2: Anxiety Diagnosis + Treatment

Question 1

Clinical presentations of GAD

Answer 1

Presence of worry and at least 3 additional symptoms:

- Restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, disturbed sleep

Question 2

Physical symptoms of GAD

Answer 2

Signs of muscle tension, somatic symptoms, exaggerated startle response, stress-associated conditions

Question 3

List 6 differential diagnoses for GAD diagnosis

Answer 3

1. Anxiety disorder d/t another medical condition
2. Substance/medication-induced anxiety disorder
3. SAD
4. OCD
5. PTSD
6. Depressive, bipolar, psychotic disorders

Question 4

List 13 differential diagnosis for SAD

Answer 4

1. Normative shyness
2. Agoraphobia
3. PD
4. GAD
5. Separation anxiety disorder
6. Specific phobias
7. Selective mutism
8. Major depressive disorder (MDD)
9. Body dysmorphic disorder
10. Delusional disorder
11. Autism spectrum disorder (ASD)
12. Personality disorder
13. Oppositional defiant disorder (ODD)

Question 5

Clinical presentations of SAD

Answer 5

• Marked by intense fear of social situations in which individual may be scrutinized by others
• May engage in extensive avoidance behaviors

Question 6

Diagnostic criteria for PD

Answer 6

• Recurrent unexpected panic attacks
• At least on of the attacks has been followed by (one month or more): persistent concern, maladaptive change in behavior r/t attacks

Question 7

Comorbidity % of Anxiety and Depression

Answer 7

70%

Question 8

List 4 differential diagnosis for PD

Answer 8

1. Other specified anxiety disorder
2. Anxiety disorder d/t another medical condition
3. Substance/medication-induced anxiety disorder
4. Other mental disorders with associated panic attacks

Question 9

Characterizations of MDD with Anxiety Distress

Answer 9

Symptoms with at least two of the following symptoms:

• Feeling tense
• Feeling unusually restless
• Difficulty concentrating (d/t worry)
• Fear of that something awful may happen
• Fear of losing control of themselves

Question 10

% of individuals that have an anxiety disorder with a combined co-morbid disorder

Answer 10

60%

Question 11

Primary mode of anxiety disorder diagnosis

Answer 11

Clinical signs, symptoms, and mental status examination observations

Question 12

The cornerstone of psychiatric disorder diagnosis (hallmarks of mental illnesses, including anxiety subtypes)

Answer 12

DSM-5

Question 13

Clinician-based questionnaire that can gauge anxiety severity

Answer 13

HAM-A

Question 14

Efforts to change thinking patterns and behavior to improve overall functioning and QOL

Answer 14

Cognitive Behavioral Therapy (CBT)

Question 15

Binds to and enhances function of GABAa receptors, thus increasing inhibition to calm signaling in key regions that mediate anxiety

Answer 15

Mechanism of Benzodiazepines

Question 16

Inhibits reuptake of leftover serotonin in the synapse resulting in an increased amount of sertonergic signaling in the brain. Primarily used as antidepressants but also approved to treat anxiety disorders

Answer 16

SSRI’s

Question 17

Potent anxiolytics that work quickly; used more frequently for acute anxiety symptom management. Available in short- and intermediate/longer-acting formulations

Answer 17

Benzodiazepines

Question 18

Describes the absorption, distribution, metabolism, and drug excretion

Answer 18

Pharmacokinetic (PK) properties

Question 19

Maximum concentration a drug reaches following dosing

Answer 19

Cmax

Question 20

Amount of time required for a drug to reach maximum concentration in the boxy

Answer 20

Tmax

Question 21

Amount of time required to metabolize 50% of drug concentration (valuable measure of drug elimination)

Answer 21

Half-life

Question 22

Intended for long-term use in treating chronic anxiety

Answer 22

SSRI’s

Question 23

A biological process of adding an O2 molecule to a substrate to modify the structure to allow for degradation

Answer 23

Oxidation

Question 24

When a molecule attaches to drug to inactivate drug for easy excretion

Answer 24

Conjugation

Question 25

Drugs metabolized by glucuronidation do not require additional chemical modification for excretion, resulting in shorter half-lives than other drugs that require additional metabolic steps

Answer 25

Conjugation with Glucuronide

Question 26

6 enzymes most drugs are metabolized by:

Answer 26

CYP1A2
CYP2C9
CYP2C19
CYP2D6
CYP3A4
CYP3A5

Question 27

Somnolence, dizziness, drowsiness, lack of concentration/coordination, risk dependencies

Answer 27

Most frequent Adverse Events (AEs)

Question 28

Substance examples include heroin, gamma hydroxybutyric acid (GHB), marijuana, methaqualone

Answer 28

Schedule 1

Question 29

Substance examples include morphine, methadone, and fentanyl

Answer 29

Schedule II

Question 30

Substance examples include anabolic steroids, codeine products with aspirin/acetaminophen, some barbiturates

Answer 30

Schedule III

Question 31

Substance examples include alprazolam and diazepam

Answer 31

Schedule IV

Question 32

Substance examples include cough medicines with codeine

Answer 32

Schedule V

Question 33

Blocks CYP450 activity, which may increase bioavailability of some concomitant drugs

Answer 33

CYP450 Inhibitors

Question 34

The metabolic pathway that breaks down lorazepam following dosing

Answer 34

Direct glucuronidation

Question 35

A reflex response in which a sudden withdrawal of a stimulus is followed by increased activity

Answer 35

Rebound