12A Anxiety disorders

Question 1

Panic Attack

Answer 1

is a fear response involving a sudden onset of intense anxiety which may be triggered or occur
spontaneously.

Panic attacks peak within minutes and usually resolve within half an hour.
Patients may continue to feel anxious for hours afterwards and believe they are experiencing a prolonged panic attack.

Question 2

in Panic Disorder patient develops

Answer 2

debilitating anticipatory anxiety about having future attacks (‘fear of the fear’).

Question 3

DSM5 panic disorder

Answer 3

Question 4

When a patient presents with an acute panic attack, must rule-out

Answer 4

potentially life-threatening medical conditions
(heart attack, thyrotoxicosis, thromboembolism, asthma).

Question 5

Panic disorder has a chronic course

Answer 5

with waxing and waning symptoms; relapses are common with
discontinuation of medication. Only a minority of patients achieve full remission of symptoms.
Up to 65% of patients also have major depression

Question 6

treatment of panic disorder

Answer 6

Combination
CBT + pharmacotherapy (SSRI, SNRI) is the most effective treatment approach.

Start SSRI or SNRI at low dose and slowly increase as side effects may initially worsen anxiety and suicidality,
especially in panic disorders.

Question 7

Agoraphobia is a

Answer 7

is an intense fear of being in public places where escape or obtaining help may be difficult.
It often develops with panic disorder.

Question 8

Agoraphobia dsm5

Answer 8

Question 9

Etiology OF AGRAPHOBIA

Answer 9

• strong genetic component (heritability about 60%);
• psychosocial component (onset frequently follows a
  traumatic event).

Question 10

ETIOLOGY OF panic disorder

Answer 10

Etiology associated with
* genetic,
* biological,
* environmental, and
* psychosocial factors

Psychosocial factors: ↑ incidence of stressors (especially loss) prior to onset of disorder; history of childhood
physical or sexual abuse

Question 11

More than 50% of patients experience a panic attack prior to developing

Answer 11

agoraphobia.

Question 12

course of agoraphobia

Answer 12

Course is persistent and chronic, with rare full remission; avoidance may become as extreme as complete
confinement to the home.

Question 13

treatment of agoraphobia

Answer 13

Treatment: similar approach as to panic disorder

Combination CBT + pharmacotherapy (SSRI, SNRI

Question 14

Specific Phobias defined as

Answer 14

phobia is defined as an irrational fear that leads to persistence of the anxiety and/or avoidance of the feared
object or situation.

Question 15

specific phobia DSM5

Answer 15

Question 16

Phobias are the most common psychiatric disorder in which gender?

Answer 16

women and

second most common in men (substance-related
disorders are first).

Question 17

treatment of specific phobias

Answer 17

behavior (exposure) therapy with 2 main approaches
* Flooding: The patient is exposed immediately to the most anxiety provoking
stimulus (ex. the top of a tall building if the fear is from heights)
*implosion: if imagination used

• Systematic
  desensitization
  The patient overcomes maladaptive anxiety by approaching
  the feared situation/object gradually and in a psychophysiologic
  state that inhibits anxiety

Question 18

Social Anxiety Disorder (Social Phobia) DSM5

Answer 18

Question 19

Generalized Anxiety Disorder (GAD) PREVELANCE

Answer 19

Lifetime prevalence 5-9%; rates are higher in women compared to men (2:1 ratio).

Question 20

Generalized Anxiety Disorder (GAD) SYMPTOMS begins at what age

Answer 20

Symptoms of worry usually begin in childhood; median age of GAD onset 30 years.

Question 21

Generalized Anxiety Disorder (GAD) dsm5

Answer 21

Question 22

course of generalized anxiety disorder

Answer 22

Course is chronic, with waxing and waning symptoms; rates of full remission are low.

GAD is highly comorbid with other anxiety and depressive disorders

Question 23

generalised anxiety disorder treatment

Answer 23

• psychotherapy (CBT) and pharmacotherapy.

SSRI (sertraline, citalopram) and SNRI (venlafaxine) are 1st-line;

can also consider a short-term course of benzodiazepines or augmentation with
* buspirone(a partial agonist at 5HT1A receptor, thereby decreasing serotonergic activity)
*non-BDZ sedative-hypnotics
*slower onset of action than BDZ (takes several weeks

Question 24

buspirone

Answer 24

(a partial agonist at 5HT1A receptor, thereby decreasing serotonergic activity)
*non-BDZ anxiolytic
*slower onset of action than BDZ (takes several weeks

Question 25

*For patients with anxiety, evaluate their —– intake

Answer 25

for caffeine use and recommend significant reduction or elimination

**Exercise can significantly reduce anxiety.

Question 26

SSRI

Answer 26

(sertraline, citalopram)

Question 27

SNRI

Answer 27

venlafaxine