Anxiety disoders

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Author:
timothy.pdlt
ID:
212262
Filename:
Anxiety disoders
Updated:
2013-04-09 07:47:52
Tags:
anxiety
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Description:
therapeutics, side-effects, drug interactions
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  1. GoT of anti-anxiety Tx
    • 1. short-term (6-12weeks)
    • a. reduce s/s
    • b. improve function
    • c. minimize s/e
    • d. education
    • 2. long-term (>12weeks)
    • a. remission
    • b. adherence
    • c. manage s/e
    • d. education
  2. Psychotherapy options for anxiety disorders
    • 1. CBT (slow onset but longer lasting)
    • 2. exposure and response prevention
    • 3. desensitization, breathing retraining, relaxation
    • 4. supportive counselling
    • 5. psychoeducation
  3. Factors favoring CBT
    • avoidance behaviour
    • clear ability to concentrate
    • able to understand and address psychological factors
    • willingness
    • access to CBT
    • preference to CBT
    • previous success with CBT
    • previous failure of pharmacotherapy
  4. Drug selection table for anxiety disorders
  5. Reasons for muter response to Tx
    • early age of onset
    • inadequate duration of therapy
    • co-morbidity (personality disorder)
    • biological markers: increased SBP/HR
    • substance abuse
  6. Uses of BDZs
    • anxiety
    • insomnia
    • seizures
    • muscle relaxants

    • *not first-line but as adjuncts for Tx onset
    • *quick onset as an anxiolytic (ie. 1-5days)
  7. S/E of BDZs
    • cognitive impairment
    • anterograde amnesia
    • drowsiness
    • incoordination
    • muscle weakness
    • paradoxical effects
    • HA
    • dizziness
    • respiratory depression
  8. MOA of buspirone
    • MOA: dose-dependent 5HT1a partial agonist
    • a. 5-30mg= presynaptic only
    • b. 30-60mg= presynaptic+postsynaptic

    • slow onset: 3-5weeks
    • *safest in pregnancy
  9. S/E of buspirone
    • HA
    • dizziness
    • nausea
    • nervousness
    • parethesia
    • *less drowsiness and psychomotor impairment than BDZ
    • *less abuse potential
    • *no alcohol INTX
  10. Anxiety counseling points
    • ask about s/s
    • emphasize that these s/s are common
    • provide info about effective Tx
    • set expectation
    • counsel about substance abuse
    • non-drug measures
    • decreases caffeine/stimulants
    • exercise (30min x3-5days/week)
    • consider anxiety diary

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