Sept 3 - Anxiety and Depression

Question 1

Describe the ABC model of anxiety.

Answer 1

A: Alarm - What triggers the anxiety for the patient
B: Beliefs - What background does the patient have about the trigger of the anxiety
C: Coping - can be positive or negative mechanisms

Question 2

List 5 common chief complaints related to anxiety.

Answer 2

racing thoughts, can’t focus, headache, chest pain, palpitations

Question 3

What is critical to understand to identify the cause of a person’s anxiety?

Answer 3

identify cause and effect - ex, did anxiety cause lack of sleep or vice versa?

Question 4

What is required for symptoms to lead to a diagnosis of anxiety disorder?

Answer 4

Are symptoms impacting their daily life and functioning?

Question 5

List 5 physical exam findings that may be consistent with anxiety disorder.

Answer 5

lack of eye contact, fidgeting, nail biting, pacing, sweaty hands

Question 6

What labs/diagnostic tests are important when a diagnosis of anxiety is considered?

Answer 6

thyroid panel, ECG

Question 7

What is required for a diagnosis of separation anxiety disorder?

Answer 7

• Separation from what brings comfort, distress/fear, somatic symptoms (N/V, diarrhea, sweating, etc.)
• Present for 4 weeks in children and 6+ months for adults

Question 8

What is required for a diagnosis of selective mutism?

Answer 8

Lack of speech at expected times with language skills usually intact. Also inc social anxiety

Question 9

What is required for a diagnosis of phobias?

Answer 9

• Disproportionate fear/anxiety the vast majority of times exposed to a specific trigger with active avoidance
• Must be present for 6 months or more

Question 10

What is required for a diagnosis of social anxiety disorder?

Answer 10

Fear and anxiety related to scrutiny of others lasting for 6+ months - prevalence increases with age.

Question 11

What is required for a diagnosis of panic disorder?

Answer 11

Recurrent, unexpected panic attacks. Prevalence peaks in adulthood and is less likely < 14 y/o

Question 12

What is required for a diagnosis of generalized anxiety disorder?

Answer 12

restlessness, easy fatigue, difficulty concentrating, irritability, sleep difficulty lasting 6+ months - prevalence peaks in mid life then declines

Question 13

What substance is known (anecdotally) to trigger anxiety disorder?

Answer 13

Wellbutrin

Question 14

T/F: Phobias are more common in men than women.

Answer 14

F: more common in women

Question 15

T/F: Social anxiety disorder is more common in men.

Answer 15

F: more common in women

Question 16

T/F: Social anxiety disorder is more common in men.

Answer 16

F: more common in women

Question 17

T/F: Panic attacks may last for hours.

Answer 17

F: typically short duration, but may recur often

Question 18

List 5 signs or symptoms of a panic attack.

Answer 18

palpitations, tachycardia, sweating, dyspnea, paresthesia

Question 19

T/F: Generalized anxiety disorder is more common in females.

Answer 19

T: females twice as likely as males

Question 20

What medical conditions can induce anxiety disorder? List four specified in the DSM-5.

Answer 20

Pheochromocytoma, DM, epilepsy, hyperthyroid, carcinoid, ETOH withdrawal, arrhythmias
DSM-5 specifies: asthma, HTN, ulcers, arthritis

Question 21

List medications that may be used to manage anxiety disorder.

Answer 21

• SSRIs: sertraline/zoloft, paroxetine/paxil
• SNRIs: venlafaxine/effexor, duloxetine/cymbalta, desvenlafaxine/pristiq
• pregabalin/lyrica
• TCAs: elavil
• buspirone
• benzodiazepines

Question 22

List 4 types of psychotherapy that may be used to manage anxiety disorder.

Answer 22

supportive therapy
exposure therapy
response prevention
cognitive behavioral therapy (CBT)

Question 23

List three physical exam findings consistent with depression.

Answer 23

appears distracted, poor affect, poor hygiene (more severe)

Question 24

List two important labs to order when depression is suspected.

Answer 24

Thyroid panel (hypo) and B12 (deficiency)

Question 25

What is required for a diagnosis of disruptive mood dysregulation disorder?

Answer 25

- Chronic severe irritability - Present for 1+ year and in 1+ setting - Verbal outbursts with irritability/anger in between - Symptom onset must be before 10 years of age and Dx must be made between ages 6 and 18

Question 26

What is required for a diagnosis of major depressive disorder?

Answer 26

Depressed mood most of day for 2+ weeks and 4 of: - Change in weight or appetite - Change in sleep - Change in psychomotor activity - Decreased energy - Felling worthless, guilt - Difficulty thinking or concentrating - Recurrent thoughts of death/suicide

Question 27

What is the prevalence of major depressive disorder in the US?

Answer 27

7% --> 18-29 y/o much more common, females > males

Question 28

When is suicide risk a concern in major depressive disorder?

Answer 28

always

Question 29

What is required for a diagnosis of dysthymia?

Answer 29

Depressed mood most of day for 2+ years and no asymptomatic period > 2 months plus 2 of: - Change in appetite - Sleep disturbances - Low energy - Low self-esteem - Poor concentration - Feeling of hopelessness

Question 30

What is required for a diagnosis of premenstrual dysphoric disorder?

Answer 30

Irritability, dysphoria, anxiety that repeatedly occurs around pre-menstrual cycle and resolves after Prevalence: 1.8% - 5.8% of menstruating women

Question 31

List medications that may be used to manage depression.

Answer 31

SSRIs: sertraline/zoloft, paroxetine/paxil escitalopram/lexapro, fluoxetine/prozac SNRIs: venlafaxine/effexor, duloxetine/cymbalta, desvenlafaxine/pristiq NDRIs: wellbutrin (Norepi DA Reuptake Inhibitors) TCAs Tetracyclic Antidepressants: mirtazapine/remeron 2nd Gen Antipsychotics: aripiprazole/abilify, quetiapine/seroquel MAOIs: phenelzine/nardil

Question 32

List three types of psychotherapy that may be used to manage depression.

Answer 32

CBT Interpersonal therapy, Psychodynamic therapy - addressing childhood issues that impact adult functioning