Anxiety 2
Terms
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- What are the classifications of anxiety disorders?
- GAD, panic, agongaphobia, OCD, phobic, acute, PTSD
- What is the structural pathophysiology of anxiety?
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hypothalamus - initiate fight of flight response via CRF
release NE, activates peripheral SNS
amygdala- center of body's fear response
hippocampus- coordinates memories from multiple sensory inputs
HORMONAL- Cortisol - What is the neurological pathophysiology of anxiety?
-
serotonin- inhibitatory HP A and locus ceruleus
GABA acid
Dopamine - reward in brain
epi/norepi - What is the tx of free floating anxiety?
-
excess worry for more than 6 months
BZDs, psychotherapy and anticonvulsants - What is the tx for panic disorder?
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4 attack within 4 weeks
BZDs, TCA's, SSRIs
MOAIS and behavior techniques - how do you treat phobic disorders?
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beta blockers
MAOIs or SSRIs - How do you treat OCD?
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clomipramine
SSRi
behavorial therapy - How do you treat ASD?
- bZD
- How do you treat PTSD?
- SSRI
- BZD
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act at GABA and BZD receptor
short term use
psysiologic dependencty after 4 weeks and need to taper - Buspirone
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partial agonist of 5HT1 receptor
requires multiple daily doses
n/dizziness & somnolence - SSRIs
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paroxetine - most sedating
fluoxetine - anxiety worse than better
for OCD and panic disorder and GAD
3-6 weeks to work - Tricyclic Antidepressants
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imipramine
clomipramine
depression/anxiety and panic disorder
limit because of AE - MAOIs
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panic disorder atypcial refractory depression
block breakdown of serotonin and NE
no tyramine
DDI with narcotics - Non SSRIs
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effects conc of serotonin +/-
mirtazapine anxiety but cause wt gain
bupropion
venlafaxine - Antihistimines
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hydroxyzine
AE- sedation, decreased cognition, anticholnergic SE's
useful with substance abuse and itch related anxiety - Anticonvulsants
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augmentation therapy
tiagabine
gabapentin- enhance GABA
Valproate, lamotrigine, topiramate - Non pharmacologic therapy
-
avoid caffiene
psychotherapy
reduce unnecessary stress - OCD
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fluxetine
fluvoxamine
sertraline
parosetine
venlafaxine - Panic
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fluxetine
sertraline
parosetine - Social anxiety
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parosetine
venlafaxine - GAD
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parosetine
venlafaxine - PTSD
- parosetine