Anxiety Disorders

Question 1

Anxiety prevalence

Answer 1

25%

pts 3-5x more likely to seek medical help

Question 2

Panic Disorder
(define)

Answer 2

recurrent panic attacks
follow by at least 1 MONTH of:
Persistent concern for next time

Significant maladaptive behavior/avoidance of triggers

Question 3

Panic Attack

Answer 3

at least 4 common sx

Question 4

panic disorder

epidemiology

Answer 4

Women 2x > men

late teens - 20s

+comorbid with psych disorder

INC risk of stroke/CV

Question 5

panic disorder TX

Answer 5

CBT (cognitive behavioral therapy)

#1 SSRIs/SNRIs
benzo - short term use
B-bloker - HR

Question 6

Agoraphobia

Answer 6

INC fear to places, crowd, outside
Last for 6month or more
impairment functioning

Question 7

Generalized Anxiety Disorder

Answer 7

INC worry for at least 6 months

Anxiety with 3 sx+
fatigue, restlessness, concentration, irritable, muscle tension, sleep

Question 8

GAD

epidemiology

Answer 8

onset 31 yo
W > M
5% prevalence
INC relapse during 1st yr stoping meds

Question 9

GAD

TX

Answer 9

SSRI + CBT

SNRI
Benzo
buspirone
pregabalin
mirtazapine/trazodone
TCAs

Question 10

PTSD

Answer 10

sx last > 1 month

Exposure (directly, witness, repeated trauma, indirectly

Re-Experiencing (1+)
Avoidance (1+)
Negative alterations in mood and cognition (2+)
Hyperarousal (2+)

Question 11

Acute Stress disorder

Answer 11

sx last max of 1 month
sx persist for at least 3 days

+dissociative sx (9 out of 14 sx)

Question 12

PTSD prevalence

Answer 12

8%

Question 13

PTSD risk factors

Answer 13

female
prior trauma
hx mood/anxiety disorder
family hx of mood/anxiety

military - TBI, sex trauma, multiple deployment, adjusting back, substance abuse

Question 14

PTSD therapy

Answer 14

CBT
exposure therapy
EMDR
anger management classes

Question 15

PTSD Rx’s

Answer 15

SSRI

SNRIs, TCAs
mood stabilizer/anticonsultant
atypical antipsychotics
Prozasin (NIGHTMARES - a-1 block)
Clonidine, Propranolol (hyperarousal sx)

NO Benzo’s - Inc risk of disinhibition, dependency

Question 16

Obsessive Compulsive Disorder

Answer 16

obsession +/- compulsion

take >1 hr per day

Question 17

obsession

Answer 17

recurrent thoughts, urges, images

Question 18

compulsions

Answer 18

repetitive actions that pt feels driven to do

Question 19

OCD prevalence

Answer 19

2-3%

M = F

Inc risk - Major depression, tourette’s, anorexia, substance dependence, schizophrenia

Question 20

OCD tx

Answer 20

SSRI HIGH DOSES

clomipramine - if failed rx with SSRI twice

CBT
exposure, response prevention

Question 21

Hoarding Disorder

Answer 21

impaired ability to function

tx - CBT

Question 22

Social Anxiety Disorder

Social Phobia

Answer 22

lasts at least 6 months

CBT
SSRIs
SNRIs
Benzo
Propanolol - performance anxiety tx

Question 23

Specific Phobia

Answer 23

lasts at least 6 months

TX - exposure therapy - systemic desensitization

Question 24

Causes of Anxiety

Answer 24

Endocrine - TSH

Cardiovascular - MI, Afib - EKG

Metabolic - CBC, CMP, temp

Neurological -EEG

Pheochromocytoma
Insulinoma

Question 25

substance - induced anxiety

Answer 25

intoxication

withdrawal - EtOH, Benzo/sedative, hypnotics, narcotics

Question 26

SSRIs

Answer 26

fluoxetine - longer T1/2
sertraline
paroxetine
citralopram
esxitalopram
fluvoxamine

AE: GI*, sexual dec

induce mania/hypomania in Bipolar

Question 27

SSRI discontinuation

Answer 27

nausea 
HA
dizziness
lethargy
flu-like sx

Question 28

Serotonin Syndrome

Answer 28

HARM
Hyperthermia
Autonomic Instability
Rigidity
Myoclonus

TX - STOP SSRIs

Question 29

SNRIs tx anxiety

Answer 29

Venlafaxine
Duloxetine
Desvenlafaxine

Question 30

Benzodiazepines

Answer 30

short term tx anxiety

NOT pregnancy

Question 31

Buspirone

Answer 31

5HT-1A partial agonist
non-habit forming anxiolytic
+antidepressant

Question 32

TCAs

Answer 32

NE, 5HT, DA

lethal overdose (cardio - block Na/Ca)

anti-cholinergic AE - histamine muscarinic