2/17: Mood and Anxiety disorders

Question 1

anxiety

Answer 1

fear + stress + psych/physio sx

Question 2

mood

Answer 2

a persistent subjective state

expressed in thought, emotion, behavior, and bodily fx

Question 3

anxiety disorders

Answer 3

painful/apprehensive uneasiness/fear for anticipated threat accompanied by physiologic signs

Question 4

major anxiety disorders

Answer 4

panic disorder, social anxiety disorder (social phobia), agoraphobia, generalized anxiety disorder, substance-induced anxiety disorders, anxiety disorder due to another medical condition

Question 5

panic disorder + definition

Answer 5

recurrent unexpected panic attacks (sudden onset of inc SNS/fear findings), +/- agoraphobia (fear of crowded places in 2+ places) bc cannot escape during another panic attack

Question 6

panic disorder + onset

Answer 6

recurrent panic attacks occurring >1 m, reach a peak w/in 10 min

Question 7

panic disorder + epid

Answer 7

women < 30 y/o, inc risk with +FMHx, monozygotic twins, inc comorbidity w/depression + substance abuse

Question 8

social phobia/anxiety disorder

Answer 8

fear of humiliating performance and exposure to unfamiliar ppl; recognized as excess/unreasonable

• important contrib of dev experiences
• DDx: looks similar to schizoid

Question 9

simple phobia

Answer 9

tx only if interfere w/important activities (e.g. claustrophobia in MRI, vasovagal (fainting) episodes w/needles)

Question 10

social phobia tx

Answer 10

Rehearsal (improve competence, Toastmasters), beta-blockers (to reduce stress)

Question 11

simple phobia tx

Answer 11

short-term tx with short-acting benzos for symptomatic reliefs (fear of flying, claustro in MRI)

repeated gradual exposure (systematic desensitization) to feared stimulus for lasting relief

Question 12

agoraphobia tx

Answer 12

gradual exposure (systemic desensitization) + SSRIs

Question 13

Generalized anxiety disorder

Answer 13

inc anxiety or worry about many events + on most days for 6 months, CC somatic sx

Question 14

Generalized anxiety disorder + diagnostic criteria

Answer 14

3 of the following that produce fx impairment:

-restlessness, irritable, easy fatigue, inc muscle tension, difficulty concentrating, sleep ∆

Question 15

OCD

Answer 15

inc obsessions or compulsions recognized as excessive/unreasonable and produce functional impairment

Question 16

substance/med-induced anxiety disorders

Answer 16

pain attacks predominate, 2˚ to med condition

e.g. cocaine, amphetamines, ADHD, caffeine, alcohol, cough syrup

Question 17

anxiety 2˚ to which general med conditions?

Answer 17

endo (pheochromocytoma, hyperthyroidism, hypoglycemia), metabolic prob, neuro prob (e.g. vestibular dysfx)

Question 18

mood disorders

Answer 18

unusually intense and persistent mood that occurs out of context and compromised self-care, adaptive fx, and the ability to effectively relate to other ppl

Question 19

Major depressive disorder sx

Answer 19

Sig-e-caps
Sleep disturbance, Interest/pleasure reduction, Guilt or thoughts of worthlessness, Energy ∆/fatigue, Concentration/attention impairment, Appetite/weight ∆, Psychmotor disturbances, Suicidal thoughts

+ depressed mood
p.373

Question 20

persistent depressive disorder (aka dysthymia)

Answer 20

low grade chronic “sub threshold” depression (sig-e-caps), persistent and long duration at least 2 yrs (≠intermittent); sx-free period cannot be >2 m.

Question 21

premenstrual dysphoric disorder

Answer 21

week before onset of menses, feelings of: irritability, anger, food cravings, sleep probs, feeling overwhelmed
sx must have lasted for the better part of a yr, and must be doc PROSPECTIVELY for at least 2 menstrual cycles
sx disappear shortly after onset of menses

Question 22

cyclothymic disorder

Answer 22

rapidly alternating mood states, occurring >2 yrs, looks like borderline,

note that chaotic life/self-injurious/history of abuse more prominent in borderline

Question 23

bipolar 1 disorder

Answer 23

classic maniac depression: pt loses contact w/reality, severely impaired judgment
manic sx can be caused by Rx and med condtns (stimulants, hyperthyroid, CNS dz, Cushings) and must be ruled out, requires at least 1 episode of mania

Question 24

bipolar 2 disorder

Answer 24

distinct period of abn and persistently irritable mood/inc activity or energy, lasting at least 4 consec days, hx of major depression lasted at least 2 wks
do not seek help bc have cycles of “up” episodes

Question 25

developmental experiences contributing to social phobia/avoidant personality disorder

Answer 25

familial modeling, being bullied, humiliation as a form of discipline, disfiguring lesions (visible burns or deformities)

Question 26

cyclothymic DO + time

Answer 26

lasts >2 y

Question 27

bipolar 1 DO + time

Answer 27

distinct period of abnormally and persistently elevated mood laying at least 1 week