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Behavioral Medicine > Anxiety 3 > Flashcards

Anxiety 3 Flashcards

1
Q

Cognitive therapy focuses on helping manage anxiety by focusing on which negative thoughts/cognitive distortions ______ (3).

A
  1. Catastrophizing
  2. Generalization
  3. Overestimating (probability of negative outcome)
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2
Q

Lifetime prevalence of general anxiety disorder

A

Lifetime Prevalence: 4-7%

–12 mo prevalence 0.9% adolescents, 2.9% adults

(female:male = 2:1)

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3
Q

Age of onset general anxiety disorder

A

Early twenties

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4
Q

General anxiety disorder: genetics

A
  • SATB1 (chromo 3)
  • ESR 1 (chromo 6)
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5
Q

Course of general anxiety disorder

A

Chronic

(severity fluctuates)

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6
Q

Complications of general anxiety disorder (3)

A
  1. MDD
  2. Substance abuse
  3. Panic disorder
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7
Q

General anxiety disorders may be comorbid with MDD and this increases the likelihood of

A

(GAD shows significant impairment at an emotional and physical level)

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8
Q

General anxiety disorder is the excessive anxiety and worry occurring more days than not for at least_____about a number of events or activities

A

six months

(they have difficulty controlling a worry)

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9
Q

General anxiety disorder criteria: anxiety and worry associated with three or more of the following symptoms (or one for children): feeling restless/”keyed up”, easily fatigued _____ (4).

A
  1. Difficulty concentrating
  2. Irritability
  3. Muscle tension
  4. Sleep disturbance
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10
Q

In general anxiety disorder the worry and anxiety or physical symptoms cause significant distress or impairment in _____(3).

A
  1. Social
  2. Occupational
  3. Other areas of functioning
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11
Q

General anxiety disorder first-line treatment

A
  1. SNRIs
  2. SSRIs
  3. CBT
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12
Q

General anxiety disorder second-line treatment (4)

A
  1. Benzos
  2. Buspirone
  3. TCAs
  4. Antihistamines
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13
Q

Prevalence of separation anxiety disorder

A

3%

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14
Q

Separation anxiety disorder may be a precursor to _____

A

Panic disorder

(maybe related to academic, athletic problems or social skills)

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15
Q

Criteria for separation anxiety: developmentally inappropriate and excessive anxiety with three or more of the following: Distress about separation from attachment figure, _______(4).

A
  1. Fear of harm to or separation event from attachment figure
  2. Refusal to go to school
  3. Fear of being alone or sleeping
  4. Nightmares about separation
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16
Q

Separation anxiety duration

A

At least 4 weeks

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17
Q

Separation anxiety disorder does NOT occur exclusively during the course of a _______(3), and is not better accounted for by Panic Disorder with Agoraphobia.

A
  1. Pervasive Developmental Disorder
  2. Schizophrenia
  3. Other psychotic disorder
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18
Q

Separation anxiety management (2)

A
  1. Identify thoughts about anxiety
  2. Parental interventions
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19
Q

What’s parental interventions can you offer for parents of separation anxiety disorder?

A
  1. Education about anxiety (effective over protection in maintaining anxiety)
  2. Parental management techniques
  3. Application of exposure hierarchies
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20
Q

Define selective mutism

A

How to speak in specific social situations where there is an expectation for speaking

(interferes with occupation and social communication)

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21
Q

Duration of selective mutism

A

At least one month

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22
Q

Failure to speak in selective mutism is not attributed to ______ (2).

A

Lack of knowledge or comfort with the language spoken

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23
Q

Prevalence and course of selective mutism

A

Rare

Begins before the age of 5

24
Q

Use of benzodiazepine is linked to ____abuse

A

opioid

25
Q

_______ are the most prescribed of the psychotropics

A

anxiolytics

(most believe these are over-prescribed)

26
Q

Anxiolytics are typically used for ________ (duration).

A

short periods

(rarely abused)

27
Q

List the long-acting benzodiazepines (5)

A
  1. Lorazepam
  2. Diazepam
  3. Clonazepam
  4. Chlordiazepoxide
  5. Chlorazapate
28
Q

List the short-acting benzodiazepines (2)

A
  1. Alprazolam
  2. Oxazepam
29
Q

Benzodiazepine indications

A
  1. anxiety
  2. insomnia
  3. musculoskeletal disorders
  4. seizure disorders
  5. alcohol withdrawal
  6. anesthesia induction
30
Q

Drug-drug interactions and toxicity with benzodiazepines

A
  • Few drug-drug interactions
  • Little toxicity
31
Q

Benzodiazepine mechanism of action

A

Bind to benzodiazepine receptors (part of GABA receptor complex) → potentiate effects of GABA

32
Q

Indications & duration for benzodiazepine with general anxiety

A
  • When severe
  • Usually short-term (months to weeks)
33
Q

Indication for benzodiazepine with panic disorder

A

Second line behind SSRIs

34
Q

Indication for benzodiazepine with anxiety and depression

A
  • More effective for anxiety than antidepressants
  • BZD withdrawn when antidepressant becomes effective
35
Q

Indication for benzodiazepine with adjustment disorder with anxiety

A

Treatment of Time limited

36
Q

Benzodiazepines are _____ (tolerability) with alcohol during alcohol withdrawal.

A

cross-tolerant

37
Q

Benzodiazepines: Pharmacokinetics

A
  • Rapid onset
  • Lipophilic (facilitating crossing of the BBB)
38
Q

Benzodiazepines should be avoided in ____(2)

A
  1. Pregnancy (neonatal anxiety & withdrawal)
  2. Caution with elderly
39
Q

Discontinuation of benzodiazepines involves ______(2).

A
  • Slow tapering
  • Change to longer acting med
40
Q

Benzodiazepine side effects: drowsiness, reduced motor coordination, _____(3)

A
  1. Memory impairment
  2. Sleepwalking
  3. Disinhibition
41
Q

Physiologic dependence of benzodiazepines is more likely with ________

A

Longer drug exposure

42
Q

Use benzodiazepines cautiously in patients with histories of _______ (2).

A
  1. Drug or alcohol
  2. Unstable personalities

(avoid combining with alcohol or opiates)

43
Q

Patients should avoid combining benzodiazepines with ______ (2).

A

Alcohol or opiates

44
Q

Benzodiazepine withdrawal symptoms include insomnia, agitation, ______ (3).

A
  1. Anxiety rebound
  2. GI distress
  3. Seizures
45
Q

Buspirone is indicationed for ______.

A

Generalized anxiety disorder

(ineffective for panic attacks, phobias or Obsession and compulsion)

46
Q

Buspirone is not effective for _____(3)

A
  1. Panic attacks
  2. Phobias
  3. Obsessions and compulsions

(indicated for general anxiety disorder)

47
Q

Buspirone takes ______ for effect

A

1-2 weeks

(no withdrawal or alcohol potentiation)

48
Q

Buspirone mechanism of action

A

5HT1A receptor Agonist

(Does not interact with BZD receptor)

49
Q

Buspirone has no ______ or ____ properties.

(5HT1A receptor agonist, tx for GAD)

A
  • Anticonvulsant
  • Muscle relaxing
50
Q

Panic attacks are seen in panic disorder, GAD & SAD, which one is:

  • Initially unexpected?
  • Related to worry?
A
  • Panic Disorder
  • GAD
51
Q

What causes anticipatory anxiety in Panic Disorder, GAD, SAD?

A
  • PD: having another panic attack
  • GAD: different types of situations
  • SAD: social or performance situations
52
Q

What are the typical cognitions present in

  • GAD
  • SAD
  • PD
A
  • GAD: money, safety, future, relationships
  • SAD: embarrassment, negative evals
  • PD: worry about dying, losing control, heart attack
53
Q

Typical sx seen in panic attack?

A
  1. Dyspnea
  2. Palpitations
  3. Lightheadedness

(they think they’re having a heart attack)

54
Q

Typical SAD physical sx (3)

A
  1. blushing
  2. sweating
  3. trembling

(how you get when you do presentations in class)

55
Q

Typical physical sx in GAD

A
  1. Tension
  2. Insomnia
  3. Restlessness
56
Q

What situations are avoided in patients with :

  • GAD
  • SAD
  • PD
A
  • GAD: reminders of worry
  • SAD: public speaking, social situations
  • PD: closed spaces, being alone

(GAD & PD seek reassurance)

Behavioral Medicine (35 decks)

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