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CDM 4 Exam 2 > Anxiety > Flashcards

Anxiety Flashcards

(61 cards)

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1
Q

Locus Coeruleus

A

overactive in eliciting fear response

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2
Q

Amygdala

A

overactive in anxiety/fear response

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3
Q

Anterior cingulate cortex

A

overactive in anxiety/fear response

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4
Q

hippocampus

A

consolidation of traumatic memory and contextual fear conditioning

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5
Q

Hypothalamus

A

integrates neuroendocrine and autonomic responses to a threat

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6
Q

Sympathetic nervous system

A

increase HR, vasoconstriction, dilation of bronchioles, decrease gastrointestinal motility

fight or flight

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7
Q

parasympathetic nervous system

A

decrease HR, no vascular changes, constriction of bronchioles, increase gastrointestinal motility

Rest and Digest

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8
Q

GAD general

A

One of the most common
Very prevalent
Linked with comorbidities

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9
Q

GAD risk factors

A

Women
economically disadvantaged
stressful event
chronic physical or mental illness
low affective support in childhood
genetics

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10
Q

GAD DSM-V definition

A

Excessive anxiety and worry, occurring most days for ≥ 6 months

Presence of ≥ 3 of (in adults, children just need 1)
-feeling on edge
-easily fatigued
-mind going blank
-irritability
-tense muscles
-sleep disturbance

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11
Q

GAD onset

A

mean 21 years
10-14 years, common in older adults

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12
Q

Treatment goal for GAD

A

Remission

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13
Q

Initial GAD treatment

A

Psychotherapy (CBT, IPT)
Medications (SSRI,SNRI)

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14
Q

Panic Disorder risk factors

A

Family history
Life stressor
Childhood abuse
Smoking
Anxious traits
Behavioral inhibition

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15
Q

Panic Attack definition

A

Distinct period of intense fear or discomfort when ≥ 4 of the following symptoms develop suddenly and peak within 10 minutes

increase HR
sweating
trembling
SOB
feeling of choking
chest pain
Nausea
Dizziness
numbness
chills/hot flash

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16
Q

Panic disorder definition

A

Recurrent, unexpected panic attacks with ≥ 1 of the attacks being followed by ≥ 1 month of one of the following

Constant concern about having another attack
Anxiety about attack
Change in behavior to avoid attack

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17
Q

if panic disorder treatment is urgent and no substance abuse

A

Short-term BZD (2-4 weeks) and SSRI or venlafaxine XR for 12 weeks

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18
Q

If panic disorder treatment is not urgent

A

SSRI or venlafaxine XR or 12 weeks

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19
Q

Social Anxiety Disorder risk factors

A

female
family history
behavioral inhibition
maternal stress
early childhood trauma

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20
Q

Social anxiety disorder DSM-V

A

Marked fear or anxiety about ≥ 1 social situation where the individual is exposed to possible scrutiny by others (e.g., eating, drinking, performing, conversing)

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21
Q

Social anxiety disorder clinical presentation

A

blushing
butterflies
diarrhea
sweating
tachycardia
trembling

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22
Q

Social anxiety disorder types

A

Generalized: fear and avoidance of a wide range of social situations
Performance specific: fear limited to speaking or public performance

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23
Q

Social anxiety disorder treatment

A

SSRI or venlafaxine XR for 12 weeks

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24
Q

BB for performance-related SAD

A

MOA: antagonist at beta-1 and beta-2 adrenoceptors
Treats physical symptoms
Propranolol
Caution -cardiovascular condition

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25
OCD risk factors
Males > females (childhood then switches in adulthood) Family history Stress or hormonal changes PANDAS
26
Obsessions
Constant and recurrent thoughts, images, or urges felt by the person to be intrusive and unwanted, and typically cause marked anxiety or distress
27
Compulsions
Repeated behaviors (e.g., handwashing) or mental acts (e.g., counting) the patient feels driven to perform to relieve an obsession, or according to rules that must be applied rigorously
28
OCD definition DSM-V
Obsessions and compulsions cause marked distress or are time consuming (e.g., ≥ 1 hour/day), or significantly interfere with the patient’s normal routine, occupation, usual social activity, or relationships
29
good/fair insight
OCD beliefs are definitely or probably false
30
poor insight
OCD beliefs are likely true
31
absent insight/delusions
fully convinced OCD are true
32
First line OCD treatment
CBT SSRI CBT + SSRI
33
OCD medication choices
Fluoxetine Fluvoxamine Paroxetine Sertraline Citalopram Escitalopram Clomipramine
34
SSRI vs Clomipramine
SSRI: Less cardiovascular, sedative, anticholinergic, weight gain, seizure risk compared to clomipramine Clomipramine: TCA with strong 5-HT reuptake inhibition Less insomnia, akathisia, nausea, diarrhea compared to SSRI
35
PTSD pre-trauma
Childhood emotional problems Low socioeconomic status Exposure to prior trauma Minority racial/ethnic status Female gender (4X > male)
36
PTSD PERI-TRAUMA
Trauma severity Intentional trauma Perceived life threat/injury Witnessing atrocities/killing an enemy (military) Dissociation
37
PTSD POST-TRAUMA
Inappropriate coping skills Acute stress disorder Subsequent trauma exposure Poor social support
38
PTSD clinical manifestations
Reduced activity of prefrontal cortex Intensified fear conditioning process (amygdala) Reduced volume of hippocampus SNS above normal --> increased epinephrine and NE --> increased arousal, selective attention, and vigilance
39
PTSD definition overview
traumatic event, intrusive thoughts, avoidance, negative cognition.mood, hyper-arousal
40
PTSD criteria A
Exposure to threatened or actual death, violence, or serious injury
41
PTSD criteria B
intrusive symptoms
42
PTSD criteria C
Ongoing avoidance of stimuli
43
PTSD criteria D
Negative alterations in mood or cognition
44
PTSD criteria E
Marked changes in reactivity and arousal
45
PTSD initial treatment
SSRI for 8-12 weeks 4-6 weeks at maximum dose
46
PTSD treatment augmentation
Prazosin --> sleep difficulties, nightmares Lamotrigine --> anger Risperidone, quetiapine --> intrusive thoughts/hyper-vigilance
47
Non-pharm general treatment
CBT, IPT relaxation training meditation exercises/mindfulness exposure therapy
48
EMDR for PTSD
8-stage therapy that focuses on identifying areas of the body that display “discomfort” or “trouble spots” Implementing constructive coping skills for future use
49
Exposure and response therapy (PTSD & OCD)
Makes individuals confront cues in order to address and lessen their importance Most appropriate for patients with mild symptoms
50
Deep brain stimulation OCD
Surgically implanted medical device to correct the “faulty wiring” of the nucleus accumbens (region of the brain that drives obsessions/compulsions) Cost is ≈ $60,000 Response rate 50%
51
Surgery for OCD
Radio frequency waves destroy small amount of brain tissue in corticostriatal circuit (responsible for goal-directed behavior) Cost ≈ $3,000-5,000 Response rate 70%
52
SSRI for anxiety disorders
symptoms may get worse before better full response 4-12 weeks
53
Medication for GAD
Paroxetine Escitalopram Sertraline* Venlafaxine Duloxetine *off label
54
Medication for Panic Disorder
Fluoxetine Sertraline Paroxetine Citalopram* Escitalopram* Venlafaxine *off label
55
Medication for SAD
Sertraline Paroxetine Escitalopram* Fluvoxamine* Venlafaxine *off label
56
Medications for OCD
Fluoxetine Sertraline Paroxetine Fluvoxamine
57
Medications for PTSD
Sertraline Paroxetine
58
BZD in anxiety
Acute treatment short term 2-3 weeks use long term use can lead to dependence, misuse, withdrawal NOT used in PTSD or widely used in OCD or SAD
59
Pregabalin Lyrica
Not FDA approved but studied in GAD, SAD helpful for BZD withdrawal lots of CNS side effects
60
Prazosin Minipress
MOA: Centrally-acting, selective alpha-1 receptor blocker USE: off label for PTSD related nightmares watch for hypotension
61
Clonidine Catapres
MOA: Stimulates presynaptic alpha-2 receptors USE: off label PTSD watch for bradycardia, hypotension

CDM 4 Exam 2 (13 decks)

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