major side effects (covered in class)

  • Xanax

    • Acts super quick, can take effect anywhere between 15/20 minutes to an hour

  • Ativan

    • Standard benzo––highly addictive, quick to act, high relapse, commonly prescribed

  • Klonopin

    • Will stay in the body for the longest because the half-life is so high

  • Valium

    • Standard benzo––highly addictive, quick to act, high relapse, commonly prescribed

• Potential to suppress slow-wave sleep, trigger depression

  • These are iatrogenic effects

  • Slow-wave sleep is the most restorative, so without it your brain isn’t able to repair brain cells and stuff

• Addiction potential (and withdrawal syndrome)

  • Their half-life is horrible though so your body will build a tolerance effect to it pretty quickly

  • Because of this, it’s vital that you never go cold turkey because even if you don’t feel the effects, it’s still coursing in your bloodstream so you will go through withdrawal

  • This will cause addiction because without it running in your system (or, without weaning off of it), you’re gonna crave that “normal” feeling

• Evidence of possible permanent alteration of GABA receptors

  • When did he ever talk about this…

• Increased dementia risk

  • This is an iatrogenic effect

  • Recent studies show a more than 50 percent increase in risk

• Estimated 85% of prescriptions written by non-psychiatrists

  • This is the same premise as the other exam I think

  • More relevant with benzos because it allows non-psychiatrists to “solve” their patient’s problem and get on with their day

Antidepressants: SSRIs & SNRIs

• Major SSRIs: Prozac, Paxil, Zoloft, Celexa, Lexapro (be able to list/recognize them)

• Major SNRIs: Effexor, Pristiq, Cymbalta (be able to list them)

• These drugs do not increase “serotonin levels”

  • They inhibit synaptic re-uptake of serotonin, with downstream effects that take 2-6 weeks

• Emotional numbing

  • It’s their job to make people feel the effect of things less

  • Because our bodies don’t have the capacity to determine exactly what emotions should and should not be repressed, it just blunts everything

  • You don’t want to feel depressed anymore so that’s why the meds work, but that also means you won’t be able to feel anger or excitement or whatever because it’s an all or nothing deal

• Anorgasmia (sexual side effects)

  • … He never specified this term but basically because antidepressants suppress everything, the already low sex drive that people have when depressed basically disappears

  • I think this is when someone asked about someone’s human desire to vent sexual frustration but not actually having sex drive, which literally makes no sense so do not pay attention to this part yet

• Activation syndrome (2-5%)

  • 2-5% of people taking SSRIs/SNRIs experience such negative emotions as a side effect that it becomes ridiculously severe and makes

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• Basics of CBT for GAD

  • Focus here is on imaginary simulation and uncertainty tolerance

  • Imaginary simulation: imagining what will happen so that your brain has an idea of what’s going to happen next

  • Uncertainty tolerance: goes with imaginary simulation––it’s basically training the brain to be able to tolerate not knowing

    • Imaginary simulation helps here because there’s not uncertainty if you have an idea of what’s going to happen