Anxiety

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What is normal anxiety?

What is abnormal anxiety? How common are anxiety disorders?
What happens if anxiety disorders are not treated?

Anxiet y is a normal response t o st ressf ul or f earf ul circumst ances. Most people experience some degree of anxiet y in react ion t o st ressf ul sit uat ions. T his allows an individual t o adapt t o or manage t he st ressf ul/t hreat ening sit uat ion. Anxiet y sympt oms generally are short -lived and do not necessarily impair f unct ion.

Anxiety that becomes excessive, causes irrational thinking or behavior, and impairs a persons functioning is considered an anxiety disorder.

Anxiety disorders are among the most frequent mental disorders encountered by clinicians.

Untreated anxiety disorders may result in increased healthcare utilization, morbidity and mortality, and poorer quality of life.

Anxiety

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What is the DOC for anxiety?

What anxiety disorders can SSRI's be used to treat?

An antidepressant, usually an SSRI, is the drug of first choice for anxiety.

SSRIs can be used to treat: 1. generalized anxiety disorder (GAD) 2. social anxiety disorder (SAD) 3. posttraumatic stress disorder (PTSD) 4. panic disorder (PD) 5. obsessive-compulsive disorder (OCD)

What are the benefits of SSRIs in GAD? What is the onset of SSRIs?

Antidepressants reduce the psychic symptoms (worry and apprehension) of anxiety with a modest effect on autonomic or somatic symptoms (e.g., tremor, rapid heart rate, and/or sweating).

2 to 4 weeks

Anxiety

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When are benzos used in GAD? What is a second-line drug for GAD? What are the benefits to Buspirone?

Can be used for ACUTE TREATMENT, or as an adjunct, or to improve sleep.

Buspirone
Buspirone does not have abuse potential, no withdrawal, does not potentiate alcohol, or sedative/hypnotic effects.

What are Hydroxyzine alternative agents for GAD? and pregabalin

Anxiety

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What are drugs of choice for PD? When are benzos used for PD?

SSRIs are the DOC. TCA or MAOI may be used if SSRI is not effective.
Benzos are used with antidepressants, especially early in treatment, or as monotherapy to acutely reduce panic symptoms.

What are the AE of May cause rebound anxiety b/t doses and alprazolam when withdrawal, including used for PD? seizures.

DOC for SAD?

SSRI's Onset is 8-12 weeks.

Anxiety

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DOCs for OCD?

What to add to regimen for a highly anxious OCD?

Clomipramine Fluoxetine Fluvoxamine Paroxetine Sertraline All FDA- approved for OCD. Efficacy same for clomipramine and SSRIs but SSRIs have a better AE profile.

Benzo or antipsychotic drug

SSRIs Sertraline, paroxetine for ACUTE Sertraline for LT Second line-venlafaxine, TCA, MAOI

DOC for PTSD?

DOC for performance anxiety?

Propanolol other Bblockers