Exam 18: Anxiety Disorders
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| Anxiety | A normal response to stress or threat. A state or feeling of apprehension, uneasiness, agitation, uncertainty and fear resulting from the anticipation of some threat or danger
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| Types of anxiety | Signal Anxiety.
Free-floating Anxiety.
Anxiety Trait.
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| Signal Anxiety | A learned response to an event such as test taking.
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| Free-floating Anxiety | Associated with feelings of dread that are not possible to identify.
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| Anxiety Trait | A learned aspect of personality. Anxious reactions to relatively non-stressful event.
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| Types of Anxiety Disorders | Generalized Anxiety
Panic
Phobias
Obsessive-Compulsive
Post-traumatic Stress Disorder
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| Generalized Anxiety: Characterization | Steady, high degree of anxiety and/or avoidance of behavior.
Tends to worry over many things and find it difficult to concentrate on the task at hand.
Possible at any age, commonly occurs around ages 20-30.
Lasts 6 months or longer.
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| Generalized Anxiety: Treatment and Prognosis | Relaxation Techniques and massage.
Exercise.
Visual and biofeedback imagery.
Anti-anxiety drug therapy.
Prognosis is variable; condition sometimes lasts 6 months or longer.
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| Panic | Attack of an acute, intense and overwhelming anxiety accompanied by a degree of personality disorganization.
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| Severe anxiety, intense fear symptoms can occur abruptly and peak within | 10 minutes.
Lasts minutes to hours and can possibly recur several times a week.
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| Panic exhibits physical manifestation suddenly without apparent reason | heart palpitations, sweating, trembling, feelings of dyspnea, chest pain, nausea, feeling dizzy/faint, fear of losing control, fear of dying, paresthesias, chills, hot flashes
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| Panic is more common in ____ than ____. | Women, men
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| Panic: Treatment and Prognosis | Use treatments for generalized anxiety disorders.
Focus on educating on the nature of the disorder.
Assist to develop better coping mechanisms with anxiety, blocking attacks pharmaceutically.
Emotional support and reassurance.
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| Phobias | (1) Characterized by persistent and irrational fear of a specific object, situation, or activity
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| Phobias: S&S | Avoid people, places, or events that have potential to trigger an attack.
More common in women.
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| Agoraphobia | high anxiety brought on by situations in which a panic attack is possible
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| Phobias: Treatment and Prognosis | With desensitization, patient learns to relax while reentering phobia situation in imagination and then in real life.
Prognosis is variable and depends on response treatment.
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| Obsessive-Compulsive | (1) Characterized by inability to stop persistent, irrational and uncontrollable acts (compulsions) or thoughts (obsessions) contrary to person’s standards or judgment
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| Obsessive-Compulsive thoughts | anxiety producing and distressful in that they are uncontrollable
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| Obsessive-Compulsive behavior | Person recognizes the behavior as absurd but is still compelled to perform the ritual to relieve tension.
Person is usually orderly, meticulous, dependable and scrupulous
Has tendency to be rigid and stubborn.
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| Obsessive-Compulsive: Treatment and Prognosis | Psychotherapy to uncover the basic fears and to help distinguish objective dangers from imagined dangers.
Drug therapy using clomipramine (Anafranil).
Prognosis is more severe than with other anxiety disorders.
Complete recovery is rare.
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| Post-traumatic Stress Disorder | (1) A response to an intense traumatic experience that is beyond the usual range of human experiences that evoke feelings of terror and helplessness i.e. war, rape, major car accident, observing tortures, witnessing a violent death.
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| Post-traumatic Stress Disorder: Experience | often relived in dreams or flashbacks that arise in response to a stimulus that resembles the experience
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| Post-traumatic Stress Disorder: Flashbacks | include hallucinations and illusions: The false interpretation of extreme sensory stimulus, usually visual or auditory i.e. mirage in the desert, voices in the wind.
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| Post-traumatic Stress Disorder: Avoidance behaviors | Emotional detachment, guilt about being a survivor, amnesia of the event, insomnia, irritability, difficulty concentrating and wariness
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| Types of post-traumatic stress disorder are | Acute.
Chronic.
Delayed.
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| Acute PTSD | Occurs within 6 months of event
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| Chronic PTSD | Lasts more than 6 months
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| Delayed PTSD | Starts 6 months or more after the event
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| Benzodiazepines and Miscellaneous Agents: Use | Management of various forms of anxiety, including generalized anxiety disorder (GAD)
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| Meds for intermittent or short-term use | Benzodiazepines
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| Meds for Long-term | Buspirone, Paroxetine, Venlafaxine
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| Benzodiazepines and Miscellaneous Agents: Action | Exert a tranquilizing effect by potentiating the effects of gamma-aminobutyric acid (GABA), an inhibitory transmitter, by binding to specific benzodiazepine receptor sites, such as the limbic system, thalamus and hypothalamus in the brain.
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| Benzodiazepines and Miscellaneous Agents: Cause | Generalized CNS depression
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| Benzodiazepines produce a ____ with long-term use and have a potential for ____ or ____ dependence. | Tolerance, psychological or physical
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| Do Benzodiazepines and Miscellaneous Agents have analgesic properties? | No
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| Benzodiazepines and Miscellaneous Agents: Category | Anti-anxiety
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| Benzodiazepines (examples) | Alprazolam (Xanax)
Chlordiazepoxide (Librium)
Diazepam (Valium)
Lorazepam (Ativan)
Midazolam (Versed)
Oxazepam (Serax)
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| Buspirone (BuSpar): Class | Anti-anxiety
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| Doxepin (Sinequan, Zonalon): Class | Tricyclic anti-depressants
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| Hydroxyzine (Atarax, Hydroxine-50, Vistaril): Class | Sedative/hypnotics
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| Meprobrate (Equanil, Miltown): Class | Carbamates
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| Paroxetine (Paxeva, Paxil, Paxil CR): Class | Selective Serotonin Re-uptake Inhibitor (SSRI)
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| Venlafaxine (Effexor, Effexor XR): Class | Anti-Depressant
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| Benzodiazepines and Miscellaneous Agents: Contraindications | Hypersensitivity
Comatose patients
Pre-existing CNS depression
Uncontrolled severe pain
Pregnancy
Lactation
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| Benzodiazepines and Miscellaneous Agents: Precautions | Hepatic dysfunction
Severe renal impairment.
Severe pulmonary disease (Benzodiazepines only).
Suicidal patients.
Previous drug addictions.
Sensitivity to CNS depressants: Dosage reduction may be required.
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