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Clerckship_USMLE > Chapter_5_ Anxiety, OCD, trauma.. > Flashcards

Chapter_5_ Anxiety, OCD, trauma.. Flashcards

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1
Q

What are the major neurotransmitters implicated in anxiety disorders?

A

Norepinephrine (NE), serotonin (5-HT), and gamma-aminobutyric acid (GABA).

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2
Q

What are the DSM-5 anxiety disorders?

A
  1. Generalized anxiety disorder (GAD),
  2. panic disorder,
  3. agoraphobia,
  4. social anxiety disorder,
  5. selective mutism, and
  6. specific phobias.
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3
Q

What are the hallmark symptoms of panic disorder?

A

Recurrent unexpected panic attacks with at least one month of persistent worry about future attacks or maladaptive behavior changes.

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4
Q

What is agoraphobia?

A

Intense fear of** public places** where escape or obtaining help may be difficult; often associated with panic disorder.

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5
Q

What are the common domains of social anxiety disorder?

A

Public speaking,
eating in public,
using public restrooms, i
nteracting with strangers.

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6
Q

What is generalized anxiety disorder (GAD)?

A

Excessive worry occurring more days than not for at least** 6 months**, difficult to control, with at least 3 associated physical symptoms.

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7
Q

How is specific phobia defined?

A

Excessive, persistent fear of a specific object or situation, leading to avoidance and significant distress.

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8
Q

What are the first-line pharmacologic treatments for anxiety disorders?

A

Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).

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9
Q

What psychotherapy technique is most effective for anxiety disorders?

A

Cognitive-behavioral therapy (CBT), particularly exposure therapy.

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10
Q

What is the mechanism of SSRIs in anxiety treatment?

A

Increase serotonin availability by inhibiting its reuptake at synaptic clefts.

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11
Q

How long do SSRIs take to show full therapeutic effect?

A

4-6 weeks, but some improvement can be seen within 2 weeks.

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12
Q

Which benzodiazepines are preferred for anxiety treatment due to their short half-life?

A

Alprazolam, lorazepam, and oxazepam.

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13
Q

What are the risks of long-term benzodiazepine use?

A

Dependence, tolerance, cognitive impairment, and withdrawal symptoms.

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14
Q

What is buspirone, and when is it used?

A

A non-benzodiazepine anxiolytic that is used for generalized anxiety disorder; lacks sedation and dependence potential.

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15
Q

What is the role of beta-blockers in anxiety disorders?

A

Used for performance-related anxiety (e.g., propranolol for stage fright).

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16
Q

What is obsessive-compulsive disorder (OCD)?

A

Characterized by intrusive, distressing thoughts (obsessions) and repetitive behaviors (compulsions) aimed at reducing anxiety.

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17
Q

What are the four common types of obsessions in OCD?

A
  1. Contamination,
  2. symmetry/order,
  3. intrusive TABOO thoughts,
  4. Doubt or harm
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18
Q

What is hoarding disorder?

A

Persistent difficulty discarding possessions due to perceived need to save them, leading to clutter that interferes with living spaces.

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19
Q

What are the core symptoms of body dysmorphic disorder?

A

Preoccupation with perceived physical flaws, leading to repetitive behaviors (e.g., mirror checking) and significant distress.

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20
Q

What is post-traumatic stress disorder (PTSD)?

A

Exposure to trauma with symptoms lasting over 1 month, including intrusive memories, avoidance, negative mood changes, and hyperarousal.

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21
Q

How is PTSD differentiated from acute stress disorder?

A

PTSD lasts more than 1 month, while acute stress disorder lasts 3 days to 1 month.

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22
Q

What is the first-line treatment for PTSD?

A

SSRIs, trauma-focused CBT, and prolonged exposure therapy.

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23
Q

What medications are used to reduce nightmares in PTSD?

A

Prazosin, an alpha-1 blocker.

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24
Q

What is adjustment disorder?

A

Emotional or behavioral symptoms occurring within 3 months of an identifiable stressor, resolving within 6 months after stressor ends.

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25
How does adjustment disorder differ from PTSD?
Adjustment disorder does not involve a life-threatening or traumatic event.
26
What is separation anxiety disorder?
Excessive fear of separation from attachment figures, causing distress and impairment in social or academic functioning.
27
What is selective mutism?
Consistent failure to speak in specific social situations despite speaking in others, lasting at least 1 month.
28
What is trichotillomania?
Recurrent hair-pulling leading to hair loss, with repeated attempts to stop.
29
How does generalized anxiety disorder differ from panic disorder?
GAD involves chronic worry over many aspects of life, while panic disorder involves episodic, intense panic attacks.
30
What is the treatment approach for social anxiety disorder?
SSRIs, CBT, and beta-blockers for performance-related anxiety.
31
Which medications are FDA-approved for PTSD?
Sertraline and paroxetine.
32
What is exposure therapy?
Gradual exposure to feared stimuli to reduce avoidance behavior, commonly used in phobias and PTSD.
33
What is eye movement desensitization and reprocessing (EMDR)?
A therapy used in PTSD that involves guided eye movements while recalling traumatic memories.
34
What distinguishes an obsession from a compulsion?
An obsession is an intrusive thought, while a compulsion is a repetitive behavior aimed at reducing distress.
35
What is the role of benzodiazepines in PTSD?
They are not recommended due to risk of dependence and worsening symptoms over time.
36
What is a phobia?
An intense, irrational fear of a specific object or situation leading to avoidance.
37
How do SSRIs compare to benzodiazepines in treating anxiety disorders?
SSRIs are preferred for long-term treatment, while benzodiazepines are for short-term use due to dependency risks.
38
What therapy is most effective for OCD?
Exposure and response prevention (ERP), a type of CBT.
39
What are the core features of anxiety disorders?
Mnemonic: **'WORRY'** - **Worry **(excessive, uncontrollable) - **Overactive autonomic system** (tachycardia, sweating) - **Restlessness** - **Reduced concentration** - **Yearning for escape** (avoidance behavior)
40
Which neurotransmitters are most involved in anxiety disorders?
Mnemonic: 'GAS up your anxiety' - GABA (↓ in anxiety) - Adrenergic (↑ Norepinephrine) - Serotonin (5-HT, involved in regulation) Answer: GABA (↓), Serotonin (5-HT, dysregulated), Norepinephrine (↑).
41
Which brain structures are implicated in anxiety disorders?
Mnemonic: 'HAPpy or ANXIOUS?' - Hippocampus (↓ size in PTSD) - Amygdala (hyperactive in anxiety) - Prefrontal cortex (hypoactive in anxiety) Answer: Hyperactive amygdala, hypoactive prefrontal cortex, reduced hippocampus size.
42
Which type of therapy is most effective for anxiety disorders?
Mnemonic: 'Conquer Anxiety with CBT' Answer: Cognitive Behavioral Therapy (CBT), specifically Exposure Therapy.
43
What are the first-line pharmacologic treatments for anxiety disorders?
Mnemonic: 'SSRIs and SNRIs Soothe Anxious Nerves' Answer: SSRIs (sertraline, fluoxetine, escitalopram) and SNRIs (venlafaxine, duloxetine).
44
What are the DSM-5 criteria for panic disorder?
Mnemonic: 'PANICS' - Palpitations - Abdominal distress - Numbness/tingling - Intense fear of dying - Chest pain - Shortness of breath, sweating, shaking Answer: Recurrent, unexpected panic attacks + 1 month of worry or avoidance.
45
What is the pharmacologic treatment of choice for acute panic attacks?
Mnemonic: 'Fast Fix for PANIC = Pam' Answer: Benzodiazepines (e.g., alprazolam, lorazepam).
46
What is the first-line long-term treatment for panic disorder?
Mnemonic: 'Settle Stress with SSRIs' Answer: SSRIs or SNRIs, plus CBT.
47
What is the most effective behavioral therapy for panic disorder?
Mnemonic: 'Face the Fear' Answer: Interoceptive exposure therapy (exposing patients to feared sensations).
48
What are the DSM-5 diagnostic criteria for GAD?
Mnemonic: 'Worry WARTS' - Worry (excessive) - Wound-up (restlessness) - Absent-minded (difficulty concentrating) - Restless (muscle tension) - Tired (fatigue) - Sleep disturbances Answer: Excessive worry ≥6 months + 3 symptoms from WARTS.
49
What is the first-line pharmacologic treatment for GAD?
Mnemonic: 'SSRIs Settle Stress' Answer: SSRIs, SNRIs (venlafaxine, duloxetine), or buspirone.
50
What is an alternative non-sedating medication for GAD if SSRIs are not tolerated?
Mnemonic: 'Buses take time, but they’re safe' Answer: Buspirone (delayed onset but non-addictive).
51
Which class of medications is second-line for GAD but has the risk of dependence?
Mnemonic: 'PAM takes the BENZ' Answer: Benzodiazepines (e.g., clonazepam, lorazepam, alprazolam).
52
How is a specific phobia diagnosed?
Mnemonic: 'Phobia = FEAR' - Fear (irrational and excessive) - Exposure causes anxiety - Avoidance of trigger - Reaction is out of proportion Answer: Excessive fear of a specific object or situation for ≥6 months.
53
What is the best treatment for specific phobia?
Mnemonic: 'Face the Fear' Answer: Exposure therapy (systematic desensitization).
54
How does social anxiety disorder differ from specific phobia?
Mnemonic: 'Social = Scrutiny, Phobia = Specific' Answer: Social anxiety disorder involves fear of embarrassment in social settings, whereas specific phobia involves fear of specific objects or situations.
55
What medication is used for performance-only social anxiety disorder?
Mnemonic: 'Beta for Butterflies' Answer: Beta-blockers (e.g., propranolol, atenolol).
56
What are the hallmark symptoms of OCD?
Mnemonic: 'OCD = Obsessions Create Distress, Compulsions Distract' Answer: Obsessions (intrusive thoughts) and compulsions (repetitive behaviors to reduce distress).
57
What is the first-line pharmacologic treatment for OCD?
Mnemonic: 'High-dose SSRIs for High Obsessions' Answer: SSRIs (high doses: fluvoxamine, fluoxetine, sertraline) or clomipramine (TCA, second-line).
58
What is the most effective form of psychotherapy for OCD?
Mnemonic: 'Expose and Prevent the Compulsion' Answer: Exposure and Response Prevention (ERP), a type of CBT.
59
What is the most common psychiatric disorder in the United States?
Mnemonic: 'Anxiety is Always Around' Answer: Anxiety Disorders (most prevalent psychiatric disorders in the U.S.).
60
What differentiates normal fear from an anxiety disorder?
Mnemonic: '4 D’s of Disorder' - Disproportionate to actual threat - Duration is excessive - Disrupts daily life - Distress is persistent Answer: Anxiety disorders cause excessive, persistent, and impairing worry.
61
What is the most common comorbid psychiatric condition in patients with anxiety disorders?
Mnemonic: 'Anxiety DEPENDS (on depression)' Answer: Major Depressive Disorder (MDD).
62
What are the main autonomic symptoms of anxiety?
Mnemonic: 'SWEATY PANIC' - Sweating - Weakness - Elevated heart rate - Agitated feeling - Tense muscles - Yawning (from hyperventilation) - Palpitations - Abdominal distress - Numbness/tingling - Insomnia - Chest tightness
63
What neurotransmitter dysfunction is thought to contribute to panic disorder?
Mnemonic: 'NEED GABA' Answer: ↑ Norepinephrine, ↓ GABA & Serotonin.
64
What medications should be avoided in panic disorder due to their potential to worsen symptoms?
Mnemonic: 'CAFFEINE makes PANIC PEAK' Answer: Caffeine, stimulants, decongestants, marijuana.
65
How long do panic attacks typically last?
Mnemonic: 'Panic Peaks in 10, Subsides in 30' Answer: Peak within 10 minutes, resolve in ~30 minutes.
66
What behavioral change is often seen in patients with panic disorder?
Mnemonic: 'Avoidance leads to Agoraphobia' Answer: Patients may avoid places where attacks occurred, leading to agoraphobia.
67
What medications can be used as second-line treatment for GAD besides SSRIs/SNRIs?
Mnemonic: 'BeCalm' - Buspirone - Clonazepam (Benzodiazepine) - Atypical antipsychotics (Adjunct) - Low-dose tricyclic antidepressants (TCAs) - Mirtazapine (in certain cases) Answer: Buspirone, benzodiazepines (short-term), atypical antipsychotics, TCAs.
68
Which medication is effective for GAD but not useful for panic disorder?
Mnemonic: 'BUSpirone is slow, don’t PANIC' Answer: Buspirone (takes weeks to work, unlike benzodiazepines).
69
What is the first-line treatment for social anxiety disorder?
Mnemonic: 'Settle SADness with SSRIs' Answer: SSRIs or SNRIs + CBT (exposure therapy).
70
Which medication is used for public speaking anxiety (performance type of SAD)?
Mnemonic: 'Propranolol Prevents Panic' Answer: Beta-blockers (e.g., propranolol).
71
What differentiates generalized SAD from performance-only SAD?
Mnemonic: 'General = All Social, Performance = One Social' Answer: Generalized SAD → Anxiety in all social settings. Performance-only SAD → Anxiety only in performance situations.
72
What is the first-line treatment for specific phobias?
Mnemonic: 'Face it to Fix it' Answer: Exposure therapy (systematic desensitization).
73
What class of medication is generally NOT effective for specific phobias?
Mnemonic: 'Pills Don’t Fix Phobias' Answer: SSRIs/SNRIs are ineffective. Therapy is key.
74
What are the four symptom clusters of PTSD?
Mnemonic: 'IANA' - Intrusions (flashbacks, nightmares) - Avoidance (of trauma reminders) - Negative mood/thoughts - Arousal (hypervigilance, exaggerated startle) Answer: Intrusions, Avoidance, Negative Mood, Arousal.
75
Which medication is best for PTSD-related nightmares?
Mnemonic: 'Prazosin for PTSD Nightmares' Answer: Prazosin (alpha-1 blocker).
76
What is the minimum duration of symptoms required for a PTSD diagnosis?
Mnemonic: 'PTSD Persists Past 1 Month' Answer: Symptoms must last >1 month.
77
How does Acute Stress Disorder (ASD) differ from PTSD?
Mnemonic: 'ASD is Short, PTSD is Long' Answer: ASD lasts 3 days to 1 month, PTSD lasts >1 month.
78
What is the first-line pharmacological treatment for OCD?
Mnemonic: 'Serotonin Stops Obsessions' Answer: High-dose SSRIs (fluvoxamine, fluoxetine, sertraline).
79
What is the best psychotherapy for OCD?
Mnemonic: 'Expose & Prevent the Compulsion' Answer: Exposure and Response Prevention (ERP).
80
Which TCA is specifically used for OCD if SSRIs fail?
Mnemonic: 'CLOMPing down OCD' Answer: Clomipramine (TCA, second-line).
81
What distinguishes OCD from Obsessive-Compulsive Personality Disorder (OCPD)?
Mnemonic: 'OCD = Distressing, OCPD = My Way' Answer: OCD: Patient knows obsessions are irrational but is distressed by them. OCPD: Rigid personality traits, perfectionism, and control but no distress.

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