Anxiety

Question 1

how to distinguish normal from pathological anxiety

Answer 1

sx interfere with daily functioning and relationships

Question 2

pathophys of anxiety

Answer 2

neurotransmitter imbalances: increased activity of NE, decreased GABA and serotonin (so give SSRI)

Question 3

medical causes of anxiety

Answer 3

hyperthyroidism, vitamin b12 def, hypoxia, neuro disorders (epilepsy, brain tumors, MS, cerebrovascular dz), cardiovascular dz, anemia, pheochromocytoma, hypoglycemia

Question 4

meds/substance causes of anxiety disorders

Answer 4

caffeine intake and w/d, theopylline, amphetamines, alcohol and sedative w/d, other illicit drug w/d, mercury/arsenic toxicity, organophosphate or benzene toxicity, penicillin, sulfonamides, sympathomimetics, antidepressants

Question 5

panic attacks

Answer 5

peak w/in 10 min and last <25 min

associated with mitral valve prolapse, asthma, PE, engine, anaphylaxis

Question 6

panic disorder

Answer 6

panic attacks on average 2x/wk bur range from several times per day to a few times per year
20-30 min
anticipatory anxiety about having another attack
ONE attack plus ONE month of worry
always specify if w/ or w/o agoraphobia
4-8x greater risk if first degree relative is affected
avg age of onset 25

Question 7

ddx of panic attack/disorder

Answer 7

medical: CHF, angina, MI, thyrotoxicosis, temporal lobe epilepsy, MS, pheo, carcinoid syndrome, COPD
meds/drugs: amphetamine, caffeine, cocaine, hallucinogens, alc/opiate w/d
other psych: depressive, phobic, OCD, PTSD

Question 8

neurotransmitters in panic

Answer 8

increased NE, decreased serotonin and GABA –> give low dose SSRI and increase slowly b/c s/e can initially worsen anxiety

Question 9

prognosis of panic disorder

Answer 9

10-20% continue sig sx that interfere w/ daily functioning
50% have mild infrequent sx
30-40% free of sx after tx

Question 10

treatment for panic disorder

Answer 10

SSRI long term esp sertraline (Zoloft) and paroxetine (paxil)
take 2-4 weeks
higher doses needed than for depression
treat for 8-12 months

Question 11

treatment for specific phobia

Answer 11

NO pharm treatment
behavior therapy (systemic desensitization)
short course of benzos or beta blockers to control autonomic sx if needed

Question 12

treatment for social phobia

Answer 12

paroxetine for social anxiety disorder
beta blockers for performance anxiety
CBT adjuncts

Question 13

ego dystonic vs ego syntonic

Answer 13

pt wishes he can get rid of distress (in OCD)

ego syntonic: pt doesn’t perceive a problem (OCPD)

Question 14

treatment for OCD

Answer 14

fluvoxamine (higher dose than for depression) or clomipramine
behavioral therapy; ERP exposure and response prevention: prolonged exposure to the ritual eliciting stimulus and prevention of compulsion
last resort: ECT or cingulotomy

Question 15

PTSD criteria and treatment

Answer 15

sx last >1 month
treat with antidepressants and anticonvulsants (for flashbacks and nightmares), AVOID addictive benzos!
CBT, supportive, psychodynamic

Question 16

acute stress disorder

Answer 16

event occurred <1 month

same treatment as PTSD

Question 17

GAD

Answer 17

persistent, excessive hyperarousal and anxiety about general daily events
at least 6 months of sx
r/o other conditions like hyperthyroidism and caffeine intake

Question 18

treatment for GAD

Answer 18

treat with combo of psychotherapy and pharm

antidepressants (SSRI, buspirone, venlafaxine) or bentos with taper

Question 19

free floating anxiety

Answer 19

(not fixed on specific person, event, activity) –> GAD