commit 6235fb1a90c62ec82ef5d87efb346d9767e7cdbe
parent 7f11f8e3c557644f9abc9de9a94ace0873a644a8
Author: Beau <cbeauhilton@gmail.com>
Date: Thu, 28 Apr 2022 10:11:15 -0500
anxiety AHD
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diff --git a/learn/2022-04-28-anxiety-psychopharmacology.md b/learn/2022-04-28-anxiety-psychopharmacology.md
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+# anxiety
+
+
+## mostly happy and mostly functional
+
+Define goal (which is not perfection),
+recognize deviations,
+and degrees of deviation
+that warrant intervention.
+
+General goals:
+Stay aligned with core values,
+participate in meaning-making activities,
+deal with issues with minimal disruption
+(relative to the magnitude of the issue)
+and get back to function.
+
+
+## waves of anxiety
+
+Moments that correspond w peak anxiety symptoms,
+which make it difficult to stay aligned w core values and perform meaning-making activities.
+
+
+### situations
+
+- triggers (sensual stimulus related to prior negative experience)
+- giving a presentation
+- taking an exam
+- starting on a particular rotation
+- plane flight
+
+
+### symptoms
+
+- heart racing
+- feeling of loss of control
+- sweating
+- inability to focus
+- difficulty sleeping
+- fatigue
+
+
+### actions
+
+Actions that move us toward or away from
+core values and meaning-making,
+i.e., adaptive vs maladaptive actions.
+
+Differentiating toward/away actions can be subtle,
+e.g. going to get a drink with a friend could be productive or destructive.
+
+
+## specific disorders
+
+Many.
+
+Defining dx may help get a general sense of which neurotransmitters to modulate,
+which meds and other approaches to try first.
+
+- Panic disorder (4+ wks of panic attacks and maladaptation to them)
+- Generalized Anxiety Disorder (3+ sx >=6mo)
+- Social Anxiety Disorder (>=6mo)
+- Specific Phobia (>=6mo)
+- Neurodevelopmental disorders (e.g. ADHD dx during the pandemic - is the current situation adult-onset anxiety or unmasking latent issues?)
+
+
+## management
+
+Modify the situation, symptoms, and/or actions to improve outcomes.
+
+Define a goal and manage expectations, similar to pain mgmt.
+Will not be able to get to 0/10 anxiety,
+but going from 10/10 to 6/10 may allow
+regain of meaningful function.
+
+
+## management of management
+
+Most SSRIs can also be activating at first,
+so communicate this to the patient
+and consider a prn for peaks (benzos, buspirone).
+
+Recognize that benzos are like afrin -
+work like gangbusters, and fast,
+but long-term they tend to worsen the problem.
+Define course of treatment
+(e.g. while we are waiting the 4-6 wks for the SSRI to fully kick in),
+define specific situations.
+Screen for substance use disorders
+and family history
+(very small percentage of people
+will go on to develop de novo substance use disorder
+with rx benzos).
+
+Sexual dysfunction from any psychotropic medicine
+does not generally get better over time,
+consider adding buspirone >=30mg to help w this.
+
+Stopping at <6mo is associated with higher degree of relapse,
+so if any benefit is derived from therapy try to continue for 6mo.
+Ideally work with a therapist to reinforce adaptive behaviors during those 6mo,
+and afterward consider whether a taper of medicine is likely to allow the person to maintain goals.
+
+# psychopharmacology
