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Y3R3 - Psychiatry 🧠 > L4: Anxiety Disorders > Flashcards

L4: Anxiety Disorders Flashcards

1
Q

Compare between Fear & Anxiety

A
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2
Q

physiologic manifestations of anxiety are …… to those of fear, They include:

A
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3
Q

DSM5 Classification of anxiety disorders and related conditions include …..

A
  1. Panic disorder
  2. Phobias (specific phobia, agoraphobia, and social anxiety disorder).
  3. Generalized anxiety disorder (GAD).
  4. Separation anxiety disorder.
  5. Selective mutism.
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4
Q

Epidemeology & Occurence of anxiety disorders

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5
Q

Comorbidity with anxiety disorders

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6
Q

Organic (Biological) Basis of anxiety

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7
Q

what are risk factors of anxiety disorders?

A
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8
Q

Charaters of Panic Disorders

A
  • Episodic (about twice weekly) periods of intense anxiety (panic attacks).
  • Sudden onset of symptoms, increasing in intensity over a period of approximately 10 min, and lasting about 30 min.
  • It has a strong genetic component.
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9
Q

DSM5 Criteria of Panic Disorders

A
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10
Q

Symptoms of Panic Disorders

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11
Q

Course of Panic Disorders

A
  • Panic disorder has a chronic course with waxing and waning symptoms & Relapses are common with discontinuation of medication.
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12
Q

Panic Disorders & Suicidality

A
  • Carefully screen patients with panic attacks for suicidality. They are at an increased risk for suicide attempts.
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13
Q

Up to 65% of patients with panic disorder also have major depression & Smoking is a risk factor for panic attacks

A

….

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14
Q

A classic panic disorder case involves …..

A

a woman who repeatedly visits the ER afraid she is dying when she experiences episodes of palpitations, diaphoresis, and shortness of breath. The patient has no prior medical history and the medical workup is negative.

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15
Q

Insight of Patients with Panic Disorders

A

Individuals with Panic disorders are more likely to seek assistance than individuals with other anxiety disorders.

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16
Q

Compare between Specific Phobia & Agoraphobia

A
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17
Q

DSM5 Cr of Specific phobia

A
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18
Q

Duration of Specific phobia

A

at least 6 months

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19
Q

Subtypes of Specific phobia

A
  • Animals
  • Natural environments
  • Blood injection injury type
  • Situational phobia
  • Others
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20
Q

DSM5 Cr of Agoraphobia

A
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21
Q

Duration of Agoraphobia

A

at least 6 months in duration

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22
Q

Agoraphobia & panic attacks

A

> 50% of patients experience a panic attack prior to developing agoraphobia.

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23
Q

DSM5 Cr of Social Anxiety Disorder

A
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24
Q

Duration of Social Anxiety Disorder

A

at least 6 months

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25
Q

what is a subtype of Social Anxiety Disorder?

A

Performance anxiety disorder: Characterized as when social anxiety disorder is restricted to public performances not in other types of social situation

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26
Q

Characters of GAD

A
  • Persistent anxiety symptoms including hyperarousal and worrying lasting 6 months or more.
  • Symptoms are not related to a specific person or situation (i.e., free-floating anxiety).
  • Commonly starts during the 20s.
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27
Q

Duration of GAD

A

6 months or more

28
Q

Incidence of GAD

A

Commonly starts during the 20s, More in females

29
Q

DSM5 Cr of GAD

A
30
Q

DSM Cr of separation anxiety disorder

A
31
Q

When an individual develops extreme fear or anxiety, regarding separation from a person with whom he is attached, he will have a minimum of three of the following:

A
32
Q

Characters of Selective Mutism

A
  • Distinguished by the failure to be able to speak in particular situations, accordingto (DSM5).
  • When the child is in social situations, such as the classroom, where he is expected to speak, he is unable to do so. However, he may be able to talk while at home.
33
Q

DSM Cr of Selective Mutism

A
34
Q

Duration of Selective Mutism

A

The condition must be present for a minimum of a month.

35
Q

Charactesr of OCD

A
  • Recurring, intrusive feelings®, thoughts®, and images® (obsessions) that cause
  • A common obsession is avoidance of hand contamination and a compulsive need to wash the hands after touching things.
  • Patients usually have insight (ego-dystonic: i.e., they realize that these thoughts and behaviors are irrational and want to eliminate them).
  • OCD is increased in first-degree relatives of Tourette disorder patients and both disorders also involve the caudate nucleus
36
Q

Insight in patients of OCD

A
  • Patients usually have insight (ego-dystonic: i.e., they realize that these thoughts and behaviors are irrational and want to eliminate them).
37
Q

Incidence of OCD

A

OCD is increased in first-degree relatives of Tourette disorder patients and both disorders also involve the caudate nucleus

38
Q

DSM def of obssesions

A
  • Repetitive thoughts, urges® or images® that are experienced recurrently, which individuals find them to be intrusive and have resulted in significant anxieties.
  • Efforts made by individuals to try to suppress these thoughts, urges or images with other thoughts or actions
39
Q

DSM def of Compulsions

A
  • Repetitive behaviors or even mental acts that individual feels obliged to perform as a response to the underlying obsessions.
  • These repetitive behaviors or even mental acts are being performed by individuals in order to reduce the anxiety experienced, or to prevent some dreadful event from happening.
40
Q

what are subtypes of OCD?

A
  1. with good or fair insight
  2. with poor insight
  3. with absent insight or even delusional belief
41
Q

what is Hair-pulling disorder (Trichotillomania)?

A

involves a strong need to pull out one’s own hair. It may also involve hair eating which can result in bezoars (hair balls) which can cause intestinal blockage.

42
Q

DDx of Anxiety Disorders

A
43
Q

Investigations of Anxiety Disorders

A
44
Q

TTT of Anxiety Disorders

A
  • Antianxiety agents
  • Antidepressants
  • Psychotherapy
45
Q

Antianxiety agents in TTT of Anxiety Disorders

A
46
Q

what are fast-acing anti-anxiety agents?

A

Benzodiazepines

47
Q

Characters of Benzodiazepines in TTT of anxiety

A

They are fast-acting antianxiety agents:

  1. Because they carry a high risk of dependence and addiction, they are usually used for only a limited amount of time to treat acute anxiety symptoms.
  2. Because they work quickly, benzodiazepines, particularly alprazolam (Xanax), are used for emergency department management of panic attacks.
48
Q

what is Buspirone (BuSpar)?

A

is a nonbenzodiazepine antianxiety agent.

49
Q

Characters of Buspirone (BuSpar) in TTT of Anxiety

A

is a nonbenzodiazepine antianxiety agent.

  1. Because of its low addiction potential, buspirone is useful as long-term maintenance therapy or patients with GAD.
  2. Because it takes up to 2 weeks to work, buspirone has little immediate effect on anxiety symptoms.
50
Q

B-Blocker in TTT of anxiety

A
  • They are used to control the autonomic symptoms of anxiety (e.g., tachycardia), particularly or anxiety about performing in public or taking an examination & also in panic attacks.
51
Q

Antidepressants in TTT of anxiety

A
52
Q

what is the most effective long term therapy for panic disorder or OCD?

A
  • MAOIs, TCA, and especially selective serotonin reuptake inhibitors (SSRIs) such as: paroxetine, fluoxetine (Prozac), and sertraline, are the most effective long term therapy for panic disorder & OCD
  • fluvoxamine is only indicated for OCD
53
Q

what is the TTT of Choice in GAD?

A

SSRIs (e.g., escitalopram ) and the selective serotonin and norepinephrine reuptake inhibitors (SNRIs) venlafaxine (Effexor) and duloxetine (Cymbalta) are approved to treat GAD.

54
Q

what is indicated in the management of social anxiety disorder?

A

Paroxetine, sertraline, and venlafaxine now also are indicated in the management of social anxiety disorder.

55
Q

Psychotherapy in TTT of anxiety

A
56
Q

what is the psychotherapy of choice for panic disorder & phobia?

A

CBT

57
Q

what is the treatment of choice for limiting the dysfunction resulting from obsessions and compulsions (OCD)?

A

using Exposure- Response Prevention (ERP) is the treatment of choice for limiting the dysfunction resulting from obsessions and compulsions (OCD).

58
Q

Late-onset anxiety symptoms without a prior history or family psychiatric history suggests …..

A

increase suspicion of anxiety caused by another medical condition or substance use.

59
Q

What are first-line medications in treatment of anxiety disorders?

A

Selective serotonin reuptake inhibitors (SSRIs) (e.g., sertraline) and serotonin-norepinephrine reuptake inhibitors (SNRIs) (e.g., venlafaxine)

60
Q

Should benzos be used in a patient has a comorbid depressive disorder?

A

No, they may worsen depression.

61
Q

SSRIs take ….. to work

A

4-6 weeks

62
Q

Pharmacologic goal in treating anxiety

A

Achieve symptomatic relief and continue treatment for at least 6 months before attempting to titrate off medications.

63
Q

Giudlines of using SSRI & SNRI in TTT of anxiety

A

Start SSRIs or SRIs at low doses and increase slowly because side effects may initially worsen anxiety, especially in panic disorder.

64
Q

Medications & Therapy combined TTT of anxiety

A

Medications can reduce symptoms enough so that a patient can participate in therapy. Therapy can help prevent relapse if medications are no longer prescribed.

65
Q

Separation anxiety may lead to complaints of …….. to avoid school/work.

A

Somatic symptoms

Y3R3 - Psychiatry 🧠 (19 decks)

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