Anxiety

Question 1

What are the main types of anxiety disorders? 🧠⚠️

Answer 1

They include:
✔️ Panic Disorder 😨
✔️ Agoraphobia 🚪
✔️ Specific Phobia 🕷️✈️🐍
✔️ Social Anxiety Disorder (Social Phobia) 🗣️
✔️ Generalized Anxiety Disorder (GAD) 💭

Question 2

What are the common peripheral (physical) manifestations of anxiety across body systems?

Answer 2

:
✔️ Gastrointestinal (GI):
  🔸 Diarrhea
  🔸 Stomach upset (“butterflies”)

✔️ Neurologic:
  🔸 Dizziness
  🔸 Lightheadedness
  🔸 Tingling in extremities
  🔸 Tremors
  🔸 Syncope
  🔸 Hyperreflexia

✔️ Autonomic:
  🔸 Palpitations
  🔸 Tachycardia
  🔸 Pupillary mydriasis (dilation)
  🔸 Hyperhidrosis (excess sweating)
  🔸 Restlessness

✔️ Urinary:
  🔸 Increased frequency
  🔸 Hesitancy
  🔸 Urgency

Question 3

True or False — Urinary symptoms such as hesitancy and urgency can be peripheral manifestations of anxiety.

Answer 3

True
🧠 Why?
✔️ Anxiety activates the autonomic nervous system, which can lead to:
  🔸 Increased urinary frequency,
  🔸 Hesitancy,
  🔸 Urgency

Question 4

True or False — Miosis (pupillary constriction) is a common peripheral manifestation of anxiety.

Answer 4

False
🧠 Why?
✔️ Anxiety activates the sympathetic nervous system, leading to mydriasis (pupillary dilation), not miosis
❌ Miosis is associated with parasympathetic activation or opioid use, not anxiety

Question 5

What are the two most effective treatments for anexity disorders ?

Answer 5

Two most effective treatments:
  🔹 Pharmacotherapy First-line treatments:
  🔹 SSRIs
  🔹 Venlafaxine (SNRI)
  🔹 Cognitive-Behavioral Therapy (CBT)

Question 6

Which class of medications provides the most rapid relief of panic symptoms, and how are they best used?

Answer 6

:
✔️ Benzodiazepines (e.g., alprazolam) have the fastest onset
✔️ Best used for:
  🔸 Acute control of severe symptoms
✔️ Must be tapered slowly to avoid withdrawal

Question 7

How are benzodiazepines typically used in treatment of panic disorder?

Answer 7

Benzodiazepines:
  🔹 Effective, but mainly for short-term use
  🔹 Used during exacerbations or as a temporary adjunct to SSRIs in acute attaks
  🔹 Not recommended as routine long-term therapy

Question 8

What is the recommended strategy when rapid control of panic is required at treatment initiation?

Answer 8

:
✔️ Start SSRI as baseline treatment
✔️ Add short course of benzodiazepine (e.g., alprazolam)
✔️ Taper off benzo once SSRI becomes effective (typically several weeks)

Question 9

True or False — Benzodiazepines are commonly used as first-line, long-term monotherapy for panic disorder.

Answer 9

False
🧠 Why?
✔️ They are not first-line
✔️ Reserved for short-term use or treatment-resistant cases
✔️ Concerns include:
  🔸 Dependence
  🔸 Cognitive side effects

Question 10

True or False — Tolerance to the anxiolytic effects of benzodiazepines typically develops with long-term use.

Answer 10

False
🧠 Why?
✔️ Evidence suggests that tolerance to anxiolytic effects does not develop
✔️ But long-term use still carries risks (dependence, cognitive side effects)

Question 11

When should long-term benzodiazepine use be considered in the treatment of panic disorder?

Answer 11

Only if the patient:
  🔹 Cannot tolerate SSRIs/SNRIs
  🔹 Or does not respond to first-line treatments
✔️ Even then, use requires caution due to side effects and dependency risk

Question 12

What key concept helps differentiate anxiety disorders with similar avoidant behaviors?

Answer 12

:
✔️ The main reason or focus of the fear behind the avoidance

Question 13

How does gender influence the prevalence of anxiety disorders?

Answer 13

A:
✔️ Women are generally more likely to have an anxiety disorder than men
✔️ OCD affects men and women equally in adults

Question 14

Q: What is the relationship between socioeconomic status (SES) and anxiety disorders?

Answer 14

The prevalence of anxiety disorders decreases with higher SES

Question 16

What psychosocial therapies are effective for treating anxiety disorders including GAD?

Answer 16

Cognitive-behavioral therapy (CBT)

Question 17

What are the first-line pharmacotherapy treatments for Generalized Anxiety Disorder (GAD)? 💊

Answer 17

A:
✔️ Selective Serotonin Reuptake Inhibitors (SSRIs)
✔️ Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

Question 18

Which medications are considered reasonable alternatives as 2nd line treatment if SSRIs and SNRIs are ineffective for GAD?

Answer 18

A:
✔️ Agomelatine
✔️ Pregabalin
✔️ Buspirone
✔️ Quetiapine
Also includes: Mirtazapine, benzodiazepines, TCAs, and antihistamines

Question 19

What are the core diagnostic criteria for Social Anxiety Disorder? 🗣️

Answer 19

A:
✔️:
✔️ Fear of certain social situations requiring interaction or performance in front of others
✔️ Fear centers on embarrassing oneself or underperforming
✔️ Not a fear of the task itself, but of negative evaluation by others
✔️ Symptoms last for more than 6 months
✔️ Includes fear of being judged in social settings
✔️ Avoidance behaviors

Question 20

How does the intensity of fear/anxiety in Social Anxiety Disorder relate to the actual social risk? ⚠️

Answer 20

A:
✔️ The fear/anxiety is out of proportion to the actual social risk or threat posed by the situation.

Question 21

In social anxiety disorder, what is the primary reason behind avoidant behavior?

Answer 21

Fear of being judged, criticized, or scrutinized by others

Question 22

What are common behaviors seen in Social Anxiety Disorder due to fear of scrutiny?

Answer 22

A:
✔️ Avoidance of feared social situations
✔️ Excessive worry about being judged or negatively evaluated
✔️ Fear that visible anxiety symptoms will increase scrutiny or rejection

Question 23

How does avoidance in avoidant personality disorder differ from social anxiety disorder?

Answer 23

A:
✔️ Avoidant personality disorder involves pervasive avoidance across most or all functional domains (general interpersonal avoidance).
✔️ Social anxiety disorder involves avoidance only in specific social situations related to fear of criticism or humiliation

Question 24

What are the key components of psychotherapy for Social Anxiety Disorder?

Answer 24

A:
✔️ Cognitive retraining (to challenge distorted beliefs)
✔️ Desensitization (gradual exposure)
✔️ Rehearsal during sessions
✔️ Homework assignments for real-world practice
Modeling – a behavioral therapy technique
✔️ Systematic desensitization – gradual exposure to feared stimuli
foolding ( not usually)

Question 25

Is Electroconvulsive Therapy (ECT) effective in treating anxiety disorders, including Social Anxiety Disorder? ⚡❌

Answer 25

❌ No, ECT is not effective in the treatment of anxiety disorders.

Question 26

What is a panic attack, and how long does it typically last? ⏱️

Answer 26

A: ✔️ A panic attack is a sudden period of intense fear ✔️ Typically lasts from a few minutes up to 30 minutes, but may extend to hours in some cases

Question 27

True or False — Palpitations, shortness of breath, and paresthesias are sufficient to diagnose panic disorder.

Answer 27

❌ False 🧠 Why? ✔️ These are symptoms of panic attacks, but panic disorder requires:   🔹 Functional impact (avoidance or worry about future attacks)   🔹 Duration ≥1 month

Question 28

What are the key physical symptoms of a panic attack? ⚠️

Answer 28

Panic!” ✔️ Tachycardia 🫀 ✔️ Palpitations 💓 ✔️ Dyspnea (shortness of breath) 😮‍💨 ✔️ Sweating 💦 ✔️ Chest tightness 🫁 ✔️ Nausea 🤢 ✔️ Dizziness 🌪️ ✔️ Tremor 🤲 ✔️ Paresthesia (tingling) ⚡ ✔️ Feeling of choking 😣

Question 29

What does current data suggest about the long-term course of panic disorder after treatment is stopped?

Answer 29

📈 Panic disorder is often chronic and recurring ✔️ Recurrence is common after stopping treatment

Question 30

What medical conditions can mimic panic attacks, and why is this important in diagnosis?

Answer 30

: ✔️ Endocrine causes:   🔸 Hypo-/Hyperthyroidism   🔸 Hyperparathyroidism   🔸 Pheochromocytoma   🔸 Insulinoma (hypoglycemia) ✔️ Neurologic causes:   🔸 Seizure disorders   🔸 Vestibular dysfunction   🔸 CNS neoplasms ✔️ Pulmonary/Cardiac causes:   🔸 COPD, asthma, arrhythmias ✔️ Drug-related:   🔸 Prescribed or illicit CNS-active substances

Question 31

What clinical clues suggest a medical (not psychiatric) cause for panic-like symptoms?

Answer 31

: ✔️ Atypical features during attacks (e.g., ataxia, altered consciousness, bladder issues) ✔️ Late onset of symptoms ✔️ Physical findings suggestive of medical illness

Question 32

What is the definition of Generalized Anxiety Disorder (GAD)? 🧠

Answer 32

✔️ Excessive anxiety and worry ✔️ Occurring most days over a period of at least 6 months ✔️ Difficult to control ✔️ Interferes with functioning

Question 33

What somatic (physical) symptoms are commonly associated with GAD? ⚠️💤 A:

Answer 33

A: ✔️ Muscle tension 💪 ✔️ Irritability 😠 ✔️ Difficulty sleeping 😴 ✔️ Fatigue 💤 ✔️ Restlessness 😵

Question 34

How do the worries in GAD differ from normal everyday worries? 🤯

Answer 34

✔️ Worries are:  ✔️ Exaggerated  ✔️ Persistent and uncontrollable  ✔️ Disproportionate to the actual situation

Question 35

Which anxiety disorder is characterized by avoidance due to fear of places where escape is difficult or needing companionship?

Answer 35

: ✔️ Agoraphobia ✔️ Avoidance is due to fear of being trapped or unable to escape

Question 36

What are the diagnostic criteria for agoraphobia? 📋🕒

Answer 36

A: ✔️ Anxiety or fear in at least 2 of 5 situations:   1. Public transportation 🚍   2. Open spaces 🌳   3. Enclosed spaces 🏢   4. Being in a crowd or standing in line 👥   5. Being alone outside the house 🏠🚶‍♂️ ✔️ Symptoms persist for over 6 months ✔️ Patients tend to avoid these situations or prefer not to be alone

Question 37

True or False — Patients with agoraphobia are often comforted by the presence of another person during anxiety-provoking situations.

Answer 37

✅ True 🧠 Why? ✔️ Individuals with agoraphobia experience distress in situations where escape might be difficult. ✔️ The presence of another person provides a sense of safety and reassurance, helping reduce anxiety in those situations.

Question 38

What defines a specific phobia, and how does it differ from a normal fear response?

Answer 38

Specific phobia = Excessive, persistent fear of a specific object, situation, or circumstance ✔️ Fear is out of proportion to the actual threat ✔️ Exposure causes intense anxiety, possibly panic ✔️ Often includes anticipation of harm (e.g., fear of dying in a car accident)

Question 39

True or False — Patients with blood and injury phobia typically exhibit a continuous increase in heart rate and blood pressure.

Answer 39

❌ False 🧠 Why? ✔️ Blood-injury phobia shows a biphasic response:   🔸 Phase 1: ↑ Heart rate & blood pressure   🔸 Phase 2: Sudden drop in BP → syncope (fainting)

Question 40

What is the first-line treatment for specific phobias, including blood-injury type?

Answer 40

Behavioral therapy (especially exposure therapy) is first-line ✔️ SSRIs may help, but evidence is limited — not considered first-line

Question 41

True or False — All specific phobias cause functional impairment.

Answer 41

True 🧠 Why? ✔️ Functional impairment is a core diagnostic criterion

Question 42

True or False — A specific phobia can be diagnosed even if the feared object poses a real danger.

Answer 42

❌ False 🧠 Why? ✔️ The fear in specific phobia must be out of proportion to the actual threat ✔️ A realistic threat would not meet diagnostic criteria for a phobia

Question 43

Why is GAD not an appropriate diagnosis when anxiety is focused on a single issue, like driving?

Answer 43

: ✔️ Generalized Anxiety Disorder (GAD) involves:   🔹 Excessive anxiety about multiple life areas   🔹 Worry present most days for ≥6 months

Question 44

What is the most common comorbid condition in patients with panic disorder, and how is it defined?

Answer 44

: ✔️ Agoraphobia — the most common comorbidity ✔️ Defined as fear or anxiety about places where escape might be difficult

Answer 45

: ✔️ Other phobias (commonly agoraphobia) ✔️ Obsessive-Compulsive Disorder (OCD) ✔️ Substance use disorders depressive disorder

Question 46

🟩 Q4: Why is it important to recognize comorbid conditions in patients with panic disorder?

Answer 46

Comorbidities can:   🔸 Complicate diagnosis   🔸 Worsen prognosis   🔸 Influence treatment planning and medication choices