Anxiety Disorders, OCD, and Trauma

Question 1

Are panic attacks a DSM-5 diagnosis in and of itself?

Answer 1

No

Question 2

Who are more likely to experience panic attacks?

Answer 2

Younger females

Question 3

What are short term treatments for a panic attack?

Answer 3

Limited options, reassurance and positive self-talk

Question 4

What are some long-term treatments for panic attack?

Answer 4

CBT and relaxation techniques

Question 5

In an individual with panic disorder what can precipitate a panic attack?

Answer 5

Inhaling CO2 or infusion with sodium bicarb - at high risk or sensitivity to acidotic states

Question 6

How does the DSM characterize panic disorder?

Answer 6

Recurrent unexpected, unprovoked panic attacks (4 or more)

Question 7

What are the treatments for panic disorder?

Answer 7

SSRI’s or SNRI’s
Benzodiazapines short term
CBT

Question 8

How long should you continue a patient with panic disorder on antidepressant therapy after the resolution of symptoms?

Answer 8

1-2 years due to the high risk of relapse

Question 9

Why should you use caution in prescribing an SSRI in adolescent/children?

Answer 9

Increased risk of suicide ideation

Question 10

What is the most common anxiety disorder?

Answer 10

Phobias

Question 11

When is the typical onset of phobias?

Answer 11

Early adolescents, usually before age 12

Question 12

What is Agoraphobia?

Answer 12

Fear of public places/places outside the home

Fear around perceived inability to exit

Question 13

What is tyrpanophobia?

Answer 13

Fear of needles

Question 14

Is it common for a patient with social anxiety disorder to self-medicate with ETOH when in public?

Answer 14

Yes

Question 15

What situations are included under the DSM-5 situations for diagnosing agoraphobia?

Answer 15

Using public transportation
Bein in open spaces
Being in enclosed spaces
Standing in line or crowd
Being outside the home alone

Question 16

What are the treatments for phobias?

Answer 16

Desensitization (gradually introducing fear)
Flooding (rapid, intense exposure)
CBT
Medications- SSRI’s are preferred

Question 17

What SSRI is considered first line in the treatment for agoraphobia or social anxiety?

Answer 17

Paroxetine (Paxil)

Question 18

What medication treatment can be used for performance anxiety?

Answer 18

Propranolol

Question 19

What other disorders is Generalized Anxiety Disorder frequently associated with?

Answer 19

Major Depression and SUD

Question 20

What neurotransmitters are impaired in GAD?

Answer 20

Norepinephrine
GABA
5-HT

Question 21

What symptoms are associated with GAD?

Answer 21

Restlessness, edgy
Easy fatigability
Difficulty with concentration
Irritability
Muscle tension
Disrupted sleep

Question 22

What is the goal of treatment in GAD?

Answer 22

Control of symptoms, complete abatement is rare

Question 23

What is the treatment options for GAD?

Answer 23

CBT (most effective)
Medications - SSRI’s (Paroxitine) and anxiolytics (Buspiron)

Question 24

What brain anatomy structures have been found to be impaired on brain autopsy in patients with OCD?

Answer 24

Basal Ganglia and Prefrontal Cortex

Question 25

What environmental association has been linked to OCD?

Answer 25

PANDAS due to streptococcal infections in pediatric patients

Question 26

What are some common compulsions in OCD?

Answer 26

Handwashing, cleaning Double, triple checking Counting Seeking/demanding reassurance Organizing Following a strict routine

Question 27

What is the cornerstone of treatment in OCD?

Answer 27

Exposure to stimuli and prevention of response (ERP)

Question 28

What SSRI is especially approved in the treatment of OCD?

Answer 28

Flovoxamine

Question 29

What other psychiatric conditions is Body Dysmorphic Disorder associated with?

Answer 29

Social phobia Major depression Suicide

Question 30

What is Trichotillomania?

Answer 30

"Hair Pulling Disease" and may involve any site with hair

Question 31

When will adjustment disorder commonly resolve?

Answer 31

Usually within 6 months of termination of the stressor with or without treatment

Question 32

Is PTSD more common in men or women?

Answer 32

Women

Question 33

What are risk factors for PTSD?

Answer 33

Younger age History of Psychiatric illness Decreased social support Victim of stressful event Severity and duration of stressor Low SES Family history of depression

Question 34

What neurotransmitters are disrupted in PTSD?

Answer 34

Norepinephrine Dopamine 5-HT

Question 35

What other physiologic disruptions are associated with PTSD?

Answer 35

Noradrenergic dysfunction Endogenous opioids Benzodiazapine receptors Endocrine dysfunction

Question 36

What is the first line medication treatment for PTSD?

Answer 36

SSRI's (Paroxetine and Sertraline)

Question 37

What medication can be used to treat nightmares in PTSD?

Answer 37

Prazosin (alpha-adrenergic blocker)

Question 38

Is dissociation a unconscious or conscious defense mechanism?

Answer 38

Unconscious