3. Anxiety and adjustment disorders

Question 1

What are some neurotransmitter imbalances seen in anxiety disorder? (3)

Answer 1

• Increased activity of Norepi
• Decreased activity of GABA
• Decreased activity of serotonin

Question 2

Panic attack criteria

Answer 2

PANICS

• palpitations
• abdominal distress
• numbness, nausea
• intense fear of death
• choking, chills, chest pain
• sweating, shaking, SOB

Question 3

What is the time-frame of panic attacks? (peak and how long it lasts)

Answer 3

• peak within 10 min

- usually lasts <25 min

Question 4

Difference b/w panic attack and panic disorder?

Answer 4

Panic disorder = spontaneous RECURRENT panic attacks w/ NO OBVIOUS precipitant

Question 5

How often do pts w/ panic disorder get panic attacks?

Answer 5

• on avg, 2x per week

but may range from several times/day to few times/yr

Question 6

What is the criteria for panic disorder? (3)

Answer 6

At least 1 of the attacks followed by minimum of 1 month of following:

• persistent concern about having additional attacks
• worry about implications of the attack (ex. “going crazy”)
• sig change in behavior related to the attacks (ex. avoidance of situations that may provoke attacks)

Question 7

What is the etiology of panic disorder?

Answer 7

Dysregulation of ANS, CNS, and cerebral blood flow

Question 8

What’s the avg age of onset for panic disorder?

Answer 8

Late teens to early 30s (avg 25 yo)

Question 9

What dose do you start SSRIs in panic disorder pts?

Answer 9

Low dose and increase slowly (b/c some SSRIs have s/es that may initially worsen anxiety)

Question 10

What tx is best for immediate treatment of panic disorder?

Answer 10

Benzodiazepines (b/c it’s effective immediately); but are best used TEMPORARILY b/c of risk of causing tolerance and dependency

Question 11

What % of agoraphobia pts have coexisting panic disorder?

Answer 11

50-75%

Question 12

Difference in prognosis of agoraphobia w/ coexisting panic disorder and agoraphobia not associated w/ panic disorder

Answer 12

• agoraphobia w/ panic disorder = when panic disorder is treated, agoraphobia usually resolves
• when not associated w/ panic disorder, usually chronic and debilitating

Question 13

What is social phobia/social anxiety disorder?

Answer 13

Fear of social situations in which embarrassment can occur

Question 14

What is a psychiatric disorder that is often associated w/ phobic pts?

Answer 14

Major depression

Question 15

Gender differences in specific phobia vs. social phobia?

Answer 15

W>M (by 2 times) for specific phobia

W=M for social phobia

Question 16

Tx for performance anxiety?

Answer 16

Beta blocker

Question 17

Systemic desensitization vs. flooding

Answer 17

Systemic desensitization = gradual exposure of a pt to the feared object/situation while teaching relaxation and breathing techniques

Flooding = directly confronting pt with their full fear

Question 18

What are other comorbid disorders with OCD?

Answer 18

Tourette syndrome and ADHD

Question 19

What neurochemical abnormality is present in OCD?

Answer 19

abnormal regulation of serotonin

Question 20

What medical conditions is OCD associated w/? (4)

Answer 20

head injury, epilepsy, basal ganglia disorders, postpartum conditions

Question 21

The onset of OCD is often triggered by?

Answer 21

stressful life event in approx 60% of pts

Question 22

What is “exposure and response prevention”?

Answer 22

Prolonged exposure to ritual-eliciting stimulus and prevention of the relieving compulsions (ex. pt must touch the dirty floor without washing his/her hands)

Question 23

What last resort tx can be used for treatment-resistant OCD?

Answer 23

ECT or cingulotomy (surgery)

Question 24

What are the diagnostic criteria for PTSD? (4)

Answer 24

1. Presence of traumatic experience
2. Persistent avoidance (ex. of a location that will remind pt of event)
3. Hyperarousal (or increased psychological and/or physiological tension) - ex. difficulty sleeping, outbursts of anger, hypervigilance, exaggerated startle response
4. Re-experiencing the traumatic event (dreams, flashbacks)
   ALL FOR MORE THAN 1 month

Question 25

Common comorbidities with PTSD? (2)

Answer 25

• substance abuse

- depression

Question 26

PTSD vs. acute stress disorder?

Answer 26

PTSD = event occurred at any time in past
- symptoms last > 1month

Acute stress disorder = event occurred less than 1 month ago
- symptoms last <1 month

Question 27

Timeline for diagnosis of GAD? (duration of symptoms)

Answer 27

> 6 months

Question 28

What are 6 symptoms of GAD? (need 3 to qualify for dx)

Answer 28

restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance

Question 29

What is the lifetime prevalence of GAD?

Answer 29

45%