7- Management of Anxiety Disorders F.pdf - Management of...

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Management of Anxiety Disorders Noémi Al Momani Aseel Al Hader
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Anxiety disorders - Panic disorder - Agoraphobia - Specific and social phobias - Obsessive compulsive disorder (OCD) - Posttraumatic stress disorder (PTSD) - Acute stress disorder (ASD) - Generalized anxiety disorder (GAD) - Anxiety disorder secondary to general medical condition - Substance-induced anxiety disorder
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Anxiety Management - Psychopharmaco therapy - Psychotherapy
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Pharmacotherapy Anti - depressants: 1. Selective Serotonin Reuptake Inhibitors (SSRI) 2. Tricyclic Antidepressatns (TCA) 3. Monoamine Oxidase Inhibitors ( MAOI) Atypical anti - depressants Anxiolytics : 1. Benzodiazepines 2. Buspirone 3. Beta blockers Anti - convulsants
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Selective Serotonin Reuptake Inhibitors (SSRIs)
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Selective Serotonin Reuptake Inhibitors MOA : inhibits the presynaptic serotonin pumps increasing serotonin availability in the synaptic clefts. The most commonly prescribed anti-depressant due to: - Low incidence of side effects. - No food restrictions. - Safer in overdose.
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Selective Serotonin Reuptake Inhibitors Fluoxetine o longest T 1/2 with active metabolites; therefore no need to taper. o Safe in pregnancy , approved for use in children. Sertraline o Highest risk for GI disturbance s . Paroxetine (most serotonin specific) o Highly protein bound several drug interactions o Short T 1/2 leading to withdrawal phenomena if not taken consistently Fluvoxamine o Only approved for OCD o Lots of drug interactions
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Citalopram o Fewest drug interactions. Escitalopram o Similar to citalopram in efficacy but possibly fewer side effects and more expensive . Selective Serotonin Reuptake Inhibitors
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Selective Serotonin Reuptake Inhibitors Indications : 1- Depression in children above 6 years ( fluoxetine ) and adults 2- In anxiety disorders: o Panic disorder paroxetine and sertraline o OCD all are effective. But if a child has OCD our first choice will be sertraline then fluvoxamine and finally citalopram . o Agoraphobia, social anxiety, Posttraumatic stress disorder (PTSD),Acute stress disorder paroxetine
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Selective Serotonin Reuptake Inhibitors 3- premenstrual dysphoric disorder (sertraline) 4- impulse control disorder 5- hypochondriasis and body dysmorphic disorder (fluoxetine) 6- premature ejaculation (fluoxetine/sertraline) 7- autism and ADHD/obesity/eating disorder/migraine/IBS
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Selective Serotonin Reuptake Inhibitors - Less side effects than TCA & MAOI due to serotonin selectivity. Side effects : (mostly resolve within a few weeks, except sexual dysfunction) 1. Sexual dysfunction 2. GI disturbance 3. Akathesia 4. Headache 5. Insomnia 6. Anorexia, weight loss 7. Seizure Serotonin syndrome caused by taking 2 drugs, both of which increase serotonin too much serotonin in the brain; like when used with MAOI symptoms : nausea, diarrhea, palpitations, chills, rigor, restlessness, confusion and lethargy, Hyperreflexia.
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  • Fall '15
  • mohamadmahmod
  • Selective serotonin reuptake inhibitor, Antidepressant, Benzodiazepine, serotonin reuptake inhibitors, Serotonin Syndrome, selective serotonin reuptake

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