EpistemisHypervigilance
Specialty: Psychiatry.
Why it occurs
- Post-traumatic stress disorder (PTSD)
- Generalized anxiety disorder (GAD)
- Withdrawal from alcohol or sedatives (initial phase of delirium tremens)
- Paranoid schizophrenia (prodromal or active phase)
- Chronic use of stimulants (cocaine, amphetamines)
- Paranoid personality disorder
Initial workup
PTSD Symptom Severity Scale (CAPS-5); blood analysis to detect metabolites of drugs of abuse; assessment of the hypothalamic-pituitary-adrenal axis (urinary or salivary free cortisol) to objectiveize the state of chronic stress.
red flags
Hypervigilance that evolves into delusional suspicion of poisoning, total insomnia lasting several days, or violent startle reactions to everyday stimuli with risk to third parties.
Standard management
- Prazosin — alpha-1 adrenergic antagonist, highly effective in reducing nocturnal hypervigilance, nightmares and autonomic activation in PTSD
- Clonidine — presynaptic alpha-2 agonist that decreases peripheral sympathetic tone
- Escitalopram — SSRIs for the basal treatment of underlying stress and anxiety
- Quetiapine at low doses — sedative and anxiolytic action to mitigate evening hyperalertness
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Psychiatry
- Listed causes
- 6
- Treatment options
- 4