Anxiety Disorders, Trauma, and Stress Related Disorders

Question 1

types of anxiety disorder

Answer 1

generalized anxiety disorder
panic disorder
phobic disorders

Question 2

types of phobic disorders

Answer 2

specific phobia
social phobia

Question 3

what do you think when you see a pt with uncontrollable worry x 1 year - she has daily sx consisting of sleep disturbance, difficulty concentrating, and irritability

Answer 3

generalized anxiety disorder

Question 4

excessive anxiety and worry ocurring more days than not - for at least 6 mo - about a number of events or activities

Answer 4

gad

Question 5

dsm 5 for gad

Answer 5

-6 months of worry that is difficult to control
-causes significant distress/impairment
-no other cause/mental disorder
-anxiety is associated w. 3 or more of the following:
-restlessness
-easily fatigued
-difficulty concentrating
-irritability
-muscle tension
-sleep disturbance

Question 6

tx for gad (5)

Answer 6

SSRIs
SNRIs
buspirone
benzos
bb
psychotherapy

Question 7

which 2 SSRIs are used for gad

Answer 7

paroxetine
escitalopram

Question 8

what SNRI is used for gad

Answer 8

venlaxafine

Question 9

how long does buspirone take to be effective

Answer 9

2 weeks

Question 10

tx for acute gad

Answer 10

benzos
bb

Question 11

what do you think when you see a pt who presents w. sudden, frequent episodes of palpitations accompanied by sweating and a feeling that she is going to pass out (but she never has) - these began when she started PA school and she is afraid to go to school for fear of having an “attack”

Answer 11

panic disorder

Question 12

dsm 5 definition of panic attack

Answer 12

sudden, unexpected period of intense fear or discomfort

Question 13

dsm 5 for panic d.o

Answer 13

-3 panic attacks in 3 weeks
-at least one attack must be followed by one month or more of one or both:
-persistent worry about additional panic attack
-significant maladaptive change in behavior related to attacks

Question 14

tx for panic d.o

Answer 14

SSRI’s
benzos
CBT

Question 15

what SSRI’s are used for panic disorder (3)

Answer 15

paroxetine
sertraline
fluoxetine
venlafaxine

Question 16

tx for acute panic attacks

Answer 16

benzos

Question 17

dsm 5 for social phobia (aka social anxiety d.o)

Answer 17

• > 6 mo of marked and persistent far of social or performance situations in which one is exposed to unfamiliar people or possible scrutiny by others
• fear of acting in a humiliating/embarrassing way - public speaking, initiating conversation, dating, eating in public

Question 18

social phobia (social anxiety d.o) may coexist w. what other disorder

Answer 18

avoidant personality disorder

Question 19

dsm 5 for specific phobias

Answer 19

-exessive and persistent fear of a specific object, situation, or activity that is generally not harmful
-lasts for 6 mo or more
-pt knows fear is irrational but they can’t overcome it
-distress causes pt to go to extreme lengths to avoid fear

Question 20

first line tx for specific phobias

Answer 20

exposure therapy - relax and try to understand/overcome fear

Question 21

pharm for specific phobias

Answer 21

SSRI + CBT
benzos for acute

Question 22

tx for agoraphobia

Answer 22

SSRI + CBT

Question 23

% of pt’s w. gad have at least one other similar psychiatric d.o at some time in their life

Answer 23

80%

Question 24

what type of therapy used for gad challenges the distortions in a patients thinking that trigger and heighten anxiety

Answer 24

cbt

Question 25

t/f: combining cbt w. other behavioral techniques is more effective than cbt alone for gad

Answer 25

t!

Question 26

what other behavioral techniques are useful to combine w. cbt for gad

Answer 26

-relaxation training: deep breathing/progressive muscle relaxation -biofeedback and imagery

Question 27

list benzos in order of shortest to longest half life

Answer 27

1. alprazolam (xanax) 2. clonazepam (klonopin) 3. diazepam (valium), clorazepate (tranzene), chlordiazepoxide

Question 28

what tx may be useful for specific phobia when exposure to feared object or situation can not be avoided

Answer 28

benzo - lorazepam bb - propranolol

Question 29

when should prophylactic tx for specific phobia be given when fear can not be avoided

Answer 29

1-2 hr before exposure

Question 30

a phobia is an excessive fear of an object or place that leads to or can be preceded by

Answer 30

panic attack

Question 31

mc psychiatric d.o in the US

Answer 31

specific phobia

Question 32

types of phobias (4)

Answer 32

animals natural environment situational injury

Question 33

what do you think when you see a pt who has experienced a traumatic event that causes an acute stress reaction with symptoms that persist past 1 month

Answer 33

ptsd

Question 34

tx for ptsd (4)

Answer 34

ssri's + CBT - 1st line prazosin benzos

Question 35

what is prazosin used for in ptsd

Answer 35

nightmares

Question 36

if benzos are used for ptsd, they should not be used longer than

Answer 36

2 weeks

Question 37

disproportionate reponse to a stressor (job loss, physical illness) that impairs ADLs

Answer 37

adjustment disorder

Question 38

adjustment disorder begins w.in _ months of the stressor and end w.in _ months after stressor has resolved

Answer 38

begin: 3 months end: 6 months

Question 39

stressors for adjustment disorder include (6)

Answer 39

marital conflict financial conclift family conflict/parental separation school problems/changing schools sexuality issues death/family illness

Question 40

tx for adjustment disorder

Answer 40

psychotherapy

Question 41

what do you think when you see a pt w. a 3 month hx of feeling depressed and extremely distressed at work after accepting a managerial position and experiencing interpersonal conflict w. 2 employees

Answer 41

adjustment disorder

Question 42

common precipitant of adjustment disorder in young adults

Answer 42

leaving home and going to college

Question 43

adjustment disorder is characterized by _ behavior and _ symptoms

Answer 43

maladaptive behavior emotional symptoms

Question 44

typical presentation of adjustment disorder (3)

Answer 44

tearful depressed reckless behavior

Question 45

hallmark features of ptsd (8)

Answer 45

intrusive recollections uncontrolled thoughts flashbacks emotional numbing avoidance difficulty sleeping severe anxiety feelings of danger, helplessness, horror

Question 46

t/f: MAOIs, TCAs, clonidinem propranolol, lithium, and buspirone have all shown efficacy with ptsd

Answer 46

t!

Question 47

why do you have to be especially careful when using benzos for ptsd

Answer 47

high rates of substance abuse disorders in this pt pop

Question 48

only 2 FDA approved meds for ptsd

Answer 48

sertraline paroxetine

Question 49

what therapy is effective for decreasing symptoms of reexperiencing and hyperarousal in ptsd (4)

Answer 49

relaxation training systematic desensitization flooding cognitive reframing

Question 50

what type of therapy is effective for processing traumatic memories in ptsd

Answer 50

emdr (eye movement desensitization and reprocessing)

Question 51

what class of drug is prazosin

Answer 51

alpha 1 antagonist effective for nightmares and insomnia in ptsd