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Flashcards in Anxiety Deck (45):
1

_________ is an unexpected, transient, normal response to stress that is likely adaptive and necessary for survival. This response can also become pathogenic under certain circumstances or conditions.

Anxiety

2

The ____________ is the instinctual fear center and as such, it is hyperactive in most anxiety disorders.

Amygdala

3

The neurotransmitter most often elevated in anxiety disorders is _____________. It is produced by the ___________, which is located in the __________ of the brain.

  • Norepinephrine.
  • Produced by locus ceruleus, which is located in the pons.

4

SSRIs work for anxiety disorders by reducing the ______________ after around two weeks of use.

firing of locus ceruleus

5

______________ is an alternate treatment for anxiety disorders that is not only as effective as antidepressant drugs for treatment, but it also protects against future relapses. This treatment option is often used when response to medication has been less than optimal.

Cognitive-behavioral therapy (CBT)

6

The (cognitive/behavioral) portion of CBT focuses on faulty or distorted thought patterns, such as overestimation of bad and underestimation of good events.

Cognitive

7

The (cognitive/behavioral) portion of CBT focuses on breathing and relaxation techniques, graduated exposure to a triggering stimulus, and the use of mindfulness skills.

Behavioral

8

Panic disorder is more common in (males/females).

Females

9

Panic disorder is five times more concordant in (monozygotic/dizygotic) twins.

Monozygotic

10

(T/F) Infusion of sodium lactate, bicarbonate, or inhalation of 5% CO2 may lead to panic attacks in patients diagnosed with a panic disorder.

True.

11

A diagnosis of ___________ is usually made after a patient presents with recurrent unexpected panic attacks, followed by one month or more of either: persistent concern about having more attacks or their consequences, or significant maladaptive changes to behavior in response to the attacks.

Panic disorder

12

What are some of the symptoms associated with panic attacks?

  • Palpitations
  • Chest pain
  • Sweating
  • Trembling
  • Shortness of breath (SOB)
  • Nausea
  • Dizziness
  • Derealization/depersonalization
  • Fear of going crazy/dying
  • Numbness/tingling
  • Chills/hot flashes

13

If you suspect a patient of having panic attacks, be sure to rule out ____________, _____________, and _____________ that might be giving the patient false symptoms.

  • Stimulants
  • Diet pills
  • Xanthines (caffeine)

14

What are some of the differential diagnoses associated with panic disorders?

  • Cardiac arrhythmias
  • Cardiomyopathy
  • COPD
  • Hyper/Hypothyroidism
  • Hyperparathyroidism
  • Hypoglycemia
  • Vertigo
  • Depression
  • Drug withdrawal

15

The primary drug to prescribe for treatment of panic disorders is a (SSNRI/SSRI/tricyclic/MAOI/benzodiazepine).

SSRI

16

____________ is the marked fear or anxiety of 2 or more of the following:

  • Public transportation
  • Being in open spaces (parking lots, bridges)
  • Being in enclosed spaces (shops, theaters)
  • Standing in line or being in a crowd
  • Being outside of the home alone

Agoraphobia

17

____________ is excessive anxiety and worry, accompanied by 3 or more of the following for at least six months:

  • Restlessness/keyed up/on edge
  • Easily fatigued
  • Difficulty concentrating/mind going blank
  • Irritability
  • Muscle tension
  • Sleep disturbance

Generalized anxiety disorder (GAD)

18

What are some of the psychological symptoms associated with GAD?

  • Anxious or irritable mood
  • Inability to relax
  • Fears
  • Difficulty concentrating
  • Insomnia

19

What are some of the somatic psychological symptoms associated with GAD?

  • GI disturbance
  • Headaches
  • Insomnia
  • Palpitations
  • Muscle tension
  • Shortness of breath (SOB)
  • Loss of libido

20

A (majority/minority) of patients diagnosed with GAD also have a comorbidity disorder.

Majority

21

Prescribing a(n) _____________ is typically the first-line treatment for GAD.

SSRI

22

The marked fear or anxiety about social situations in which the person is exposed to possible scrutiny by others is referred to as _______________. This is essentially fear of scrutiny, humiliation, or embarrassment.

Social anxiety disorder (SAD)

23

Prescription of a(n) _______________ is typically the first-line treatment of SADs.

SSRI

24

(T/F) Prescribing a β-blocker may be useful in the treatment of "performance type" SADs, or social anxiety associated with performing a job or service in public.

True.

Propanolol

25

The irrational fear of an object that causes avoidance behavior is referred to as a(n) ______________.

Phobia

26

What are the five types of phobias?

  • Animal
  • Natural environment
  • Blood/injection/injury
  • Situational
  • Other

27

The best evidence for treatment of phobias is _________.

Cognitive behavioral therapy

28

The presence of excessive compulsions or obsessions that may become time-consuming (e.g. >1 hour/day) or cause significant distress or impairment is known as _______________.

Obsessive compulsive disorder (OCD)

29

__% of patients afflicted with Tourette's disorder also suffer from a compulsion, with __% meeting the criteria for diagnosis of obsessive-compulsive disorder (OCD).

90% suffer from a compulsion

66% meet OCD criteria

30

In OCD paitents, what structures in the brain have been found by PET and SPECT to have increased metabolism?

  • Orbitofrontal cortex
  • Anterior cingulate gyrus
  • Caudate nuclei

31

A(n) (obsession/compulsion) is defined as a repetitive behavior or mental act that one is driven to perform in response to obsession or to rigidly self-applied rules.

Compulsion

32

A(n) (obsession/compulsion) is defined as recurrent or persistent thoughts, impulses, or images seen as intrusive or inappropriate that cause marked anxiety or distress.

Obsession

33

What specific stype of CBT should be done in patients suffering from OCD? What is structure is desinsitized from this therapy?

Exposure-response prevention therapy

Amygdala is desensitized

34

Prescription of a(n) _____________ is the first-line treatment of OCD and related disorders.

SSRI

35

(T/F) Clomipramine is indicated for treatment of obsessive compulsive disorders, but is not often used in the real world.

True.

36

The neuroleptic drug ____________ should be prescribed to OCD patients also suffering from comorbid Tourette's disorder.

Risperidone

37

The preoccupation with one or more perceived defects or flaws in one's physical appearance that is not observable or noticeable to others is referred to as ______________.

Body dysmorphic disorder (BDD)

38

Recurrent skin picking that results in skin lesions may be diagnosed as ______________.

Excoriation disorder

39

The persistent difficulty discarding or parting with possessions, regardless of their actual value is often times referred to as __________________.

Hoarding disorder

40

The recurrent pulling out of one's hair that results in hair loss is known as ________________.

Trichotillomania (Hair pulling disorder)

41

19yo female presents to the clinic with chief complaint of "there's something wrong with me." She reports a 6 month h/o episodes of sudden onset of feeling "dread and doom", increased heart rate, nausea, diarrhea, SOB, "tingling all over" and "feeling like I'm out of my body." Episodes last 5-20 minutes. She is frightened by them and worries about when the next one will happen.

  • What is this patient's diagnosis?
  1. Generalized Anxiety Disorder
  2. Panic Disorder
  3. Obsessive-Compulsive Disorder
  4. Social Anxiety Disorder
  5. Post-traumatic Stress Disorder

2. Panic Disorder

42

19yo female presents to the clinic with chief complaint of "there's something wrong with me." She reports a 6 month h/o episodes of sudden onset of feeling "dread and doom", increased heart rate, nausea, diarrhea, SOB, "tingling all over" and "feeling like I'm out of my body." Episodes last 5-20 minutes. She is frightened by them and worries about when the next one will happen.

  • Appropriate first-line therapy for this disorder would include:
  1. Carbamazepine
  2. Thioridazine
  3. Propranolol
  4. Paroxetine
  5. Phenelzine

4. Paroxetine

43

16yo male brought in to clinic by mother for "counting everything". He admits to feeling driven to count objects around him, like chairs, cars and even bricks. He is embarrassed about this and appears anxious. States that he has to do it or "something bad will happen to my family."

  • What is the diagnosis?
  1. Obsessive-Compulsive Personality Disorder
  2. Panic Disorder
  3. Social Anxiety Disorder
  4. Developmental Counting Disorder
  5. Obsessive-Compulsive Disorder

5. Obsessive-Compulsive Disorder

44

16yo male brought in to clinic by mother for "counting everything". He admits to feeling driven to count objects around him, like chairs, cars and even bricks. He is embarrassed about this and appears anxious. States that he has to do it or "something bad will happen to my family."

  • Effective pharmacologic treatments for this condition include:
  1. Lithium
  2. Haloperidol
  3. Bupropion
  4. Clomipramine
  5. Methylphenidate

4. Clomipramine (or an SSRI)

45

In general, what is the type of psychotherapy that is most effective for the treatment of anxiety disorders?

  1. Insight-oriented Psychotherapy
  2. Interpersonal Therapy
  3. Dialectical-Behavioral Therapy
  4. Cognitive-Behavioral Therapy
  5. Psychodynamic psychotherapy

4. Cognitive Behavioral Therapy