Anxiety

Question 1

What are the DSM-V criteria for sedative, hypnotic and anxiolytic withdrawal syndrome?

Answer 1

1. Cessation/reduction of prolonged sedative, hypnotic or anxiolytic use
2. At least 2 of following within several hrs-few days after:
   a. Autonomic hyperactivity (sweating, HR>100)
   b. Hand tremor
   c. Insomnia
   d. N/V
   e. Hallucinations (visual, tactile, auditory)
   f. Psychomotor agitation
   g. Anxiety
   h. Grand mal seizures
3. Sx in #2 cause clinically significant distress or impairment in social/occupational/other function
4. Not better explained by another medical condition or mental disorder (intoxication or withdrawal from another substance)

Question 2

What are DSM-V Criteria for Sedative, Hypnotic and Anxiolytic Use Disorder?

Answer 2

Must have at least TWO of following criteria:
CAR WIG TRIP
1. Craving
2. Activities can’t do (work, school, home)
3. Recurrent use despite negative personal consequences
4. Withdrawal symptoms/use of drug to avoid withdrawal
5. Increased quantity/time of use
6. Great deal of time spent getting or recovering
7. Tolerance
8. Recurrent use despite physically hazardous situations
9. Inability/desire to cut down
10. Persistent use despite social/interpersonal problems

Question 3

What are 8 risk factors for late life anxiety?

Answer 3

1. Female
2. Early onset anxiety disorder
3. Medical illness
4. Medications
5. Poor self rated health
6. Other psych illness
7. Lack of social supports
8. Recent traumatic event

Question 4

What are pharm and non pharm tx for anxiety?

Answer 4

Pharm
1. SSRI - sertraline, citalopram
2. SNRI - duloxetine, venlafaxine

Non Pharm
1. CBT

Question 5

Ddx for anxiety

Answer 5

1. Cognitive impairment (dementia, delirium)
2. Medications/drugs
   - Steroids, beta agonists, Synthroid, levodopa
   - Amphetamines, caffeine, alcohol withdrawal
3. Medical disorders (cardiac, hypoxia, hyperTSH, hyperglycemias, hyperCa)

Question 6

What is the DSM-V criteria for GAD?

Answer 6

1. Excessive anxiety and worry, more days than not for at least 6 months, about multiple things
2. Difficult to control the worry
3. Three of six symptoms:
   a. Blank mind/poor concentration
   b. Energy low
   c. Sleep poor
   d. Keyed up/restless/on edge
   e. Irritability
   f. Muscle tension
4. Sx cause distress, impair function
5. Not due to effects of substance, another medical condition or mental disorder

Question 7

What medical conditions may increase the risk of anxiety?

Answer 7

1. Hearing impairment
2. Poor sleep
3. HTN
4. Respiratory disease

Question 8

How do older adults present differently with anxiety?

Answer 8

Avoidance/excess anxiety may be difficult to detect
May attribute sx to physical illness
May have difficulty remembering sx - get collateral
Functional impairment harder to assess

Question 9

What non pharmacologic therapies have evidence for treatment for anxiety?

Answer 9

1. CBT
2. Supportive therapy
3. Relaxation training
4. Cognitive therapy

Question 10

What are some scales used for anxiety in older adults?

Answer 10

1. Geriatric anxiety inventory
2. Penn State Worry Questionnaire
3. Rating Anxiety in Dementia

Question 11

What are some limitations for CBT in older adults and how can you adapt?

Answer 11

1. Hard to find widespread acces
2. Longer time to effect
3. Slow pace
4. Repetition
5. Less abstract techniques
6. Greater focus on behaviour change
7. Greater engagement with family