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CDM 4 Exam 2 > Anxiety > Flashcards

Anxiety Flashcards

1
Q

Locus Coeruleus

A

overactive in eliciting fear response

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2
Q

Amygdala

A

overactive in anxiety/fear response

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3
Q

Anterior cingulate cortex

A

overactive in anxiety/fear response

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4
Q

hippocampus

A

consolidation of traumatic memory and contextual fear conditioning

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5
Q

Hypothalamus

A

integrates neuroendocrine and autonomic responses to a threat

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6
Q

Sympathetic nervous system

A

increase HR, vasoconstriction, dilation of bronchioles, decrease gastrointestinal motility

fight or flight

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7
Q

parasympathetic nervous system

A

decrease HR, no vascular changes, constriction of bronchioles, increase gastrointestinal motility

Rest and Digest

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8
Q

GAD general

A

One of the most common
Very prevalent
Linked with comorbidities

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9
Q

GAD risk factors

A

Women
economically disadvantaged
stressful event
chronic physical or mental illness
low affective support in childhood
genetics

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10
Q

GAD DSM-V definition

A

Excessive anxiety and worry, occurring most days for ≥ 6 months

Presence of ≥ 3 of (in adults, children just need 1)
-feeling on edge
-easily fatigued
-mind going blank
-irritability
-tense muscles
-sleep disturbance

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11
Q

GAD onset

A

mean 21 years
10-14 years, common in older adults

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12
Q

Treatment goal for GAD

A

Remission

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13
Q

Initial GAD treatment

A

Psychotherapy (CBT, IPT)
Medications (SSRI,SNRI)

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14
Q

Panic Disorder risk factors

A

Family history
Life stressor
Childhood abuse
Smoking
Anxious traits
Behavioral inhibition

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15
Q

Panic Attack definition

A

Distinct period of intense fear or discomfort when ≥ 4 of the following symptoms develop suddenly and peak within 10 minutes

increase HR
sweating
trembling
SOB
feeling of choking
chest pain
Nausea
Dizziness
numbness
chills/hot flash

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16
Q

Panic disorder definition

A

Recurrent, unexpected panic attacks with ≥ 1 of the attacks being followed by ≥ 1 month of one of the following

Constant concern about having another attack
Anxiety about attack
Change in behavior to avoid attack

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17
Q

if panic disorder treatment is urgent and no substance abuse

A

Short-term BZD (2-4 weeks) and SSRI or venlafaxine XR for 12 weeks

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18
Q

If panic disorder treatment is not urgent

A

SSRI or venlafaxine XR or 12 weeks

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19
Q

Social Anxiety Disorder risk factors

A

female
family history
behavioral inhibition
maternal stress
early childhood trauma

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20
Q

Social anxiety disorder DSM-V

A

Marked fear or anxiety about ≥ 1 social situation where the individual is exposed to possible scrutiny by others (e.g., eating, drinking, performing, conversing)

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21
Q

Social anxiety disorder clinical presentation

A

blushing
butterflies
diarrhea
sweating
tachycardia
trembling

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22
Q

Social anxiety disorder types

A

Generalized: fear and avoidance of a wide range of social situations
Performance specific: fear limited to speaking or public performance

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23
Q

Social anxiety disorder treatment

A

SSRI or venlafaxine XR for 12 weeks

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24
Q

BB for performance-related SAD

A

MOA: antagonist at beta-1 and beta-2 adrenoceptors
Treats physical symptoms
Propranolol
Caution -cardiovascular condition

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25
Q

OCD risk factors

A

Males > females (childhood then switches in adulthood)
Family history
Stress or hormonal changes
PANDAS

26
Q

Obsessions

A

Constant and recurrent thoughts, images, or urges felt by the person to be intrusive and unwanted, and typically cause marked anxiety or distress

27
Q

Compulsions

A

Repeated behaviors (e.g., handwashing) or mental acts (e.g., counting) the patient feels driven to perform to relieve an obsession, or according to rules that must be applied rigorously

28
Q

OCD definition DSM-V

A

Obsessions and compulsions cause marked distress or are time consuming (e.g., ≥ 1 hour/day), or significantly interfere with the patient’s normal routine, occupation, usual social activity, or relationships

29
Q

good/fair insight

A

OCD beliefs are definitely or probably false

30
Q

poor insight

A

OCD beliefs are likely true

31
Q

absent insight/delusions

A

fully convinced OCD are true

32
Q

First line OCD treatment

A

CBT
SSRI
CBT + SSRI

33
Q

OCD medication choices

A

Fluoxetine
Fluvoxamine
Paroxetine
Sertraline
Citalopram
Escitalopram
Clomipramine

34
Q

SSRI vs Clomipramine

A

SSRI: Less cardiovascular, sedative, anticholinergic, weight gain, seizure risk compared to clomipramine

Clomipramine: TCA with strong 5-HT reuptake inhibition
Less insomnia, akathisia, nausea, diarrhea compared to SSRI

35
Q

PTSD pre-trauma

A

Childhood emotional problems
Low socioeconomic status
Exposure to prior trauma
Minority racial/ethnic status
Female gender (4X > male)

36
Q

PTSD PERI-TRAUMA

A

Trauma severity
Intentional trauma
Perceived life threat/injury
Witnessing atrocities/killing an enemy (military)
Dissociation

37
Q

PTSD POST-TRAUMA

A

Inappropriate coping skills
Acute stress disorder
Subsequent trauma exposure
Poor social support

38
Q

PTSD clinical manifestations

A

Reduced activity of prefrontal cortex
Intensified fear conditioning process (amygdala)
Reduced volume of hippocampus
SNS above normal –> increased epinephrine and NE –> increased arousal, selective attention, and vigilance

39
Q

PTSD definition overview

A

traumatic event, intrusive thoughts, avoidance, negative cognition.mood, hyper-arousal

40
Q

PTSD criteria A

A

Exposure to threatened or actual death, violence, or serious injury

41
Q

PTSD criteria B

A

intrusive symptoms

42
Q

PTSD criteria C

A

Ongoing avoidance of stimuli

43
Q

PTSD criteria D

A

Negative alterations in mood or cognition

44
Q

PTSD criteria E

A

Marked changes in reactivity and arousal

45
Q

PTSD initial treatment

A

SSRI for 8-12 weeks
4-6 weeks at maximum dose

46
Q

PTSD treatment augmentation

A

Prazosin –> sleep difficulties, nightmares
Lamotrigine –> anger
Risperidone, quetiapine –> intrusive thoughts/hyper-vigilance

47
Q

Non-pharm general treatment

A

CBT, IPT
relaxation training
meditation exercises/mindfulness
exposure therapy

48
Q

EMDR for PTSD

A

8-stage therapy that focuses on identifying areas of the body that display “discomfort” or “trouble spots”

Implementing constructive coping skills for future use

49
Q

Exposure and response therapy
(PTSD & OCD)

A

Makes individuals confront cues in order to address and lessen their importance

Most appropriate for patients with mild symptoms

50
Q

Deep brain stimulation OCD

A

Surgically implanted medical device to correct the “faulty wiring” of the nucleus accumbens (region of the brain that drives obsessions/compulsions)
Cost is ≈ $60,000
Response rate 50%

51
Q

Surgery for OCD

A

Radio frequency waves destroy small amount of brain tissue in corticostriatal circuit (responsible for goal-directed behavior)
Cost ≈ $3,000-5,000
Response rate 70%

52
Q

SSRI for anxiety disorders

A

symptoms may get worse before better
full response 4-12 weeks

53
Q

Medication for GAD

A

Paroxetine
Escitalopram
Sertraline*
Venlafaxine
Duloxetine

*off label

54
Q

Medication for Panic Disorder

A

Fluoxetine
Sertraline
Paroxetine
Citalopram*
Escitalopram*
Venlafaxine

*off label

55
Q

Medication for SAD

A

Sertraline
Paroxetine
Escitalopram*
Fluvoxamine*
Venlafaxine

*off label

56
Q

Medications for OCD

A

Fluoxetine
Sertraline
Paroxetine
Fluvoxamine

57
Q

Medications for PTSD

A

Sertraline
Paroxetine

58
Q

BZD in anxiety

A

Acute treatment
short term 2-3 weeks use
long term use can lead to dependence, misuse, withdrawal
NOT used in PTSD or widely used in OCD or SAD

59
Q

Pregabalin Lyrica

A

Not FDA approved but studied in GAD, SAD
helpful for BZD withdrawal
lots of CNS side effects

60
Q

Prazosin Minipress

A

MOA: Centrally-acting, selective alpha-1 receptor blocker
USE: off label for PTSD related nightmares
watch for hypotension

61
Q

Clonidine Catapres

A

MOA: Stimulates presynaptic alpha-2 receptors
USE: off label PTSD
watch for bradycardia, hypotension

CDM 4 Exam 2 (13 decks)

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