Treatment of Anxiety Disorders Controlled Substance Workshop. Shonda Phelon MSN, FNP-BC, APMHNP-BC MNA Convention 2011

Size: px
Start display at page:

Download "Treatment of Anxiety Disorders Controlled Substance Workshop. Shonda Phelon MSN, FNP-BC, APMHNP-BC MNA Convention 2011"

Transcription

1 Treatment of Anxiety Disorders Controlled Substance Workshop Shonda Phelon MSN, FNP-BC, APMHNP-BC MNA Convention 2011

2 Term used to describe both symptoms and disorders Occurs normally Very common symptom in multiple disorders Difference between Fear and Anxiety real or perceived threat Adaptive value : helps to plan and prepare for threat moderate levels enhance learning and performance Maladaptive when chronic / severe

3 Symptoms include : physiological symptoms of activated sympathetic nervous system (increased heart rate, increased respiration, sweating etc.) cognitive component (awareness of being frightened) behavioral components (urge to escape)

4 Panic disorder with or without agoraphobia Agoraphobia without panic disorder Specific phobias Social phobia Obsessive compulsive disorder Posttraumatic stress disorder Acute stress disorder Generalized anxiety disorder Anxiety disorder due to a general medical condition Substance-induced anxiety disorder Anxiety disorder not otherwise specified

5 Some amount of anxiety is normal and is associated with optimal levels of functioning. Only when anxiety begins to interfere with social or occupational functioning is it considered abnormal.

6 Fear Panic Anxiety Anxiety Disorder

7 CNS equilibrium is determined by a balance between excitatory and inhibitory neurotransmission Excitation -> Glutamate is prototypical NT. Inhibition -> GABA is prototypical NT. Inhibition via GABA is primarily mediated by the ionotropic GABA-A receptor. GABA binding to GABA-A results in an increase in neuronal Cl - conductance and subsequent neuronal hyperpolarization.

8 Anxiety disorders: >25% of population A psychological disorder characterized by unrealistic fear and anxiety. Panic disorder Panic Disorder: generalized anxiety obsessive compulsive behavior A disorder characterized by episodes of intense fear accompanied by symptoms such as shortness of breath and irregularities in heartbeat.

9 General characteristics Prevalence and age of onset Comorbidity with other disorders Treatment

10

11 The psychoanalytic viewpoint Classical conditioning to many stimuli The role of unpredictable and uncontrollable events A sense of mastery: immunizing against anxiety

12 Genetic factors A functional deficiency of GABA Neurobiological differences between anxiety and panic

13

14

15 Prevalence and age of onset Comorbidity with other disorders Biological causal factors The role of Norepinephrine and Serotonin

16 Copyright 2004 Allyn and Bacon

17

18 Genetic factors Cognitive and behavioral causal factors Interoceptive fears

19

20 Brain Mechanisms MRI reveals lower activity in frontal cortex during panic attack in panic subjects compared to controls Decreased frontal activity may inhibit one s ability to control reactions to panic inducing stimuli

21 Anticipatory anxiety: A fear of having a panic attack; may lead to the development of agoraphobia. Agoraphobia: An unrealistic and intense fear of being away from home or other protected places. In severe cases people will not leave home!

22 Perceived control and safety Anxiety sensitivity as a vulnerability factor for panic Safety behaviors and the persistence of panic Cognitive biases and the maintenance of panic

23

24 Panic disorder Panic versus anxiety Agoraphobia Agoraphobia without panic

25 Medications Behavioral and cognitive-behavioral treatments

26

27 Phobias 1. Specific phobias 2. Social phobia 3. Agoraphobia

28 Psychosocial causal factors Genetic and temperamental causal factors Preparedness and the nonrandom distribution of fears and phobias Treating specific phobias

29

30 General characteristics Fear of being in social situations in which one will be embarrassed or humiliated

31

32 Interaction of psychosocial and biological causal factors Social phobias as learned behavior Social fears and phobias in an evolutionary context Preparedness and social phobia

33

34

35 Characteristics of OCD Types of compulsions Types of obsessions Treatment

36

37 Obsessions- repetitive unwanted ideas that the person recognizes are irrational Compulsions- repetitive, often ritualized behavior whose behavior serves to diminish anxiety caused by obsessions Affects 2-3% of general population

38 Genetic influences Abnormalities in brain function The role of serotonin

39 Examples of obsessions: Concern for order and constancy Cleanliness (body or living space) Forbidden sexual thoughts Examples of compulsions: Hand washing Checking Collecting Repeating behaviors (in and out of a door) Arranging things Cleaning

40

41 Acute Stress Disorder Added to DSM-IV in 1994 symptoms 2 days to 4 weeks following traumatic event PTSD Added to DSM-III in 1980 symptoms beyond 4 weeks delayed onset

42 Critical Components Symptoms occurs AFTER a traumatic stressor Response involves intense fear, helplessness, or horror Re-experiencing of the event and numbing response Increased Arousal Interference in Social and Occupational Functioning

43

44 Intrusive Thoughts distressing recollections dreams flashbacks psychological trigger reactions physiological trigger reactions

45 Avoidance Behaviors avoid thoughts, feelings or discussions avoid activities, places memory blocks anhedonia (without pleasure) numb alexithymia (emotions unknown) feeling of doom

46 Hyperarousal Symptoms sleep disturbance anger problems concentration startle response on guard hypervigilence

47 All ages Both genders Across Cultures and ethnic groups

48 Natural Earthquakes Floods Fires Hurricanes Human induced War Violent Crimes Motor Vehicle Accidents

49 Alcoholism 75% for Vietnam Veterans with PTSD Depression 77% of firefighters with PTSD also have depression Generalized Anxiety Panic Attacks

50

51 Assessment Nonpharmacologic Medication Therapy

52 Hypersensitivity and Allergies Use of alcohol and other CNS depressants Drug abuse and dependence All current prescribed medication

53 Cognitive behavioral therapy Counseling Biofeedback techniques Meditation

54

55 Historically barbiturates were used to treat severe cases of anxiety (not seem much anymore) Benzodiazapines (valium, ativan, librium) had less severe side effects Other GABA agonists Gabapentin Serotonin agonists Tricyclic Antidepressants

56 Antidepressants-First Line -SSRI s -Tricyclics Benzodiazepines -Klonopin GABA Agonists -Gabepentin

57 Serotonin's involvement in impulse control via orbitofrontal cortex and basil ganglia (both receive SE input) SSRIs are most effective (Zoloft and Paxil ) Serotonin antagonists worsen symptoms (Trazodone) Tricyclic Antidepressants very helpful in OCD There is controversy as to how lone Benzodiazepines should be used. They are not the Mainstay of treatment!

58 Librium introduced in 1957 s Mother s little helper Valium came out in 1970 s and quickly became the top selling drug Xanax introduced in 1986 and again became top selling drug SSRI s began to replace some chronic benzo use for anxiety

59 General characteristics Differ in action, duration, drug-drug interactions & side effects based on differences in absorption rate, lipid solubility & metabolism. Indications/uses include anxiety d/o, panic d/o, mania, seizure d/o, phobias, insomnia, alcohol withdrawal, muscle spasm, agitation, catatonia, akathisia hospital use (IV/IM) in sedation for procedures Side effects sedation, cognitive impairment, anterograde amnesia respiratory depression at high dose or with alcohol may worsen obstructive sleep apnea symptoms disinhibition in susceptible individuals

60 alprazolam (Xanax) short/mid chlordiazepoxide (Librium) long clonazepam (Klonopin) mid-long clorazepate (Tranxene) long diazepam (Valium) long estazolam (ProSom) mid flurazepam (Dalmane) long lorazepam (Ativan) short-mid oxazepam (Serax) short-mid temazepam (Restoril) mid triazolam (Halcion) short (used in Procedures)

61 Abuse and dependence Risk of abuse is small in individuals who are not abusing other substances Withdrawal symptoms and physical dependence are not in themselves problematic if reductions are done gradually to minimize symptoms use of longer acting agents to minimize between-dose breakthrough and avoiding PRN dosing are helpful symptoms of withdrawal may represent breakthrough of the underlying anxiety disorder needing to increase the dose (tolerance) not generally an issue at therapeutic doses

62 Partial agonist at the serotonin 1a receptor. Relieves anxiety without producing sedation, impairment of motor skills, or memory loss. Does not induce withdrawal symptoms upon discontinuation. Does not act immediately works best with chronic anxiety Can take up to 1-2 weeks to become effective. Pharmacokinetics: Rapidly absorbed orally. Rapid first-pass effect. Elimination half-life = 2-4 hrs. Metabolism is primarily hepatic.

63 Based on the idea that our thoughts cause or feelings and behaviors Uses in-vivo exposure with Anxiety Disorders Uses Exposure/Response Prevention with OCD Uses exposure and cognitive restructuring with Social Anxiety Disorder Has proven very useful in weaning patients off benzodiazepines

64 Medication may correct an underlying biological abnormality. CBT may correct maladaptive behavior or cognitions. Neither helps everyone---research has shown combination therapy is best.

65 Sources for evidence regarding combined therapy Literature search for databases (e.g., Medline, PsycINFO) using keywords (e.g., anxiety and disorder and social and phobia and combined or pharmacotherapy or psychotherapy ) Results consisted of: Articles comparing treatment approaches + Provides details of research methods and analysis - Difficult to compare results across different studies Meta-analytic studies + Synthesizes research by transforming results from diff. studies into a common metric (effect size) - No gold standard; exclusionary criteria my bias conclusions Literature reviews + Allows for gross comparison of different studies - Exclusionary criteria may bias conclusions

66 The only thing that helps me is Xanax Refuses to try other meds even as an adjucnt Refuses inpatient treatment to regulate medications (even if it s free!) Refuses Cognitive Behavioral Therapy Calls in for frequent refills Usually short on meds at follow-up Often asks to go up on dose without attempting alternative therapies.

67

Using Benzodiazepines in Primary Care

Using Benzodiazepines in Primary Care Using Benzodiazepines in Primary Care Spencer A. Tighe MD, FRCPC Saturday, Feb. 16, 2008 Overview Historical context Drug information Indications Side effects Abuse vs. physical dependence Clinical practice

More information

Anxiety Disorders. Fear & Anxiety. Anxiety Disorder? 26/5/2014. J. H. Atkinson, M.D. Fear. Anxiety. An anxiety disorder is present when

Anxiety Disorders. Fear & Anxiety. Anxiety Disorder? 26/5/2014. J. H. Atkinson, M.D. Fear. Anxiety. An anxiety disorder is present when Anxiety s J. H. Atkinson, M.D. HIV Neurobehavioral Research Center University of California, San Diego Department of Psychiatry & Veterans Affairs Healthcare System, San Diego Materials courtesy of Dr.

More information

Depression and Anxiety. What is Depression? What is Depression? By Christopher Okiishi, MD Spring Not just being sad A syndrome of symptoms

Depression and Anxiety. What is Depression? What is Depression? By Christopher Okiishi, MD Spring Not just being sad A syndrome of symptoms Depression and Anxiety By Christopher Okiishi, MD Spring 2016 What is Depression? Not just being sad A syndrome of symptoms Depressed mood Sleep disturbance Decreased interest in usual activities (anhedonia)

More information

11/1/2010. Psychology 472 Pharmacology of Psychoactive Drugs. Listen to the audio lecture while viewing these slides

11/1/2010. Psychology 472 Pharmacology of Psychoactive Drugs. Listen to the audio lecture while viewing these slides Treatment for Anxiety Disorders Benzodiazepines and Other Anxiolytics Psychology 472 Pharmacology of Psychoactive Drugs Listen to the audio lecture while viewing these slides Ethanol Barbiturates and related

More information

Safe and Effective Medication Approaches for Anxiety and Insomnia

Safe and Effective Medication Approaches for Anxiety and Insomnia Safe and Effective Medication Approaches for Anxiety and Insomnia Joe Wegmann, PD, LCSW The PharmaTherapist Joe@ThePharmaTherapist.com 504.587.9798 www.pharmatherapist.com Are you receiving our free monthly

More information

Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe Chapter 7: Anxiety Disorders. Anxiety Disorders

Abnormal Child Psychology, 3rd Edition, Eric J. Mash, David A. Wolfe Chapter 7: Anxiety Disorders. Anxiety Disorders Anxiety Disorders Experiencing Anxiety Anxiety: characterized by strong negative emotion and tension in anticipation of future danger or threat Moderate amounts of anxiety is adaptive; helps us cope with

More information

Psychopharmacology in the Emergency Room. Michael D. Jibson, M.D., Ph.D. Professor of Psychiatry University of Michigan

Psychopharmacology in the Emergency Room. Michael D. Jibson, M.D., Ph.D. Professor of Psychiatry University of Michigan Psychopharmacology in the Emergency Room Michael D. Jibson, M.D., Ph.D. Professor of Psychiatry University of Michigan Pretest 1. Which of the following conditions is LEAST likely to benefit from emergency

More information

Contemporary Psychiatric-Mental Health Nursing Third Edition. Theories: Anxiety Disorders. Theories: Anxiety Disorders (cont'd) 10/2/2014

Contemporary Psychiatric-Mental Health Nursing Third Edition. Theories: Anxiety Disorders. Theories: Anxiety Disorders (cont'd) 10/2/2014 Contemporary Psychiatric-Mental Health Nursing Third Edition CHAPTER 18 Anxiety Disorders Theories: Anxiety Disorders Biological changes in the brain Neurotransmitters are associated with anxiety. low

More information

Benzodiazepines: Comparative Effectiveness and Strategies for Discontinuation. Ann M. Hamer, PharmD, BCPP Rural Oregon Academic Detailing Project

Benzodiazepines: Comparative Effectiveness and Strategies for Discontinuation. Ann M. Hamer, PharmD, BCPP Rural Oregon Academic Detailing Project Benzodiazepines: Comparative Effectiveness and Strategies for Discontinuation Ann M. Hamer, PharmD, BCPP Rural Oregon Academic Detailing Project This project is funded through a grant from the Pew Charitable

More information

Mental Health Nursing: Anxiety Disorders. By Mary B. Knutson, RN, MS, FCP

Mental Health Nursing: Anxiety Disorders. By Mary B. Knutson, RN, MS, FCP Mental Health Nursing: Anxiety Disorders By Mary B. Knutson, RN, MS, FCP A Definition of Anxiety Diffuse apprehension that is vague in nature and associated with feelings of uncertainty and helplessness

More information

Anxiolytic and Hypnotic drugs

Anxiolytic and Hypnotic drugs Anxiolytic and Hypnotic drugs Anxiolytic and Hypnotic drugs Anxiety is unpleasant state of tension and fear that seems to arise from unknown source. The symptoms of severe anxiety are similar to those

More information

1/20/2017. Benzodiazepines Overuse. Pharmacist Objectives. Technician Objectives. A Bit of History. Benzodiazepines: Mechanism of Action

1/20/2017. Benzodiazepines Overuse. Pharmacist Objectives. Technician Objectives. A Bit of History. Benzodiazepines: Mechanism of Action Pharmacist Objectives Participants will review the pharmacology of benzodiazepines and be able to identify how various benzodiazepines differ. Benzodiazepines Overuse Steve Jenkusky, MD January 29, 2017

More information

Anxiety. Definition. Sometimes anxiety results from a medical condition that needs treatment. Whatever form of anxiety you have, treatment can help.

Anxiety. Definition. Sometimes anxiety results from a medical condition that needs treatment. Whatever form of anxiety you have, treatment can help. Anxiety Definition Experiencing occasional anxiety is a normal part of life. However, people with anxiety disorders frequently have intense, excessive and persistent worry and fear about everyday situations.

More information

Friend or Foe? Review of the Regulations & Benefits: Risk Profiles of the Benzodiazepines

Friend or Foe? Review of the Regulations & Benefits: Risk Profiles of the Benzodiazepines Friend or Foe? Review of the Regulations & Benefits: Risk Profiles of the Benzodiazepines Program Learning Objectives At the conclusion of the activity, participants should be able to: Have a basic understanding

More information

Anxiety Disorders. Dr. Ameena S. Mu min, LPC Counseling Services- Nestor Hall 010

Anxiety Disorders. Dr. Ameena S. Mu min, LPC Counseling Services- Nestor Hall 010 Anxiety Disorders Dr. Ameena S. Mu min, LPC Counseling Services- Nestor Hall 010 Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in the United States age 18

More information

Phenomenology. Epidemiology

Phenomenology. Epidemiology Phenomenology Anxiety (definition): a "warning signal", functioning to make us aware of present or potential danger. The warning can be appropriate or inappropriate. By definition, the anxiety disorders

More information

Psychopharmacology in the Emergency Room. Michael D. Jibson, M.D., Ph.D. Associate Professor of Psychiatry University of Michigan

Psychopharmacology in the Emergency Room. Michael D. Jibson, M.D., Ph.D. Associate Professor of Psychiatry University of Michigan Psychopharmacology in the Emergency Room Michael D. Jibson, M.D., Ph.D. Associate Professor of Psychiatry University of Michigan Pretest 1. Appropriate target symptoms for emergency room medication treatment

More information

PTSD HISTORY PTSD DEFINED BY SONNY CLINE M.A., M.DIV. PA C. PTSD: Post Traumatic Stress Disorder

PTSD HISTORY PTSD DEFINED BY SONNY CLINE M.A., M.DIV. PA C. PTSD: Post Traumatic Stress Disorder PTSD BY SONNY CLINE M.A., M.DIV. PA C HISTORY PTSD: Post Traumatic Stress Disorder The term was coined in the mid 70 s during the anti Vietnam war protest. The condition was more pronounced in those returning

More information

PSYCHOLOGICAL DISORDERS CHAPTER 13 MEYERS AND DEWALL

PSYCHOLOGICAL DISORDERS CHAPTER 13 MEYERS AND DEWALL PSYCHOLOGICAL DISORDERS CHAPTER 13 MEYERS AND DEWALL OVERVIEW What are Psychological Disorders? Anxiety Disorders, OCD, and PTSD Substance Use and Addictive Disorders Mood Disorders Schizophrenia Additional

More information

Panic Disorder with or without Agoraphobia

Panic Disorder with or without Agoraphobia Panic Disorder with or without Agoraphobia LPT Gondar Mental Health Group www.le.ac.uk Panic Disorder With and Without Agoraphobia Panic disorder Panic versus anxiety Agoraphobia Agoraphobia without panic

More information

8/22/2016. Contemporary Psychiatric-Mental Health Nursing Third Edition. Theories: Anxiety Disorders. Theories: Anxiety Disorders (cont'd)

8/22/2016. Contemporary Psychiatric-Mental Health Nursing Third Edition. Theories: Anxiety Disorders. Theories: Anxiety Disorders (cont'd) Contemporary Psychiatric-Mental Health Nursing Third Edition CHAPTER 18 Anxiety Disorders Theories: Anxiety Disorders Biological changes in the brain Noradrenergic system is sensitive to norepinephrine;

More information

Fortunately, panic disorder is one of the most treatable anxiety disorders. The illness can be controlled with medication and focused psychotherapy.

Fortunately, panic disorder is one of the most treatable anxiety disorders. The illness can be controlled with medication and focused psychotherapy. Anxiety Disorders Anxiety disorders are the most common mental illness in America. More than 19 million Americans suffer from anxiety disorders, which include panic disorder, obsessive-compulsive disorder,

More information

What is Schizophrenia?

What is Schizophrenia? What is Schizophrenia? Module 33 What symptoms would you expect this person to display? It is also one of the most misunderstood of all psychological disorders! 1 Who has Schizophrenia? A middle-aged man

More information

Treatment of Anxiety (without benzos)

Treatment of Anxiety (without benzos) Treatment of Anxiety (without benzos) Alison C. Lynch MD MS Clinical Professor Departments of Psychiatry and Family Medicine University of Iowa Health Care None Disclosures Overview/objectives Review common

More information

Contemporary Psychiatric-Mental Health Nursing. Theories: Anxiety Disorders. Theories: Anxiety Disorders - continued

Contemporary Psychiatric-Mental Health Nursing. Theories: Anxiety Disorders. Theories: Anxiety Disorders - continued Contemporary Psychiatric-Mental Health Nursing Chapter 18 Anxiety and Dissociative Disorders Theories: Anxiety Disorders Biological changes in the brain Noradrenergic system is sensitive to norepinephrine;

More information

DSM-IV-TR Diagnostic Criteria For Posttraumatic Stress Disorder

DSM-IV-TR Diagnostic Criteria For Posttraumatic Stress Disorder DSM-IV-TR Diagnostic Criteria For Posttraumatic Stress Disorder PTSD When an individual who has been exposed to a traumatic event develops anxiety symptoms, re-experiencing of the event, and avoidance

More information

WHEN AND HOW TO USE BENZODIAZEPINES IN TREATING ANXIETY: AM I WITHHOLDING TREATMENT IF I DON'T USE BENZODIAZEPINES?

WHEN AND HOW TO USE BENZODIAZEPINES IN TREATING ANXIETY: AM I WITHHOLDING TREATMENT IF I DON'T USE BENZODIAZEPINES? Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences WHEN AND HOW TO USE BENZODIAZEPINES IN TREATING ANXIETY: AM I WITHHOLDING TREATMENT IF I DON'T USE BENZODIAZEPINES?

More information

Treating Anxiety Disorders. Adil Virani, BSc (Pharm), Pharm D, FCSHP

Treating Anxiety Disorders. Adil Virani, BSc (Pharm), Pharm D, FCSHP Treating Anxiety Disorders Adil Virani, BSc (Pharm), Pharm D, FCSHP Outline! Michelle s Case! Types of anxiety disorders! Goals of therapy! Treatment options and guidelines! Pharmacological options! Benzodiazepines

More information

Anxiolytic & Hypnotic Drugs. Asst Prof Dr Inam S Arif

Anxiolytic & Hypnotic Drugs. Asst Prof Dr Inam S Arif Anxiolytic & Hypnotic Drugs Asst Prof Dr Inam S Arif isamalhaj@yahoo.com Anxiolytic & Hpnotic Agents Anxiety: unpleasant state of tension, apprehension or uneasiness, characterised by, tachycardia, sweating,

More information

Who has Schizophrenia? What is Schizophrenia? 11/20/2013. Module 33. It is also one of the most misunderstood of all psychological disorders!

Who has Schizophrenia? What is Schizophrenia? 11/20/2013. Module 33. It is also one of the most misunderstood of all psychological disorders! What is Schizophrenia? Module 33 It is also one of the most misunderstood of all psychological disorders! Who has Schizophrenia? A middle-aged man walks the streets of New York with aluminum foil under

More information

Antidepressants and Sedatives. David G. Standaert, M.D., Ph.D. Massachusetts General Hospital Harvard Medical School

Antidepressants and Sedatives. David G. Standaert, M.D., Ph.D. Massachusetts General Hospital Harvard Medical School Antidepressants and Sedatives David G. Standaert, M.D., Ph.D. Massachusetts General Hospital Harvard Medical School Depression A frequent problem, affecting up to 5% of the population Common presentations

More information

Benzodiazepines Revisited. Professor of Psychiatry Director, Treatment Resistant Depression Program New York University School of Medicine

Benzodiazepines Revisited. Professor of Psychiatry Director, Treatment Resistant Depression Program New York University School of Medicine Benzodiazepines Revisited Professor of Psychiatry Director, Treatment Resistant Depression Program New York University School of Medicine Benzodiazepines Benzodiazepine Use 5.2% of adults aged 18-80 years

More information

Clonazepam temazepam clonazepam temazepam compared temazepam clonazepam klonopin temazepam Clonazepam vs Temazepam Clonazepam Temazepam Temazepam

Clonazepam temazepam clonazepam temazepam compared temazepam clonazepam klonopin temazepam Clonazepam vs Temazepam Clonazepam Temazepam Temazepam Compare Clonazepam vs. Temazepam, which is better for uses like: Anxiety and Insomnia. Compare head-to-head ratings, side effects, warnings, dosages, interactions and patient reviews. Patients rated Clonazepam

More information

MEDICATION ALGORITHM FOR ANXIETY DISORDERS

MEDICATION ALGORITHM FOR ANXIETY DISORDERS Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences MEDICATION ALGORITHM FOR ANXIETY DISORDERS RYAN KIMMEL, MD MEDICAL DIRECTOR HOSPITAL PSYCHIATRY UNIVERSITY OF WASHINGTON

More information

Brief Psychiatric History and Mental Status Examination

Brief Psychiatric History and Mental Status Examination 2 Brief Psychiatric History and Mental Status Examination John R. Vanin A comprehensive medical evaluation includes a thorough history, physical examination, and appropriate laboratory, imaging and other

More information

Benzodiazepines. Benzodiazepines

Benzodiazepines. Benzodiazepines : History 1950s - Invented by Swiss chemists who identified its sedative effects 1950s 60s - Chlordiazepoxide (Librium) marketed as a safer alternative to barbiturates; along with newer benzodiazepines

More information

Obsessive Compulsive and Related Disorders

Obsessive Compulsive and Related Disorders Obsessive Compulsive and Related Disorders Obsessive-Compulsive and Related Disorders Obsessive-Compulsive and Related Disorders Obsessive -Compulsive Disorder (OCD) Body Dysmorphic Disorder Hoarding Disorder

More information

Anxiolytic, Sedative and Hypnotic Drugs. Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia

Anxiolytic, Sedative and Hypnotic Drugs. Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia Anxiolytic, Sedative and Hypnotic Drugs Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia Anxiolytics: reduce anxiety Sedatives: decrease activity, calming

More information

CHAPTER 5 ANXIETY DISORDERS (PP )

CHAPTER 5 ANXIETY DISORDERS (PP ) CHAPTER 5 ANXIETY DISORDERS (PP. 128-179) 1 Anx, Fear, Panic Clin. Descr. Complexity Statistics GAD Suicide & Physical Comorbid Clin. Descr. Treatment Stats Anxiety Disorders Panic Treat. Clin. Descr.

More information

Anxiety Disorders Overview

Anxiety Disorders Overview Anxiety Disorders Anxiety Disorders Overview What is anxiety? Categories of anxiety disorders Generalized Anxiety Disorder Panic Disorder Specific Phobia/Social Phobia Obsessive Compulsive Disorder DSM-IV

More information

Class Objectives: 8/31/2014. Anxiety is a future-oriented apprehension or sense of dread

Class Objectives: 8/31/2014. Anxiety is a future-oriented apprehension or sense of dread Chapter 8 Anxiety, Obsessive-Compulsive, and Trauma and Stressor-Related Disorders Class Objectives: What is Anxiety? How are anxiety, fear and panic similar? Different? What is Generalized Anxiety Disorder?

More information

ANTIANXIETY DRUGS: BENZODIAZEPINES

ANTIANXIETY DRUGS: BENZODIAZEPINES Margaret Gnegy Professor of Pharmacology pgnegy@umich.edu 1 ANTIANXIETY DRUGS: BENZODIAZEPINES Sedatives and hypnotics M. Gnegy, Ph.D. 1 2 Reading: Goodman & Gilman, 11th ed. Chapter 16, pp. 401-427. Drug

More information

KNOW WHAT CATEGORY ANY DISORDER FITS INTO

KNOW WHAT CATEGORY ANY DISORDER FITS INTO KNOW WHAT CATEGORY ANY DISORDER FITS INTO Categories of Disorder: 1. Anxiety 2. Mood 3. Dissociative 4. Schizophrenia 5. Personality 6. Somatoform (Not in Book) 7. Facticious (Not in Book) Anxiety Disorders

More information

Chapter 5 - Anxiety Disorders

Chapter 5 - Anxiety Disorders Chapter 5 - Anxiety Disorders I. PANIC DISORDER A. Description - with &without Agoraphobia 1. PD w/o Agora - panic attacks - feeling of imminent death - numerous symptoms (racing heart, sweating, dizziness)

More information

Jonathan Haverkampf PANIC ATTACKS PANIC ATTACKS. Christian Jonathan Haverkampf MD

Jonathan Haverkampf PANIC ATTACKS PANIC ATTACKS. Christian Jonathan Haverkampf MD Christian MD Panic attacks can be highly debilitating as they occur spontaneously and come with a dread of impending doom and often death. Their unpredictability and the strong feelings of anxiety can

More information

Anxiety vs. Fear. Anxiety. Fear. Both involve physiological arousal. Both can be adaptive. Apprehension about a future threat

Anxiety vs. Fear. Anxiety. Fear. Both involve physiological arousal. Both can be adaptive. Apprehension about a future threat Anxiety Disorders Anxiety vs. Fear Anxiety Apprehension about a future threat Fear Response to an immediate threat Both involve physiological arousal Sympathetic nervous system Both can be adaptive Fear

More information

Sedative / Hypnotics

Sedative / Hypnotics Sedative / Hypnotics David H. Rubin, MD Executive Director, Massachusetts General Hospital Psychiatry Academy Director of Child and Adolescent Psychiatry Residency Training Massachusetts General Hospital

More information

Anxiety Pharmacology UNIVERSITY OF HAWAI I HILO PRE -NURSING PROGRAM

Anxiety Pharmacology UNIVERSITY OF HAWAI I HILO PRE -NURSING PROGRAM Anxiety Pharmacology UNIVERSITY OF HAWAI I HILO PRE NURSING PROGRAM NURS 203 GENERAL PHARMACOLOGY DANITA NARCISO PHARM D Learning Objectives Understand the normal processing of fear vs fear processing

More information

AP PSYCH Unit 12.1 Abnormal Psychology Anxiety Disorders

AP PSYCH Unit 12.1 Abnormal Psychology Anxiety Disorders AP PSYCH Unit 12.1 Abnormal Psychology Anxiety Disorders Defining Psychological Disorders Abnormal Psychology At various moments, all of us feel, think or act the same way disturbed people do much of

More information

CHILDHOOD/ADOLESCENT ANXIETY DISORDERS: EVALUATION AND TREATMENT

CHILDHOOD/ADOLESCENT ANXIETY DISORDERS: EVALUATION AND TREATMENT CHILDHOOD/ADOLESCENT ANXIETY DISORDERS: EVALUATION AND TREATMENT PHILIP L. BAESE, MD ASSISTANT PROFESSOR OF PSYCHIATRY CHIEF, DIVISION OF CHILD AND ADOLESCENT PSYCHIATRY UNIVERSITY OF UTAH, SCHOOL OF MEDICINE

More information

10. Psychological Disorders & Health

10. Psychological Disorders & Health 10. Psychological Disorders & Health We will now study different psychological disorders and theories for treating psychopathology. We will also cover health, stress and how to cope with them. The sections

More information

Kari A. Stephens, PhD & Wayne Bentham, MD Psychiatry & Behavioral Sciences University of Washington. Approach for doing differential diagnosis of PTSD

Kari A. Stephens, PhD & Wayne Bentham, MD Psychiatry & Behavioral Sciences University of Washington. Approach for doing differential diagnosis of PTSD IN PRIMARY CARE June 17, 2010 Kari A. Stephens, PhD & Wayne Bentham, MD Psychiatry & Behavioral Sciences University of Washington Defining and assessing Approach for doing differential diagnosis of Best

More information

Tranquilizers & Sedative-Hypnotics

Tranquilizers & Sedative-Hypnotics Tranquilizers & Sedative-Hypnotics 1 Tranquilizer or anxiolytic: Drugs used therapeutically to treat agitation or anxiety Sedative-Hypnotic: drugs used to sedate and aid in sleep Original sedatives (before

More information

Pharmacological Help for a Good Night s s Sleep. Thomas Owens, MD

Pharmacological Help for a Good Night s s Sleep. Thomas Owens, MD Pharmacological Help for a Good Night s s Sleep Thomas Owens, MD Objectives 1. Define insomnia and characterize the symptoms and array of causes. 2. Describe traditional and new pharmacologic approaches

More information

Anxiolytic drugs. Anxiolytics: reduce anxiety. Sedatives: decrease activity, calming effect. Hypnotics: induce sleep

Anxiolytic drugs. Anxiolytics: reduce anxiety. Sedatives: decrease activity, calming effect. Hypnotics: induce sleep Anxiolytic drugs Anxiolytics: reduce anxiety Sedatives: decrease activity, calming effect Hypnotics: induce sleep Some drugs have anxiolytic and sedative/hypnotic effects. Anxiety disorders Excessive,

More information

Visualizing Psychology

Visualizing Psychology Visualizing Psychology by Siri Carpenter & Karen Huffman PowerPoint Lecture Notes Presentation Chapter 13: Psychological Disorders Siri Carpenter, Yale University Karen Huffman, Palomar College Lecture

More information

2/9/2016. Anxiety. Early Intervention for childhood Mental Health issues. ANXIETY DISORDERS in Children and Adolescents.

2/9/2016. Anxiety. Early Intervention for childhood Mental Health issues. ANXIETY DISORDERS in Children and Adolescents. ANXIETY DISORDERS in Children and Adolescents. Joy Lauerer DNP PMHCNS BC Discussion Points Anxiety Early Intervention for childhood Mental Health issues Why? Important to long term health outcomes! What

More information

Guideline for the Diagnosis and Management of Generalized Anxiety Disorder for Primary Care Physicians

Guideline for the Diagnosis and Management of Generalized Anxiety Disorder for Primary Care Physicians MAGELLAN BEHAVIORAL HEALTH/ BLUE CROSS BLUE SHIELD OF NORTH CAROLINA Guideline for the Diagnosis and Management of Generalized Anxiety Disorder for Primary Care Physicians This guideline includes recommendations

More information

Cannabinoids and Mental Health

Cannabinoids and Mental Health Cannabinoids and Mental Health https://upload.wikimedia.org/wikipedia/commons Karen M. Lounsbury, PhD Professor of Pharmacology 802-656-3231, Karen.lounsbury@uvm.edu Objectives Describe the underlying

More information

Posttraumatic Stress Disorder

Posttraumatic Stress Disorder Posttraumatic Stress Disorder History and Treatment June 6, 2017 Yves Newmen, Ph.D. DSM V (2013) Trauma, and Stressor-Related Disorders Reactive Attachment Disorder Disinhibited Social Engagement Disorder

More information

PRISM SECTION 15 - STRESSFUL EVENTS

PRISM SECTION 15 - STRESSFUL EVENTS START TIME : PRISM SECTION 15 - STRESSFUL EVENTS Statement I.1: These next questions are about difficult or stressful things that can happen to people. It may be hard to remember everything about these

More information

Highs and Lows. Anxiety and Depression

Highs and Lows. Anxiety and Depression Highs and Lows Anxiety and Depression ANXIETY Anxiety is a normal reaction to stress and can actually be beneficial in some situations. For some people, however, anxiety can become excessive. However a

More information

Mental Health and Stress

Mental Health and Stress Mental Health and Stress Learning Objectives Ø Define mental health and discuss the characteristics of mentally healthy and selfactualized people Ø Describe the various mental disorders and appropriate

More information

Anxiolytics and anxiety disorders. MUDr. Vítězslav Pálenský Dept. of Psychiatry, Masaryk University, Brno

Anxiolytics and anxiety disorders. MUDr. Vítězslav Pálenský Dept. of Psychiatry, Masaryk University, Brno Anxiolytics and anxiety disorders MUDr. Vítězslav Pálenský Dept. of Psychiatry, Masaryk University, Brno Anxiety disorders 1. Panic disorders and agoraphobia 2. Specific phobia and social phobia 3. Obsessive

More information

Anxiety-based disorders

Anxiety-based disorders Anxiety-based disorders the mountain lion anxiety Words/experiences used to describe Definition: Anxiety is the psychological experience of fear: apprehension, tension, fear itself, sense of danger, hypervigilance,

More information

Consequences of Anxiety. Common Difficulties Due to Anxiety and How Post-Secondary Educators Can Help. Slide 1

Consequences of Anxiety. Common Difficulties Due to Anxiety and How Post-Secondary Educators Can Help. Slide 1 1 Common Difficulties Due to Anxiety and How Post-Secondary Educators Can Help Julie L. Ryan, Ph.D. Assistant Professor of Psychology Fairleigh Dickinson University 2 Facts about Anxiety Disorders Anxiety

More information

Anxiety Disorders NCLEX

Anxiety Disorders NCLEX Anxiety Disorders NCLEX Study online at quizlet.com/_dluaq 1. A cab driver, stuck in traffic, suddenly is lightheaded, tremulous, diaphoretic, and experiences tachycardia and dyspnea. An extensive workup

More information

Feeling nervous? What is Anxiety? Class Objectives: 2/9/2011. Chapter 4-Anxiety Disorders. What is Anxiety?

Feeling nervous? What is Anxiety? Class Objectives: 2/9/2011. Chapter 4-Anxiety Disorders. What is Anxiety? Feeling nervous? Chapter 4-Anxiety Disorders Class Objectives: What is Anxiety? How are anxiety, fear and panic similar? Different? What is an Anxiety Disorder What is Generalized Anxiety Disorder? What

More information

Molly Faulkner, PhD, CNP, LISW UNM, Dept of Psychiatry and Behavioral Sciences Div of Community Behavioral Health

Molly Faulkner, PhD, CNP, LISW UNM, Dept of Psychiatry and Behavioral Sciences Div of Community Behavioral Health Molly Faulkner, PhD, CNP, LISW UNM, Dept of Psychiatry and Behavioral Sciences Div of Community Behavioral Health What is anxiety? What causes anxiety? When is anxiety a problem? What is the size of the

More information

Anxiety Disorders.

Anxiety Disorders. Anxiety Disorders Shamim Nejad, MD Medical Director, Psycho-Oncology Services Swedish Cancer Institute Swedish Medical Center Seattle, Washington Shamim.Nejad@swedish.org Disclosures Neither I nor my spouse/partner

More information

WHAT SHOULD WE DO ABOUT BENZODIAZEPINES? Miriam Komaromy, MD Associate Director, Project ECHO August 2014

WHAT SHOULD WE DO ABOUT BENZODIAZEPINES? Miriam Komaromy, MD Associate Director, Project ECHO August 2014 WHAT SHOULD WE DO ABOUT BENZODIAZEPINES? Miriam Komaromy, MD Associate Director, Project ECHO August 2014 EPIDEMIOLOGY OF BENZO USE 7-18% of US population uses a benzo for medical purposes each year Average

More information

ANXIETY: SCREENING, DIFFERENTIAL DIAGNOSIS, TREATMENT MONITORING

ANXIETY: SCREENING, DIFFERENTIAL DIAGNOSIS, TREATMENT MONITORING Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences ANXIETY: SCREENING, DIFFERENTIAL DIAGNOSIS, TREATMENT MONITORING DEB COWLEY MD OCTOBER 20, 2016 OBJECTIVES At the

More information

PTSD Defined: Why discuss PTSD and pain? Alicia Harding, RN-C, FNP-C Gretchen Noble, PsyD

PTSD Defined: Why discuss PTSD and pain? Alicia Harding, RN-C, FNP-C Gretchen Noble, PsyD Alicia Harding, RN-C, FNP-C Gretchen Noble, PsyD Why discuss PTSD and pain? The symptoms reported by your patients may represent an undiagnosed disorder. Mental health impairment may complicate physical

More information

Stress Disorders. Stress and coping. Stress and coping. Stress and coping. Parachute for sale: Only used once, never opened.

Stress Disorders. Stress and coping. Stress and coping. Stress and coping. Parachute for sale: Only used once, never opened. Stress Disorders Parachute for sale: Only used once, never opened. Stress and coping The state of stress has two components: Stressor: event creating demands Stress response: reactions to the demands Stress

More information

Psychobiology Handout

Psychobiology Handout Nsg 85A / Psychiatric Page 1 of 7 Psychobiology Handout STRUCTURE AND FUNCTION OF THE BRAIN Psychiatric illness and the treatment of psychiatric illness alter brain functioning. Some examples of this are

More information

Identification and Management of Posttraumatic Stress Disorder after Traumatic Brain Injury

Identification and Management of Posttraumatic Stress Disorder after Traumatic Brain Injury Identification and Management of Posttraumatic Stress Disorder after Traumatic Brain Injury Curtis McKnight, MD Saturday March 23 rd, 2019 @DrCaMcKnight 2019 Barrow Traumatic Brain Injury Symposium Creighton

More information

Soma (carisoprodol), Soma Compound (carisoprodol and aspirin), Soma Compound w/ Codeine (carisoprodol and aspirin and codeine)

Soma (carisoprodol), Soma Compound (carisoprodol and aspirin), Soma Compound w/ Codeine (carisoprodol and aspirin and codeine) Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.75.07 Subject: Page: 1 of 7 Last Review Date: September 15, 2016 Description (carisoprodol), Compound

More information

C HAPTER 8 A NXIETY D ISORDERS IN P ATIENTS W ITH HIV/AIDS

C HAPTER 8 A NXIETY D ISORDERS IN P ATIENTS W ITH HIV/AIDS C HAPTER 8 A NXIETY D ISORDERS IN P ATIENTS W ITH HIV/AIDS GENERAL RECOMMENDATION: Primary care practitioners should recognize the distinct anxiety disorders that are common in persons with HIV infection.

More information

Anxiety Disorders are very common in children, adolescents and adults.

Anxiety Disorders are very common in children, adolescents and adults. RECOGNIZING ANXIETIES AND WHAT YOU CAN DO ABOUT THEM Lane F. Smith, M.D., D.L.F.A.P.A. Medical Director, Provo Canyon School November 16, 2010 Anxiety Disorders are very common in children, adolescents

More information

Some Common Mental Disorders in Young People Module 3B

Some Common Mental Disorders in Young People Module 3B Some Common Mental Disorders in Young People Module 3B MENTAL ILLNESS AND TEENS About 70% of all mental illnesses can be diagnosed before 25 years of age When they start, most mental illnesses are mild

More information

HDSA welcomes you to Caregiver s Corner. Funded by an educational grant from

HDSA welcomes you to Caregiver s Corner. Funded by an educational grant from HDSA welcomes you to Caregiver s Corner Funded by an educational grant from Caregiver s Corner Webinar, DATE Managing Psychiatric Symptoms Peg Nopoulos, M.D. Professor of Psychiatry, Neurology, and Pediatrics

More information

Insomnia: Updates in Medical Management. Michael Newnam M.D.

Insomnia: Updates in Medical Management. Michael Newnam M.D. Insomnia: Updates in Medical Management Michael Newnam M.D. Sleep Neurobiology Delicate balance of excitatory and inhibitory neurotransmitters that control the switch between wakefulness and sleep Circadian

More information

An algorithm for medication in the treatment of Complex PTSD

An algorithm for medication in the treatment of Complex PTSD An algorithm for medication in the treatment of Complex PTSD Andreas Laddis, M.D. aladdis@gmail.com ESTD Conference Bern November 10, 2017 The purpose for the presentation Algorithm for medication: My

More information

Learning Targets: To identify characteristics & symptoms of Anxiety, OCD & PTSD To discuss what life is like for people with Anxiety, OCD & PTSD

Learning Targets: To identify characteristics & symptoms of Anxiety, OCD & PTSD To discuss what life is like for people with Anxiety, OCD & PTSD Anxiety, OCD & PTSD Learning Targets: To identify characteristics & symptoms of Anxiety, OCD & PTSD To discuss what life is like for people with Anxiety, OCD & PTSD Anxiety Based Disorders They are in

More information

This is because the situation is demystified and the element of fear of the unknown is eliminated.

This is because the situation is demystified and the element of fear of the unknown is eliminated. This is more or less along the lines of the strategies we have already discussed for stress. These include common sense measures such as engaging in healthy lifestyle activities: exercising, eating well,

More information

PSY337 Psychopathology Notes

PSY337 Psychopathology Notes PSY337 Psychopathology Notes DSM Definition of mental s: clinically significant set of symptoms that result in some type of impact in an individual s life. No single rule, which captures a broad definition

More information

Mental Illness. Doreen L. Rasp, APN, FNP, PMHNP Advanced Behavioral Counseling

Mental Illness. Doreen L. Rasp, APN, FNP, PMHNP Advanced Behavioral Counseling Mental Illness Doreen L. Rasp, APN, FNP, PMHNP Advanced Behavioral Counseling Moodiness Changing Bodies Narcissism Self-Esteem Ignorant Naïve Insecure Self-Centered Independent Adolescence Disorders Affecting

More information

Some newer, investigational approaches to treating refractory major depression are being used.

Some newer, investigational approaches to treating refractory major depression are being used. CREATED EXCLUSIVELY FOR FINANCIAL PROFESSIONALS Rx FOR SUCCESS Depression and Anxiety Disorders Mood and anxiety disorders are common, and the mortality risk is due primarily to suicide, cardiovascular

More information

Soma (carisoprodol), Soma Compound (carisoprodol and aspirin), Soma Compound w/ Codeine (carisoprodol and aspirin and codeine)

Soma (carisoprodol), Soma Compound (carisoprodol and aspirin), Soma Compound w/ Codeine (carisoprodol and aspirin and codeine) Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.75.07 Subject: Soma Page: 1 of 7 Last Review Date: September 15, 2017 Soma Description Soma (carisoprodol),

More information

P A N A N X I E T Y C

P A N A N X I E T Y C P A N A N X I E T Y C The terms panic attack and anxiety attack are used interchangeably, but they are not the same. Key characteristics distinguish one from the other, though they have several symptoms

More information

Post-Traumatic Stress Disorder

Post-Traumatic Stress Disorder Post-Traumatic Stress Disorder Teena Jain 2017 Post-Traumatic Stress Disorder What is post-traumatic stress disorder, or PTSD? PTSD is a disorder that some people develop after experiencing a shocking,

More information

25 Things To Know. mood. disorders

25 Things To Know. mood. disorders 25 Things To Know mood disorders Mood Disorders Depression Bipolar Anxiety Depression Major Depressive Disorder Lasts for weeks at a time Depression Symptoms Lack energy & pleasure Helpless Sad Depression

More information

Unit 12 REVIEW. Name: Date:

Unit 12 REVIEW. Name: Date: Name: Date: 1. Which of the following disorders is classified as a mood disorder? A) antisocial personality disorder B) agoraphobia C) catatonia D) generalized anxiety disorder E) bipolar disorder 2. Mania

More information

Psychopathology Psychopathy (con t) Psychopathy Characteristics High impulsivity Thrill seeking Low empathy Low anxiety What is the common factor? Callous Self-Centeredness N M P Dr. Robert Hare

More information

Anxiety& Depression in Primary Care- a Pharmacology Primer. Lisa Deloris Slade, DNP, MSN, FNP-BC North Carolina NP Spring Symposium March 27, 2017

Anxiety& Depression in Primary Care- a Pharmacology Primer. Lisa Deloris Slade, DNP, MSN, FNP-BC North Carolina NP Spring Symposium March 27, 2017 Anxiety& Depression in Primary Care- a Pharmacology Primer Lisa Deloris Slade, DNP, MSN, FNP-BC North Carolina NP Spring Symposium March 27, 2017 Objectives Describe pharmacology, treatment considerations,

More information

Psychological Definition of a Mental Disorder

Psychological Definition of a Mental Disorder Mental Illness Disclaimer Please do not start diagnosing yourself, friends, family, or school mates. This section will provide common traits of certain Mental Illnesses, it will not enable you to make

More information

ENTITLEMENT ELIGIBILITY GUIDELINE POSTTRAUMATIC STRESS DISORDER

ENTITLEMENT ELIGIBILITY GUIDELINE POSTTRAUMATIC STRESS DISORDER ENTITLEMENT ELIGIBILITY GUIDELINE POSTTRAUMATIC STRESS DISORDER MPC 00620 ICD-9 309.81 ICD-10 43.1 DEFINITION Posttraumatic Stress Disorder (PTSD) is a condition in the Diagnostic and Statistical Manual

More information

Anxiety. DISORDERs? What ARE ANXIETY. What Are Anxiety Disorders? Physical Symptoms. Psychological Symptoms

Anxiety. DISORDERs? What ARE ANXIETY. What Are Anxiety Disorders? Physical Symptoms. Psychological Symptoms PRESENTS What ARE Anxiety s? w orry stress payments headache ANXIETY work bills What Are Anxiety Disorders? Individuals with an anxiety disorder can experience psychological or physical symptoms, or both.

More information

Brief Notes on the Mental Health of Children and Adolescents

Brief Notes on the Mental Health of Children and Adolescents Brief Notes on the Mental Health of Children and Adolescents The future of our country depends on the mental health and strength of our young people. However, many children have mental health problems

More information

PTSD Guide for Veterans, Civilians, Patients and Family

PTSD Guide for Veterans, Civilians, Patients and Family PTSD Guide for Veterans, Civilians, Patients and Family Overview There are a variety of PTSD booklets available, so with ours we wanted to hand-pick the content we felt our audience could use most. We

More information