First Aid CH5 Anxiety/OCD/Trauma & Stressors

Question 1

define anxiety

Answer 1

emotional and physical fear response to a perceived threat, causes significant distress or impairment in social/occupational situations

Question 2

major neurotransmitter systems implicated in anxiety

Answer 2

NE, 5HT, GABA

Question 3

tx guidelines

Answer 3

begin with psychotherapy for mild cases, combo pharm + therapy for moderate-severe cases

Question 4

late onset anxiety? what’s your suspicion

Answer 4

if there’s no personal or fam psychiatric history, consider medical condition or substance use

Question 5

what part of caffeine intake involves anxiety?

Answer 5

intoxication

Question 6

what three substances can cause anxiety throughout their use cycle?

Answer 6

ETOH, stimulants, tobacco

Question 7

first-line tx for anxiety

Answer 7

SSRIs or SNRIs, Benzos (avoid in pts w/ h/o substance abuse), Buspirone (often low efficacy, Propranolol (performance anxiety)

TCAs = second-line d/t risk profile

Question 8

define CBT

Answer 8

explores relationship between anxiety-provoking thoughts, emotions, and behaviors

Question 9

define psychodynamic psychotherapy

Answer 9

facilitates understanding and insight into dev of anxiety, helps to increase anxiety tolerance

Question 10

define panic attack

Answer 10

fear response involving abrupt surge in intense anxiety that peaks within minutes and usually resolve within 30 min
- can occur outside panic disorder

Question 11

benzo use for anxiety

Answer 11

prn or as bridge medication

Question 12

symptoms of panic attacks

Answer 12

Da PANICS
dizziness, derealization, depersonalization
palpitations, paresthesias
abd distress
numbness, nausea
intense fear of dying, losing control
chills, chest pain
sweating, shaking, SOB

Question 13

is smoking a risk for panic attacks?

Answer 13

yes

Question 14

what group is clozapine in?

Answer 14

SGAP

Question 15

define panic disorder

Answer 15

recurrent panic attacks that occur spontaneously (out of the blue), can also have clear trigger, can lead to agoraphobia

Question 16

are relapses of panic disorder common with med cessation?

Answer 16

yes

Question 17

MC co-morbidity with panic disorder

Answer 17

depression

Question 18

first-line tx for panic disorder

Answer 18

SSRI

Question 19

how long must agoraphobia sxs be present for for diagnosis?

Answer 19

at least 6 months

Question 20

tx for agoraphobia

Answer 20

therapy, SSRIs

Question 21

define phobia

Answer 21

irrational fear that leads to endurance of the anxiety and/or avoidance of the feared object or situation

Question 22

define social anxiety

Answer 22

fear of social situations d/t fear of judgment by others.. fear of possibly acting in a humiliating/embarrassing way, this fear then impairs academic or occupational efficacy

Question 23

how long must phobia-like sxs last before official diagnosis?

Answer 23

at least 6 months

Question 24

treatment for performance anxiety

Answer 24

propranolol (beta-blocker)

Question 25

selective mutism can't be due to what?

Answer 25

language difficulty or communication disorder

Question 26

how long must selective mutism sxs last prior to diagnosis?

Answer 26

greater than one month

Question 27

tx for selective mutism

Answer 27

CTB, SSRIs

Question 28

stranger anxiety vs separation anxiety

Answer 28

``` stranger = 6-9 months old separation = 1 year - 18 months old ```

Question 29

separation anxiety may manifest as what in kids?

Answer 29

somatic sxs to avoid school/work

Question 30

separation anxiety sxs must occur for how long for diagnosis?

Answer 30

at least 4 weeks in kids | at least 6 months in adults

Question 31

separation anxiety tx

Answer 31

SSRIs + CBT

Question 32

GAD Mnemonic

Answer 32

``` Worry WARTS worried wound up, worn-out absent-minded restless tense sleepless ```

Question 33

for patients with anxiety, consider suggesting eliminating what? consider suggesting adding what?

Answer 33

caffeine! | exercise (low-impact, inc HR can exacerbate anxiety)

Question 34

define general anxiety disorder

Answer 34

persistent and excessive anxiety (fear/worry out of proportion) about many aspects of daily lives, can manifest as physical sxs

Question 35

how long must someone be consistently anxious to have GAD?

Answer 35

at least 6 months

Question 36

long-term prognosis of GAD?

Answer 36

few pts fully remit, waxes and wanes, can be well-controlled

Question 37

GAD tx

Answer 37

CTB + SSRI

Question 38

What is OCD?

Answer 38

obsessions and/or compulsions that are time consuming, distressing, and impairing obsessions: intrusive, undesired thoughts that inc anxiety compulsions: the attempt to relieve anxiety, repetitive behaviors or mental rituals

Question 39

DSM5 of OCD

Answer 39

o/c's that are time consuming (>1hr per day) or cause sig distress/dysfunction

Question 40

OCD co-morbidities

Answer 40

SI (50%) and attempts (25%), other anxiety disorders (75%), mood disorders (60%), OCPD (30%), tics (30%)

Question 41

OCD tx

Answer 41

pharm (SSRI) + CBT | - second-line pharm = Clomipramine (TCA)

Question 42

define body dysmorphic disorder

Answer 42

pt preoccupied w/ body parts they perceive as flawed or defective, believe they're unattractive, imperfections are minimal but perceived as severe/grotesque - pt tries to correct w/ makeup, derm procedures, plastic surg

Question 43

what body perception disorders are in each eithers ddx?

Answer 43

body dysmorphic disorder, eating disorder, concerns w/ body fat/wt

Question 44

what population does body dysmorphic disorder persist in?

Answer 44

F, those w/ childhood abuse and neglect

Question 45

high risk of what in those w/ body dysmorphic disorder?

Answer 45

suicidal ideation and attempts

Question 46

tx for body dysmorphic disorder?

Answer 46

SSRIs + CBT

Question 47

define hoarding disorder

Answer 47

difficulty discarding possessions regardless of value leading to congestion of living spaces

Question 48

is hoarding genetic?

Answer 48

often yes

Question 49

hoarding tx

Answer 49

specialized CBT (difficult to tx overall)

Question 50

What areas are involved w/ trichotillomania? what's typically the initiating event?

Answer 50

scalp, eyebrows and lashes, facial hair, axillary hair, pubic hair stress/trauma

Question 51

tx for trichotillomania?

Answer 51

SSRIs, SGAPs, lithium, CBT

Question 52

define excoriation disorder

Answer 52

recurrent skin picking resulting in lesions

Question 53

define PTSD

Answer 53

exposure to traumatic event causes nightmares, flashbacks, avoidance of triggering stimuli, depressed mood, negative thoughts, increased arousal (fight or flight), sxs occur for at least one month

Question 54

acute stress disorder vs ptsd

Answer 54

``` ASD = less than 1 month of sxs, trauma occurred less than 1 month ago PTSD = sxs for at least 1 month, trauma occurrred at any time in past ```

Question 55

PTSD tx

Answer 55

prazosin to stop dreams

Question 56

how long can it take to recover from PTSD?

Answer 56

complete recovery within 3 months

Question 57

PTSD tx

Answer 57

SSRI or SNRI, prazosin (a-1 antagonist), CBT

Question 58

what's a high-prevalence risk in PTSD? what's a tx that should be avoided

Answer 58

substance abuse, benzos (etc)

Question 59

adjustment disorder

Answer 59

when behavioral or emotional sxs develop after a stressful life event (within 3 months) that cause distress in excess of what's expected and/or sig impairment

Question 60

how long until sxs resolve?

Answer 60

6 months