13. Psychiatry

Question 1

Nam widely used anxiety screening tools (2)

Answer 1

• SCARED
• Social Phobia Inventory

Question 2

Describe work-up : Anxiety

Answer 2

• CBC, FBG, Lipids, Lytes, Bili, Cr, urinalysis, TSH, Vit B12
• Drug screen (if warranted)
• ECG (if > 40)

Question 3

Describe : General Anxiety Disorder

Answer 3

Uncontrollable and excessive worry occurring more days than not for at least 6 months, about a number of everyday, ordinary experiences or activities. Difficult to control anxiety.

3 of 6 SICK FM + difficulty controlling worry >6months, affects function
* Sleep disturbance
* Irritable / Hyperarousal
* Concentration poor or mind goes blank
* Keyed up or restless or on edge
* Fatiqued easily
* Muscle Tension

Question 4

Describe : Panic attacks

Answer 4

STUDENTS Fear the 3Cs, peaks in minutes

Question 5

Name panic attcack sx ()

Answer 5

4 out of 13 STUDENTS Fear the 3Cs
* Sweating
* Trembling
* Unsteadiness, diziness
* Derealization
* Excess HR, palpitations
* Nausea
* Tingling
* Sob
_
* Fear of death/going crazy
* Choking
* Chills
* Chest pain +/- agoraphobia

Question 6

Describe : Agoraphobia

Answer 6

anxiety aboul being in a situation where escape is
(e.g., escape, need for reassurance)
difficult or embarrassing, situation avoided or endured with distress or

Question 7

Describe : Panic disordor (1)

Answer 7

Recurrent unexpected panic attacks without any
obvious siluational trigger, concern about them or mal adaptation >1 month

Question 8

Name sx : Separation Anxiety ()

Answer 8

3 of 8 HUG PANDaS:

• Harm or loss of an attachment figure is a persistent fear
• Untoward event that causes separation is a persistent fear (e.g. fear of being kidnapped
• Going out of home is persistently refuse
• Physical symptoms complaints (i.e., H/A) when separated
• Alone is a big fear
• Nightmares involving the theme of separatio
• Distress when anticipating or experiencing separation
• Sleeping - refuse to sleep away from home / attachment figure

Question 9

Name criteas : Social Anxiety Disorder

Answer 9

All criteria needed - PERSONNSS
* Persistent fear of social setting (work, school, activities)
* Exposure produces anxiety
* Reaction / anxiety out of proportion to actual danger
* Social situation is avoided or endured with distress
* Occupational / social dysfunction
* Negative evaluation is a significant fear
* Not <6months duration
* Substance abuse not the cause
* Specific medical condition / other psych disorder not the cause

Question 10

Name therapy : Social Anxiety Disorder (1)

Answer 10

CBT * similar efficacy as medication

Question 11

Name criteria : Specific Phobia

Answer 11

All criteria needed - FEARED
* Fear persistent/excessive, cued by specific object / situation
* Exposure causes anxiety
* Avoids situation or endure w/ anxiety
* Reaction / anxiety out of proportion to actual danger
* Experience social stress and dysfunction
* Duration >6 months

Question 12

Describe therapy : Specific Phobia (3)

Answer 12

• exposure based (vivo + virtual)
• sessions grouped closely together
• exposure is prolonged / real and in multiples settings

Question 13

Describe medication : Specific Phobia (2)

Answer 13

• benzodiazepines if pt has to face fear (ex. Claustrophobia + MRI)
• minimal evidence for paroxetine, escitalopram

Question 14

Name anxiety medication that can be used during pregnancy (2)

Answer 14

SSRI or SNRI

Question 15

Name anxiety medication that can be used during breasteeding (2)

Answer 15

paroxetine or sertraline

Question 16

Describe management anxiety : Children and Youth

Answer 16

Psychoeducation with helping children dace fear / modeling coping strategies. Address school / social stressors
* Reinforce positive family routine (shared meals, regular sleep,
* limit screen / caffeine)
* Positive parenting (1) recognize / acknowledge / name feelings (2) avoid avoidance (3) empathize and validate anxiety (4) connect and maintain secure attachment (5) foster confidence (6) encourage opinion / choice / independence (7) break task into manageable pieces (8) reward attempts (9) model coping (10) be involved in school (11) model positive handling of conflict

Psychotherapy / CBT

Mod to severe symptoms: combine CBT w/ pharmacotherapy (off-label used of SSRI), citalopram, escitalopram, fluoxetine, fluvoxamine. sertraline. SNRIs, avoid paroxetine because of short half life