18% Anxiety disorders; Trauma- and stress-related disorders Flashcards
(SmartyPance)
treatment for adjustment disorder
psychotherapy
(SmartyPance)
reaction out of proportion to a stressor
adjustment disorder
(SmartyPance)
disproportionate RESPONSE TO A STRESSOR that would normally be expected which BEGIN WITHIN 3 MONTHS of the stressor and END WITHIN 6 MONTHS after stressor resolved
adjustment disorder
(SmartyPance)
define panic disorder
an occurrence of THREE PANIC ATTACK (sudden unexpected periods of intense fear or discomfort) episodes in THREE WEEKS
(SmartyPance)
treatment for an occurrence of 3 panic attacks in 3 weeks
SSRIs (paroxetine, sertraline, fluoxetine)
Benzodiazepines (acute attacks)
CBT (relaxation, desensitization, examining behavior consequences)
(SmartyPance)
for defining panic disorder ~
at least one of the attacks has been followed by ______
…one month (or more) of one or both of the following:
1 - persistent concern or WORRY ABOUT ADDITIONAL PANIC ATTACKS or their consequences
2 - a significant MALADAPTIVE CHANGE IN BEHAVIOR related to the attacks
(SmartyPance)
what disorder is treated with SSRIs, benzos, and CBT?
panic disorder
(SmartyPance)
define generalized anxiety disorder
EXCESSIVE ANXIETY and worry OCCURRING MORE DAYS THAN NOT for at least SIX MONTHS about a number of events or activities (such as work or school performance)
(SmartyPance)
a 35 y/o female with a complaint of worry which she cannot control for the last year. She tells you her symptoms daily consist of sleep disturbances, difficulty concentrating, and irritability. She reports her symptoms started around age 17 but have worsened.
Generalized anxiety disorder
(SmartyPance)
diagnosis for Generalized Anxiety Disorder requires three or more of the following symptoms
RESTLESSNESS or feeling keyed up or on edge
FATIGUE - being easily fatigued
CONCENTRATING - difficulty concentrating or mind going blank
IRRITABILITY
MUSCLE TENSION
SLEEP DISTURBANCE (difficulty falling or staying asleep, or restless, unsatisfying sleep)
(SmartyPance)
what two exclusions are made for diagnosing generalized anxiety disorder?
disturbance is not attributable to the physiological effects of a substance or another medical condition
disturbance is not better explained by another mental disorder
(SmartyPance)
two key features of generalized anxiety disorder
its difficult to control the worry
the anxiety causes clinically significant distress or impairment
(SmartyPance)
four mainstays of treatment for generalized anxiety disorder
1 - SSRIs (paroxetine and escitalopram); SNRIs (venlafaxine)
2 - buspirone (start at 5mg PO bid or tid, takes 2 wks to start working)
3 - benzos (short term use), beta blockers
4 - psychotherapy
(SmartyPance)
duration of a social phobia to be defined as social phobia
6 months
(SmartyPance)
first line therapy for specific phobias
exposure therapy
(RoshReview) "Which of the following patients would be most likely to present with generalized anxiety disorder?" a) 16 y/o boy b) 21 y/o woman c) 35 y/o man d) 45 y/o woman
b) 21 y/o woman
GAD typically begins in early adulthood, slightly more common in women
(RoshReview)
which of the following is a risk factor for panic disorder?
a) advanced age
b) male sex
c) neuroticism personality trait
d) obesity
C) NEUROTICISM PERSONALITY TRAIT
- panic disorder most often begins in adolescence or young adults
- panic disorder is more common in female sex
- obesity does not increase risk of panic disorder
(RoshReview)
“what psychiatric comorbidities are most commonly associated with post-traumatic stress disorder?”
depressive disorders
anxiety disorders
substance use disorders
(RoshReview)
alterations in behavior (reactivity) commonly seen with PTSD (4)
reckless or self-destructive behavior
hypervigilance
concentration difficulty
sleep disturbance
(RoshReview)
risk factors for PTSD (5)
females personal psychiatric hx childhood trauma or abuse poor social support lower SES
(RoshReview)
timeline of s/s of PTSD
w/in a few months of inciting event
(RoshReview)
preferred first line treatment of PTSD
psychotherapy
meds should be considered for pts who are unable or unwilling to undergo psychotherapy
(PPP 596)
what can be done for PTSD affects on sleep?
TRAZADONE - may be helpful for insomnia
PRAZOSIN - may be used for nightmares and hypervigilance
(PPP 596)
management of PTSD
SSRIs - first line med treatment (paroxetine, sertraline, fluoxetine)
CBT - psychotherapy including individual or group counseling, relaxation techniques
(PPP 596)
PTSD qualifying diagnostic criteria
AT LEAST 2 NEGATIVE ALTERATIONS IN COGNITION AND MOOD
AT LEAST 2 AROUSAL & REACTIVITY SYMPTOMS
(RoshReview)
what are three risk factors for panic disorder?
FH of panic disorder
NEUROTICISM PERSONALITY TRAIT
childhood physical or sexual abuse
(RoshReview)
a common finding in panic disorder is
agoraphobia
(PPP 568)
MOA of buspirone
partial 5HT-1A receptor agonist & dopamine receptor antagonist
(PPP 568)
when is buspirone prescribed?
GAD
- - does not cause sedation & does not potentiate the CNS depression of alcohol
(PPP 568)
how long does it take buspirone to take full effect?
1-2 weeks
(PPP 569)
two key pieces of diagnostic criteria for specific phobias
- persistent intense fear or anxiety of a specific situation, object or place
- at least 6 months
- everyday activities must be impaired by distress or avoidance of the situation or object
(PPP 569)
how do we manage specific phobias?
exposure
desensitization therapy
short-term benzos or beta-blockers can be used in some pts
(PPP 568)
first line management of generalized anxiety disorder
SSRIs (fluoxetine, paroxetine, escitalopram)
or
SNRIs (venalfaxine)
(PPP 568)
what is an adjunct to SSRIs for treatment of GAD?
buspirone can be adjunct to SSRIs (does not cause sedation)
