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Psychiatry > Anxiety & Adjustment Disorders > Flashcards

Anxiety & Adjustment Disorders Flashcards

1
Q

Autonomic sx of anxiety?

A

Palpitations, perspiration, dizziness, mydriasis, GI disturbances, urinary urgency and frequency

Also tingling in peripheral extremities, SOB/choking sensation

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2
Q

Medical causes of anxiety disorders

A
  • Hyperthyroidism
  • Vitamin B12 deficiency
  • Hypoxia
  • Neuo (epilepsy, brain tumors, MS)
  • CVD
  • Anemia
  • Pheochromocytoma
  • Hypoglycemia
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3
Q

Medication or substance abuse causes of anxiety disorders?

A
  • Caffeine
  • Amphetamines
  • Alcohol/sedative withdrawal
  • Mercury or arsenic toxicity
  • Organophosphate or benzene toxicity
  • Penicillin
  • Sulfonamides
  • Sympathomimetics
  • Antidepressants
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4
Q

Time frame for panic attack? Other stuff?

A

Peak in several minutes and subside within 25 min, rarely lasting past 1 hour.

“Sudden rush of fear”, unexpected OR provoked by specific triggers. Usually the first episode is unexpected; subsequent ones may be spontaneous or assoc with specific situations

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5
Q

DSM-IV criteria for panic attack?

A

Discrete pd of intense fear/discomfort with at least 4:

  • Palpitations
  • Sweating
  • Shaking
  • SOB
  • Choking sensation
  • Chest pain (many think it’s an MI)
  • Nausea
  • Lightheadedness
  • DEPERSONALIZATION
  • Fear of “going crazy”
  • Fear of dying
  • Numbness or tingling
  • Chills or hot flushes
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6
Q

DSM-IV criteria for panic disorder?

A
  1. Spontaneous recurrent panic attacks (see list of sx) with NO OBVIOUS precipitant
  2. At least one of the attacks has been followed by a minimum of 1 month of:
    - Persistent concern about having another
    - Worry about the implications of the attack (Am I crazy)
    - Changing your behavior (avoiding situations you think provoke attacks)

ALWAYS SPECIFY WITH OR WITHOUT AGORAPHOBIA

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7
Q

Neuro for cause of panic disorder?

A

Inc norepinephrine activity, decreased serotonin and GABA activity

Research: ANS, CNS, and CBF dyrregulation

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8
Q

Conditions associated with panic disorder and agoraphobia

A

Major depression (40-80%)
Substance dependence (20-40%)
Social and specific phobias
OCD

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9
Q

Panic disorder treatment?

A

Benzos (only short course IF necessary) then taper as SSRI treatment is started. Start SSRI as low dose then increase slowly bc otherwise drug can CAUSE ANXIETY sx.

Long term use of paroxetine and sertraline. Need higher doses than for depression.
8-12 months at least

Beta blockers NOT as effective as benzos in controlling the anxiety sx.

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10
Q

Agoraphobia DSM-IV? Rx?

A

All of:

  • Anxiety about being in places or situations where escape could be difficult or help may not be readily available in event of panic attack
  • Situations are avoided; endured with severe stress; faced only with companion
  • Can’t be explained by another disorder

50-75% also have coexisting panic disorder

SSRIs

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11
Q

Specific phobias DSM-IV? Social phobia?

A

All of:

  1. Persistent excessive fear brought on by situation or object
  2. Exposure brings immediate anxiety response
  3. Patient RECOGNIZES fear as excessive
  4. Situation avoided if possible or tolerated with intense anxiety
  5. If under age 18 must have lasted at least 6 months

Social phobia is the same criteria except related to social situations

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12
Q

Most common mental disorder in USA?

A

PHOBIAS

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13
Q

Onset of phobias?

A

Very variable, can be as early as 5 as old as 35 for situational fears

Average age is mid-teens

Women 2x for SPECIFIC PHOBIA

M=F for social phobia

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14
Q

Rx for performance anxiety?

A

Beta blockers

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15
Q

Rx for specific phobia?

A

Systemic desensitization (with or without hypnosis) and supportive psychotherapy

Short course of benzos or beta blockers during desensitization for autonomic sx IF needed

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16
Q

Rx for social phobia?

A

Paroxetine

17
Q

OCD DSM-IV?

A
  1. Either obsessions or compulsions as defined here:
    Obsessions- recurrent/persistent intrusive thoughts or impulses that cause marked anxiety (NOT excessive worrying); person tries to suppress the thoughts; person understands the thoughts are products of their mind
    Compulsions- repeated behaviors; aimed to reduce stress
  2. Aware that O/C’s are unreasonable and excessive
  3. Obsessions cause marked distress, impairment, or take time

75% of patients have BOTH O/C

18
Q

OCD other associated disorders?

A

MDD, eating disorders, other anxiety disorders, obsessive-compulsive personality disorder

19
Q

OCD prognosis? Rx?

A

Usually chronic.

Only 30% significantly improve with treatment
40-50% moderate improvement
20-40% stay impaired or get worse

SSRIs at higher-than-normal doses
TCAs eg. clomipramine

Exposure and response prevention= give them stimulus and don’t let them do their compulsion

ECT in severe/refractory

20
Q

PTSD DSM-IV? Comorbid? Progonsis?

A
  • At least 1 month
  • Experienced or witnessed traumatic event
  • Persistently re-experience it
  • Avoidance of stimuli associated
  • Numbing of responsiveness (limited range of affect, feelings of detachment or estrangement from others)
  • Persistent sx of increased arousal (eg. outbursts of anger, exaggerated startle response, difficulty concentrating)

Substance abuse & depression

50% stay symptom free after 3 months of rx

21
Q

PTSD rx? What to be vigilant about?

A

TCAs- imipramine and doxepin
SSRIs, MAOIs
Anticonvulsants (for flashbacks/nightmares)

AVOID addictive substances like benzos bc they tend to be substance abusers (MC alcohol)

22
Q

Acute stress disorder DSM-IV? Rx?

A

Major traumatic event but anxiety for only a short duration.
WITHIN 1 month OF the event and lasts 1 month MAX (for PTSD event occurred anytime in the past)

Rx same as PTSD

23
Q

GAD?

A

-Excessive anxiety and worry about various daily events for AT LEAST 6 MONTHS
-May be difficult to control the worry
-Must be assoc with at least THREE of:
Restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance

Women 2x men
Onset usually before 20; many report a lifetime of feeling anxious

MOST SEE DR FOR SOMATIC COMPLAINTS like muscle tension or fatigue

24
Q

GAD pharm?

A

Buspirone
Benzos (usually clonazepam or diazepam); taper asap due to dependence risk
SSRIs
Venlafaxine

25
Q

Adjustment disorders general info?

A

NOT considered anxiety disorders.

Occur when a stressful life event results in maladaptive behavior or emotional sx.

Unlike in PTSD, the stressful life event is not considered life-threatening

26
Q

DSM-IV for adjustment disorder? Rx?

A
  1. Emotional or behavioral sx develop w/in 3 months of stressful life event. The sx produce either severe distress beyond expected or significant decline in daily fn
  2. Sx are NOT bereavement
  3. Sx resolve within 6 mo after stressor has terminated

Best rx is supportive psychotherapy
Pharm for associated sx if anxiety, insomnia, etc.

Psychiatry (5 decks)

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