Anxiety Disorders

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?

Clomipramine Signup and view all the answers

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

To prevent addiction or dependence 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?

Fluoxetine Signup and view all the answers

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

Buspirone Signup and view all the answers

What is important to consider when tapering off benzodiazepines?

Withdrawal symptoms may occur if tapered too quickly Signup and view all the answers

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

Avoidance of high-tyramine foods Signup and view all the answers

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

Clonazepam Signup and view all the answers

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

Weight gain Signup and view all the answers

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

60mg/day Signup and view all the answers

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

Paroxetine Signup and view all the answers

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

Alprazolam Signup and view all the answers

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

Sertraline Signup and view all the answers

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

Paroxetine Signup and view all the answers

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

Venlafaxine Signup and view all the answers

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

Increased norepinephrine function Signup and view all the answers

Where are the majority of serotonergic neurons located?

Raphe nuclei in the rostral brainstem Signup and view all the answers

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

Neuropeptide Y Signup and view all the answers

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

The limbic system Signup and view all the answers

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

It increases serotonin turnover Signup and view all the answers

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

Increased size of cerebral ventricles Signup and view all the answers

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

Potential lateralized brain function impairment Signup and view all the answers

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

CT Scan Signup and view all the answers

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

Asymmetry of the right and left hemispheres Signup and view all the answers

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

1.4% Signup and view all the answers

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

20-25 years Signup and view all the answers

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

Declines, reaching 0.7% by age 64 Signup and view all the answers

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

2 females to 1 male Signup and view all the answers

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

Low prevalence at 0.4% Signup and view all the answers

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

Anxiety-like responses Signup and view all the answers

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

Serotonin Signup and view all the answers

What effect does Yohimbine have on patients with panic disorder?

Stimulates high rates of panic-like activity Signup and view all the answers

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

Basolateral amygdala, midbrain, and hypothalamus Signup and view all the answers

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

MHPG correlates with cortisol and cardiovascular responses Signup and view all the answers

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

Signal anxiety Signup and view all the answers

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

Displacement Signup and view all the answers

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

Development of phobias Signup and view all the answers

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

The phobic object symbolizes the primary source of conflict. Signup and view all the answers

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

Anxiety Signup and view all the answers

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

Lower concentrations of homovanillic acid Signup and view all the answers

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

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

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

Amygdala Signup and view all the answers

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

Heightening sensitivity or release levels 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.

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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