Anxiety Disorders
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Questions and Answers

Which medications are recommended for treating panic disorder with benzodiazepines?

  • Escitalopram, Citalopram, Sertraline
  • Paroxetine, Sertraline, Fluvoxamine
  • Buspirone, Clomipramine, Imipramine
  • Alprazolam, Lorazepam, Clonazepam (correct)

    • What is the recommended duration for using SSRIs in generalized anxiety treatment?

  • 12 weeks
  • 4-6 weeks
  • 6-8 months
  • 12 months or longer (correct)

    • Which medication is specifically categorized under serotonin-norepinephrine reuptake inhibitors (SNRIs)?

  • Venlafaxine (correct)
  • Buspirone
  • Alprazolam
  • Imipramine

    • Which of the following is indicated for panic disorder treatment using tricyclics or tetracyclics?

    <p>Clomipramine</p> Signup and view all the answers

    What is the primary reason for limiting the use of Alprazolam to a maximum of 12 weeks?

    <p>To prevent addiction or dependence</p> Signup and view all the answers

    Which of the following SSRIs should be started at a lower dose due to its potential activating (panic-like) effects?

    <p>Fluoxetine</p> Signup and view all the answers

    What is a recommended alternative medication for generalized anxiety disorder (GAD) that is not an SSRI?

    <p>Buspirone</p> Signup and view all the answers

    What is important to consider when tapering off benzodiazepines?

    <p>Withdrawal symptoms may occur if tapered too quickly</p> Signup and view all the answers

    What is a significant dietary consideration when taking Monoamine Oxidase inhibitors like Phenelzine?

    <p>Avoidance of high-tyramine foods</p> Signup and view all the answers

    Which medication is recommended for patients anticipating situations that may induce panic?

    <p>Clonazepam</p> Signup and view all the answers

    What is a common side effect of Paroxetine that may affect patient compliance?

    <p>Weight gain</p> Signup and view all the answers

    What is the maximum recommended dose of Paroxetine for treating panic disorder?

    <p>60mg/day</p> Signup and view all the answers

    Which medication is specifically recommended for long-term use in treating panic disorder, especially when comorbid with depression?

    <p>Paroxetine</p> Signup and view all the answers

    Which of these medications is recommended for the rapid control of severe anxiety symptoms?

    <p>Alprazolam</p> Signup and view all the answers

    For initial and isolated panic attacks, which of the following medications would be typically recommended?

    <p>Sertraline</p> Signup and view all the answers

    Which SSRI is specifically mentioned as effective for treating panic disorder?

    <p>Paroxetine</p> Signup and view all the answers

    Which of the following SSRIs is NOT mentioned for the treatment of initial panic attacks?

    <p>Venlafaxine</p> Signup and view all the answers

    What is primarily implicated in chronic symptoms of anxiety, including panic attacks and insomnia?

    <p>Increased norepinephrine function</p> Signup and view all the answers

    Where are the majority of serotonergic neurons located?

    <p>Raphe nuclei in the rostral brainstem</p> Signup and view all the answers

    Which peptide is specifically associated with anxiety and is known for its high conservation across species?

    <p>Neuropeptide Y</p> Signup and view all the answers

    Which system is primarily affected by galanin, involved in multiple functions including anxiety regulation?

    <p>The limbic system</p> Signup and view all the answers

    What effect does acute stress have on serotonin levels in the brain?

    <p>It increases serotonin turnover</p> Signup and view all the answers

    What brain structural change is indicated by an MRI in cases of anxiety?

    <p>Increased size of cerebral ventricles</p> Signup and view all the answers

    What does asymmetry between the right and left cerebral hemispheres suggest in anxiety patients?

    <p>Potential lateralized brain function impairment</p> Signup and view all the answers

    Which brain imaging technique is most useful for identifying increased ventricular sizes associated with anxiety?

    <p>CT Scan</p> Signup and view all the answers

    In individuals suffering from anxiety, what does an MRI reveal about the cerebral hemispheres?

    <p>Asymmetry of the right and left hemispheres</p> Signup and view all the answers

    What is the overall lifetime prevalence of panic disorder measured in the general population?

    <p>1.4%</p> Signup and view all the answers

    At what age is the median onset of panic disorder typically observed in the United States?

    <p>20-25 years</p> Signup and view all the answers

    How does the prevalence of panic disorder change with age in older adults?

    <p>Declines, reaching 0.7% by age 64</p> Signup and view all the answers

    What gender differentiation is observed in the prevalence of panic disorder?

    <p>2 females to 1 male</p> Signup and view all the answers

    What trend is observed regarding the prevalence of panic disorder in children under 14 years old?

    <p>Low prevalence at 0.4%</p> Signup and view all the answers

    What physiological response might result from the attenuation of local inhibitory GABAergic transmission?

    <p>Anxiety-like responses</p> Signup and view all the answers

    Which neurotransmitter is found at lower levels in patients with panic disorder as compared to control subjects?

    <p>Serotonin</p> Signup and view all the answers

    What effect does Yohimbine have on patients with panic disorder?

    <p>Stimulates high rates of panic-like activity</p> Signup and view all the answers

    Which brain areas are primarily affected by impaired GABAergic transmission leading to anxiety?

    <p>Basolateral amygdala, midbrain, and hypothalamus</p> Signup and view all the answers

    What is the relationship between MHPG and panic disorder patients when exposed to Yohimbine?

    <p>MHPG correlates with cortisol and cardiovascular responses</p> Signup and view all the answers

    What activates the ego's defense mechanisms in response to the unconscious drive pushing for conscious expression?

    <p>Signal anxiety</p> Signup and view all the answers

    Which defense mechanism involves redirecting anxiety from a significant person to a seemingly unimportant one?

    <p>Displacement</p> Signup and view all the answers

    What typically occurs when repression fails to keep unconscious drives from reaching conscious awareness?

    <p>Development of phobias</p> Signup and view all the answers

    Which of the following correctly describes the relationship between the phobic object and the primary source of conflict?

    <p>The phobic object symbolizes the primary source of conflict.</p> Signup and view all the answers

    What is a common emotional reaction to sexual arousal due to feelings of castration?

    <p>Anxiety</p> Signup and view all the answers

    What biological factor is associated with an increased risk of social anxiety disorder?

    <p>Lower concentrations of homovanillic acid</p> Signup and view all the answers

    Which statement best describes the genetic predisposition in social anxiety disorder?

    <p>First-degree relatives show a 2-6x greater chance of having the disorder</p> Signup and view all the answers

    Which brain structure is implicated in the biological factors of separation anxiety?

    <p>Amygdala</p> Signup and view all the answers

    What role does adrenergic stimulation play in patients with performance phobia?

    <p>Heightening sensitivity or release levels</p> Signup and view all the answers

    Study Notes

    Pharmacological Treatment for Anxiety Disorder

    • Benzodiazepines are often used to manage both panic disorder and generalized anxiety disorder.
    • Alprazolam is effective for panic attacks, commonly administered as needed (PRN).
    • Lorazepam is typically prescribed for a duration of 6-8 weeks to aid anxiety relief.
    • Clonazepam may be utilized over a period of 4-12 weeks for sustained treatment.

    SSRIs (Selective Serotonin Reuptake Inhibitors)

    • SSRIs are a primary choice for long-term treatment of both panic and generalized anxiety disorders.
    • Paroxetine is specifically noted for its effectiveness in panic disorder.
    • Escitalopram and Citalopram serve as mainstays for generalized anxiety.
    • Sertraline and Fluvoxamine are included in treatment protocols, with a recommendation of at least 12 months of use for optimal results.

    SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)

    • Venlafaxine is indicated for both panic and generalized anxiety disorders, offering a dual mechanism of action.

    Azapirones

    • Buspirone is particularly noted for generalized anxiety disorder, emphasizing its distinct class of medication.

    Tricyclic and Tetracyclic Antidepressants

    • Clomipramine is recognized for its utility in managing anxiety symptoms.
    • Imipramine may be prescribed for 8-12 weeks to achieve therapeutic effects on anxiety disorders.

    Pharmacological Treatment for Anxiety Disorder

    • Benzodiazepines: Utilized for panic disorder, includes Alprazolam, Lorazepam, Clonazepam, with treatment duration of 4-12 weeks.
    • Benzodiazepines for Generalized Anxiety: Administered as needed (PRN) for up to 6-8 weeks.

    SSRIs (Selective Serotonin Reuptake Inhibitors)

    • SSRIs for Panic Disorder: Paroxetine, Sertraline, Citalopram, Fluvoxamine, and Fluoxetine, generally prescribed for 12 months or more.
    • SSRIs for Generalized Anxiety: Escitalopram, Citalopram, and Sertraline, also recommended for a minimum duration of 12 months.

    SNRI (Serotonin-Norepinephrine Reuptake Inhibitor)

    • Venlafaxine: Used for both panic disorder and generalized anxiety disorder.

    Azapirone

    • Buspirone: Specifically indicated for generalized anxiety disorder.

    Tricyclics and Tetracyclics

    • Tricyclics for Panic Disorder: Clomipramine and Imipramine are effective options, with a treatment span of 8-12 weeks.

    Classifications de Tratamento Farmacologic pro Anxietate

    • Benzodiazepines

      • Utilisation pro Panic: Alprazolam, Lorazepam, Clonazepam per 4-12 septimanas.
      • Utilisation pro Generale Anxietate: Pro necessitate whenever, per 6-8 septimanas.

    • Inhibitor Selectiv de Reuptake de Serotonina (SSRI)

      • Substitutos pro Panic: Paroxetine, Sertraline, Citalopram, Fluvoxamine, Fluoxetine per 12 menses+.
      • Substitutos pro Generale Anxietate: Escitalopram, Citalopram, Sertraline per 12 menses+.

    • Inhibitor de Reuptake de Serotonina-Norepinephrine (SNRI)

      • Venlafaxine utilizate pro ambos Panic e Generale Anxietate.

    • Azapirone

      • Buspirone utilizate solmente pro Generale Anxietate.

    • Tricyclics e Tetracyclics

      • Clomipramine e Imipramine utilizate pro Panic per 8-12 septimanas.

    Trattamento Farmacologic pro Difficoltà d'Anxietate

    • Benzodiazepines son usate pro panic, cu Alprazolam, Lorazepam, e Clonazepam, per un periodo de 4-12 septemanas.
    • Benzodiazepines son administrate whenever necessarie pro anxiety generalizzate, per un periodo de 6-8 septemanas.

    Inhibitores de Captura de Serotonina Selective (SSRI)

    • Trattamentos inclue Paroxetine, Sertraline, Citalopram, Fluvoxamine, e Fluoxetine pro panic, recommendate pro un minimo de 12 menses.
    • Escitalopram, Citalopram, e Sertraline son usate pro anxiety generalizzate, etiam per 12 menses o plus.

    Inhibitor de Recaptura de Serotonina e Noradrenalina (SNRI)

    • Venlafaxine es usate pro tanto panic como anxiety generalizzate, senza restriccion de durada explicitate.

    Azapirone

    • Buspirone es specificamente usate per treatment de anxiety generalizzate.

    Triciclics e Tetraciclics

    • Clomipramine e Imipramine son option pro panic, cu un periodo de treatment de 8-12 septemanas.

    Alprazolam e Benzodiazepinas

    • Alprazolam es un medicamento potente con un onset rapide de action, effective contra panic disorder.
    • Uso limitate a un maximum de 12 septimanes pro evitar addiction o dependence.
    • Lorazepam ha un effecto simil a Alprazolam.
    • Benzodiazepinas pote esser date ad un base PRN: solmente in situatios que pote causar panic o anxiety generalisate.
    • Clonazepam es destinate pro pacientes que anticipa situatios donde panic pote ocorrer.
    • Diminuer benzodiazepinas debe esser facite con caution e lente pro evitar symptoms de withdrawal.

    Paroxetine e SSRIs

    • Paroxetine, un SSRI, ha effectos sedative que calma le paciente immediate, promovente maior compliance.
    • Side effect notable include aumento de peso.
    • Dosage initial de 5-10mg pro 1-2 septimanes, con un incremento a 15-20mg si non c'e improvement.
    • Si non improvement in un mense o duos, augmentar de 10mg, con un maximum de 60mg/die.
    • Si le paciente se mejora, mantener le dose pro circa un anno; si le side effects es intolerabile, considera diminuente le dose o cambiando a un altere SSRI.

    Considerations pro Panic Disorder

    • Panic disorders es chronic, presentando riscos de relapse post discontinuation de medicamentes, non pro addiction ma pro continui symptomes.
    • Pacientes debe essere avertite a evitar:
      • Alcoholic beverages
      • Medicationes CNS depressives
      • Conducir o operar apparatus periculose specialmente con benzodiazepinas (va ser molto sedative).

    Altere Medicamentos

    • Sertraline, Citalopram, e Fluvoxamine es recommendate pro panic attacks initial e isolate.
    • Alprazolam e SSRIs es recommendate pro control rapide de symptomes severe.
    • Paroxetine es effective pro panic disorder cum depression comorbide.
    • Fluoxetine pote ser activante; debe esser date in parve doses e aumentar lentamente.
    • Omne SSRIs es effective pro panic disorder o any tipo de anxiety disorder.
    • Venlafaxine e Buspirone es recommendate pro GAD e panic cum depression.

    Monoamine Oxidase Inhibitors e Tricyclics

    • Monoamine Oxidase inhibitors como Phenelzine e Tranylcypromine ha minus risco de overstimulation comparate a SSRIs o tricyclic drugs.
    • Dietary restrictions pote esser difficile pro le paciente.
    • Tricyclic e Tetracyclics como Clomipramine e Imipramine es effective pro panic disorder, ma non populaire pro severe adverse effects in doses alte.

    Medicamento pro Tractar Ansietate

    • Sertraline, Citalopram, e Fluvoxamine: Indicati pro tractar attaccos de panico isolate e initiale.
    • Alprazolam: Utilisate pro controllar symptomatas severe rapidemente, frequentemente combinato con un SSRI.
    • Paroxetine: Efficace pro uso a longo termine, specialmente in pacientes con disorder de panico e comorbiditate de depression.

    Norepinephrine

    • Function de norepinephrine aumentate causa signales chronic de anxietate, como panic attacks, insomnia, responsa de startle e hyperarousal autonomic.
    • Cellulas nerviose noradrenergic localisate principalmente in le locus coeruleus e rostral pons, projecta axones a le cortex cerebral, systema limbic, tronco cerebral e medulla spinal.

    GABA Receptors

    • Le sistema limbic contine altas concentrationes de receptors GABA, implicante in le regulation de anxietate.

    Serotonin

    • Turnover de serotonina (5-HT) aumenta in le cortex prefrontal, nucleus accumbens, amygdala e hypothalamus lateral durante stress acute.
    • Cellulas de neuronios serotonergic localisate in le raphe nuclei del tronco cerebral rostral, projecta a le cortex cerebral e systemas limbic, specialmente amygdala, hippocampus e hypothalamus.

    Neuropeptide Y (NPY)

    • Neuropeptide Y es un peptide conservate de 36 aminoacidos, implicate in le anxietate per su effecto super le amygdala.
    • Studias de soldatos sub stress extreme indica que alte nivellos de NPY es associate con melior performance.

    Galanin

    • Galanin es un peptide de 30 aminoacidos implicate in apprendimento, memoria, controle de dolore, ingestion de alimento, regulation neuroendocrine, regulation cardiovascular e anxietate.
    • Un sistema dense de fibras immunoreactive de galanin originante del locus coeruleus innervate le hippocampus, hypothalamus, amygdala e cortex prefrontal.

    Trattamento Farmacologico de l'Ansietate

    • Sertralina, Citalopram, e Fluvoxamina recommendate pro attaccos de panico initial e isole.
    • Alprazolam e SSRI recommendate pro control rapid de symptomata severe.
    • Paroxetine efficace pro uso a longe prazo e pro panico disorder co-comorbid con depression.

    Table 2: Tratamento Farmacologico pro Ansietate

    • Benzodiazepinas
      • Alprazolam, Lorazepam, Clonazepam usate pro panico, tipicamente x 4-12 semanas.
      • Usate a demanda (PRN) pro ansietate generalizada x 6-8 semanas.
    • SSRI (Inhibidores de Reuptake de Serotonina Seletivos)
      • Paroxetine, Sertraline, Citalopram, Fluvoxamine, Fluoxetine pro panico x 12 meses+.
      • Escitalopram, Citalopram, Sertraline pro ansietate generalizada x 12 meses+.
    • Inhibidor de Reuptake de Serotonina-NEPI
      • Venlafaxine usate pro panico e ansietate generalizada.
    • Azapiron
      • Buspirone recommendate pro ansietate generalizada.
    • Triciclicos e Tetraciclitos
      • Clomipramine e Imipramine usate x 8-12 semanas pro panico.

    Detalhes de Medicamentos

    • Alprazolam: alta potentia, onset rapid, maximo uso de 12 semanas pro evitar addiction.
    • Lorazepam: similaritate de effectivitate con Alprazolam.
    • Paroxetine: SSRI con effectos sedativos, dose iniziale de 5-10mg, maximo 60mg/dia, possibili side effects de aumento de peso.
    • Fluoxetine: pote causar symptomate panic-like, debe ser administrate in dosis basse e aumentar lentemente.

    Funcionamento Neuroquimico

    • Norepinephrine: incremento de function. Simptomas chronic de ansietate ligate a incremento de norepinephrine, originando de loca coeruleus.
    • GABA: malfunction de receptores de GABA, con alta concentration in limbic system.
    • Serotonina: turnover aumentate in cortex prefrontal e amigdala durante stress acuto.
    • Neuropeptide Y (NPY): associata con performance in situante de stress alt.
    • Galanin: implicate in control de ansietate e regulazione neuroendocrin.

    Considerationes Clinicas

    • Stabilisamento required pro disminuendo benzodiazepinas pro evitar symptomate de withdrawal.
    • Pacientes debe evitar alcohol e medicamentos depressive del SNC.
    • L'opinione de pacientes meliorate con continuazione de medicamento per circa un anno, considerando possibilitate de relapse.

    Epidemiologia del Disorder de Panic

    • Prevalentia durante vita: 1-4%, con valore mediane de 1.7%.
    • Prognose de 2.7% in le World Mental Survey, con inferiores valores in Asia, Africa, e America Latina (0.1-0.8%).
    • Ratio de feminas a viri: 2-3:1, con differentiations de genere observate ante le 14 annos.
    • Onset tipic: 20-25 annos, con mediane de onset in le États-Unis de 20-25 annos e media de 34.7 annos.
    • Incidencia in infantes es rar, cum 0.4% ante le 14 annos.
    • Rates de disorder de panic aumenta gradual durante adolescentia post onset de pubertate, peaking durante adultezza.
    • Less prevalente in personas senior, associate con decrease de activitate del Sistema Nervioso Autonomic (ANS).
    • Prevalentia in personas plus vetere: 1.2% pro adultos plus grande que 55 annos e 0.7% pro plus grande que 64 annos.
    • Declination in prevalentie pro personas grandiores pote reflecter a symptomates de subclinica gravitate, resultante del dampening del ANS.

    Dysfunction de Neurotransmittors

    • Dysfunction serotonergic implicat hypersensibilitate postsynaptic ad serotonina.
    • Studi de pacientes con disorder de Parkinson (PD) monstrava niveles inferior de serotonina (5HT) comparate con sujetos de control.
    • Attenuation de transmission GABAergic local inhibitora in amygdala basolateral, mesencephalon, e hypothalamus causa responsas physiologic simile a anxietate.

    Sistema Noradrenergic

    • Pacientes con disorder de panica mostrava sensitivitá alt a effectos anxiogenic de Yohimbine.
    • Yohimbine es un antagonista presynaptic alpha 2 que stimula firing del locus coeruleus.
    • Nove nivele elevato de activitate panica e response exaggerate de MHPG, cortisol, e cardiovascular durante l'uso de Yohimbine.

    Freud's Theory of Anxiety and Defense Mechanisms

    • Quando un impulso inacceptable del inconsciente se manifesta, l'ego reacciona con un signal de anxietate.
    • Le mecanismo de defensa es un function del ego, agendo contra fuerzas instintivas minacciose, especialmente impulsos sexuales e aggressivos del id.
    • Le io, superego, e le realitate externa deve esser equilibrate pro un functioning saludable del individuo.
    • Phobias emergente ex conflictos non resolvite; impulsos sexuales poden conservar significato incestuoso in adultos.
    • Las arousal sexual può provocar sentimientos de anxietate, frequentemente associati con le fear de castration.
    • Repression es tipicamente le primo mecanismo de defensa del ego, ma quando non es effective, altri mecanismos, como desplazamento, son invocate.
    • Displacement implica transferir un conflicto sexual de un persona significativa ad un objecte o situation insignificante, provocando una serie de emociones.
    • "Signal anxiety" es un emotion que surgi quando un objecte/situation fobica ha un connection associative directa con le fonte primaria del conflicto.
    • Le objecte, persona, o situation fobica serve como un symbolo del conflicto, facilitante l'evitation del situationes provocante anxietate.
    • Evitar contextos fobicos es un modo de proteger se de l'ansietate, hindrando le confrontamento directe con le impulsos minacciose.

    Anxiety Social

    • In personas con phobia de performance, l'epinefrina e norepinefrina in le sistema nervose central (SNC) e peripheric (SNP) es liberar in quantitate maior o ha un aumento de sensibilitate a niveaux normal de stimulation adrenergic.
    • Un studio indica concentrationes significativemente inferior de acido homovanillic, suggerente dysfunction de dopamina in le disorder de ansietate social.
    • Un altere studio revela un densitate de reuptake site de dopamina striatal reducite, indicando problemas dopaminergic in le disorder de ansietate social.
    • Le disorder de ansietate social es inheritate; parentes de primo grado habita un chance/risco 2-6 vices plus grande de developpar le disorder.
    • Le liability pro le disorder involve un interplay de factores:
      • Specifico pro le disorder: timor de evaluation negative.
      • Non-specific: negative affectivitate.
    • Le contribution genetic es plus importante in infantes que in adultos.

    Ansietate de Separation

    • Activitation augmentate del amygdala es un fator biologic relevante.

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