Anxiety Disorders

Question 1

Panic attack S/S

Answer 1

palpitations, chest pain, nausea , sweating, shaking, SOB, dizziness, hot flashes

Question 2

Panic Disorder Dx

Answer 2

1+ panic attack + fear of having another attack lasting 1+mo

Question 3

Agoraphobia Dx

Answer 3

2/5: Fear of: use of public transportation, open spaces, enclosed spaces, standing in lines, being outside of home alone

Question 4

Social Phobia Dx

Answer 4

fear of embarrassment in social situations

Question 5

Specific Phobia Dx

Answer 5

fear of a specific object

Question 6

General Anxiety Disorder Dx

Answer 6

3/6, persisting for >6mo: muscle tension, fatigue, concentration problems, restlessness, irritability, sleep disturbances

Question 7

Describe the neural fear circuit

Answer 7

limbic system (temporal lobe): thalamus -> amygdala -> hypothalamus -> midbrain -> spinal cord

Question 8

Dysfunctional NTs in anxiety/fear:

Answer 8

decreased serotonin & GABA

increased NE

Question 9

Serotonin is released from the

Answer 9

raphe nucleus (brainstem)

Question 10

NE is released from the

Answer 10

locus ceruleus (rostral pons)

Question 11

Avoidance is considered a ______ reinforcer

Answer 11

negative

Question 12

Cognitive Triad

Answer 12

negative view of self, world, future

Question 13

Benzodiazepines MOA

Answer 13

increase GABA activity (more inhibition)

Question 14

Benzodiazepines S/E

Answer 14

addiction, CNS impairment

Question 15

Avoid giving Benzodiazepines to

Answer 15

pts with a Hx of EtOH abuse

Question 16

Which drug may be only used for GAD?

Answer 16

Buspirone

Question 17

Buspirone MOA

Answer 17

5-H11A receptor agonist (SLOW)

Question 18

First-line anxiolytic

Answer 18

SSRI

Question 19

Serotonin Syndrome

Answer 19

sleep, sex, shitting, spinning

Question 20

SSRI OD (excessive 5-HT) Sx

Answer 20

hyperthermia, autonomic instability (CV collapse), myoclonus, confusion, flushing, diarrhea

Question 21

Tx of excessive 5-HT

Answer 21

cyproheptadine

Question 22

Cognitive restructuring

Answer 22

identify & modify maladaptive cognitions + logical analysis

Question 23

Insight therapy

Answer 23

bring the conflict to the surface to allow understanding, healing, awareness

Question 24

Technique: Free Association

Answer 24

analyst interprets the unconscious meaning of pts disclosed thoughts

Question 25

Panic Disorder Tx

Answer 25

1. SSRIs (fluoxetine, paroxetine, sertraline, citalopram) 2. initiate w/ Benzos (alprazolam, clonazepam) 3. Psychotherapy

Question 26

Which SSRI may cause discontinuation Syndrome?

Answer 26

Paroxetine (Sx get worse once medication is stopped)

Question 27

Social Phobia Tx

Answer 27

1. SSRI 2. SNRI (Venlafaxine) 3. b-blocker for anticipated situation 4. Psychotherapy

Question 28

Specific Phobia Tx

Answer 28

1. Benzo for specific anticipated situation 2. b-blocker 3. antidepressant 4. Psychotherapy

Question 29

GAD Tx

Answer 29

1. Buspirone 2. Initiate w/ Benzo 3. Psychotherapy

Question 30

SSRI notorious for activation syndrome

Answer 30

Fluoxetine (makes Sx worse initially)

Question 31

For pts that do not respond to SSRIs, give?

Answer 31

+ SSRI then try + Benzo

Question 32

Most common mistake w/ benzos is

Answer 32

to continue treatment indefinitely

Question 33

What are the 3 main systems that drugs for anxiety should be acting on?

Answer 33

GABA, Raphe nucleus, nucleus cerulous

Question 34

Pt w/ specific fear should first be treated with?

Answer 34

SSRI (Paroxetine)

Question 35

Pt w/ specific fear w/ anticipated situation tomorrow should be given?

Answer 35

Benzo (Lorazepam)

Question 36

Drug used for rapid anxiolytic effect for acute management of anxiety?

Answer 36

Benzo (Alprazolam)