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Summary Notes Royal College > Anxiety > Flashcards

Anxiety Flashcards

Anxiety guidelines

1
Q

Chronological age - development of anxiety disorders?

A

Separation Anxiety (age 3-6 years)
Selective Mutism (< age 5)
Specific phobia (age of onset age 7)
Social anxiety disorder (age of onset 13)
Panic disorder (age of onset 20)
Agoraphobia (age of onset 25)
Generalized anxiety disorder (age of onset 30)

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2
Q

Risk factors for anxiety disorders

A

F> M (2:1 ratio)
Family history
ACE
Chronic medical illness: CVD, asthma, obesity

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3
Q

Anxiety guidelines meds - Social Anxiety Disorder?

A 
VPS PEF
Venlafaxine
Paroxetine
Sertraline
Pregabalin
Escitalopram
Fluoxetine
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4
Q

Meds - Panic Disorder?

A 
VPS CEFF
Venlafaxine
Paroxetine
Sertraline
Citalopram
Escitalopram
Fluoxetine
Fluvoxamine
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5
Q

Meds - GAD ?

A 
VESPPA D
Venlafaxine
Escitalopram
Sertraline
Paroxetine
Pregabalin
Agomelatine
Duloxetine
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6
Q

Adjunctive therapy - Panic Disorder?

A

Second line: Alprazolam, Clonazepam

Third line: Aripiprazole, Divaloproex, Olanzapine, Pindolol, Risperidone

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7
Q

Which phobias does virtual reality exposure work for ?

A

Specific phobias

heights, spiders, claustrophobia

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8
Q

Adjunctive therapy - Social Anxiety Disorder?

A

Third line: Aripiprazole, Buspirone, Paroxetine, Risperidone

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9
Q

Adjunctive therapy - GAD ?

A

Second line: Pregabalin

Third line: Aripiprazole, Olanzapine, Quetiapine, Risperidone

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10
Q

GAD - prevalance/epi ?

A

Bimodal distribution (early 20s and 30/40 year olds)

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11
Q

OCD - Meds ?

A 
F2EPS
Fluxoetine
Fluvoxamine
Escitalopram
Paroxetine
Sertraline
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12
Q

OCD - Adjunctive therapy ?

A

First line - aripiprazole, risperidone

Second line - memantine , quetiapine, topiramate

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13
Q

What is not recommended in OCD ?

A

Clonazepam
Clonidine
Desimpramine

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14
Q

PTSD - meds ?

A 
VFPS
Venlafaxine
Fluxoetine
Paroxetine
Sertraline
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15
Q

PTSD - Adjunctive therapy?

A

Second line - eszopiclone, Olanzapine, risperidone

Third line - aripiprazole, clonidine, gabapentin

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16
Q

What is not recommended in PTSD ?

A

alprazolam, citalopram, clonazepam, desimpramine, divaloproex, olanzapine, tiagabine

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17
Q

Most common- specific phobia

A

animal - adults

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18
Q

In kids < age 10, most common phobia

A

natural env’t (hts, water, storms)

19
Q

Acute stress disorder ?

A 
9 symptoms in 5 domains - any 9
timeline - between 3 days and 1 month after trauma
Exposure symptoms - experiencing trauma
Intrusion symptoms - flashbacks, etc
Negative Mood
Dissociative symptoms
Avoidance symptoms
Arousal symptoms
20
Q

Good prognosis for PTSD ?

A

rapid onset of symptoms
short duration (< 6 months)
good premorbid functioning
strong social supports

21
Q

Are all anxiety disorders more common in males or females?

A

females

22
Q

Lifetime prevalence of anxiety disorders?

A 
All anxiety disorders - 28%
Social anxiety disorder - 12.1%
PTSD - 6.8%
GAD - 5.7%
Panic Disorders - 4.7%
23
Q

Recurrence rates over 12 year follow up - anxiety disorders?

A

60% panic
40% for SAD and GAD

33% convert to another anxiety disorder

24
Q

Risk factors for childhood anxiety disorder?

A 
Age of onset (early = worse)
Divorced parents (no partner)
History of childhood trauma
Residual symptoms
Parental substance abuse
antidepressant discontinuation
comorbid mood disorder
25
Q

Psychological risk factors for developing anxiety disorders?

A 
Neuroticism
Introversion
Behavioral Inhibition
Anxiety sensitivity
Harm avoidance
Perfectionism
Intolerance of Uncertainty
26
Q

Anterior Cingulate Cortext

A

role of integration of attention such as decision making, reward anticipation, decision making
TOP DOWN INHIBITION

27
Q

Hippocampus

A

Important for forming storage - episodic memories

BOTTOM UP INHIBITION –> inhibit amygdala

28
Q

What is the lag time between the urge and reaction?

A

0.25 secs

29
Q

Anxiety Disorders in DSM5

A 
Panic Disorder
Generalized Anxiety Disorder
Separation Anxiety Disorder
Agoraphobia
Specific Phobia
Selective Mutism
30
Q

Obsessive Compulsive Related Disorders?

A 
Obsessive Compulsive Disorder
Body Dysmoprhic Disorder
Hoarding Disorder
Tricholitllomania
Excoriation (skin picking)
31
Q

Trauma/Stressor Related Disorders

A 
PTSD
Acute Stress Disorder
Adjustment Disorders
Reactive Attachment Disorder
Disinhibited Social Engagement Disorder
32
Q

Agoraphobia - DSM 5

A 
Marked fear or anxiety about 2 or more of the following situations:
Using public transportation
Being in open spaces
Being in enclosed spaces
Standing in line or being in a crowd
Being outside of the home alone

The fear, anxiety or avoidance:
Is persistent, typically lasting 6 months or longer
Causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning
Is clearly excessive, if another medical condition is present ( eg. IBD,
Parkinsons)

33
Q

Neuroanatomical basis of worry?

A

Excitation of the cortico-striatal-thalamic-cortical loop

34
Q

Top risk factors for developing an anxiety disorder?

A 
family history of anxiety
being female
childhood stressful life events/trauma
chronic medical issues
behavioral inhibition
35
Q

Social Anxiety Disorder - RF

A

lifetime prevalance 8-12%
more common in women
onset after 25 years is rare
lower SES, unmarried

36
Q

Generalized Anxiety Disorder - RF

A

another anxiety disorder
substance abuse
MDD

37
Q

MOA - Gabapentin and Pregabalin

A

Alpha-2 delta ligands ( pregabalin and gabapentin) bind to voltage sensitive calcium channels which in turns blocks the release of excitatory neurotransmitters ( like
glutamate). When this occurs in the amygdala or in the CSTC , then an anxiolytic effect may result.

38
Q

Childhood onset OCD - RF

A

associated with higher symptom severity
higher rates of clinical obsessions and compulsions
higher rates of co occurring tic disorders
less chance of SRI response as adult

39
Q

How many more x likely is someone with first degree relative of OCD likely to have OCD ?

A

4x

40
Q

Obsessions and Compulsions in non clinical samples

A

80% obsessions

55% compulsions

41
Q

What is the treatment for treatment resistant OCD?

A

cingulotomy or anterior capsulotomy

42
Q

What percentage of patients with OCD are treatment refractory?

A

At least 10% of patients with OCD are treatment refractory

43
Q

Prognostic indicators for poor prognosis in OCD?

A 
early age of onset
yielding to compulsions
bizarre compulsions
hospitalization
comorbid depression
lack of insight
-delusions
- overvalued ideas
-schizotypal personality disorder

Summary Notes Royal College (16 decks)

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