anxiety

Question 1

Symptoms of anxiety?

Answer 1

general: sweating, shivering, fatigue

GI: abdominal pain, N/V, constipation, diarrhea

heart: palpitations, chest pain, tachycardia, HTN

resp: hyperveNtilation, SOB

neuro: tremors, paresthesias, vertigo, light-headedness, insomnia, muscle tension

Question 2

anxiety main treatment?

Answer 2

mild: psychotherapy (CBT, psychodynamic psychotherapy)

moderate-severe: combination psychotherapy and medications

Question 3

main medications for anxiety?

Answer 3

SSRI / SNRI 1st line with benzodiazepines as anxiolytic short term tx until meds take effect

BUT in patients with current or previous hx of substance abuse, AVOID benzos and use gabapentin or antihistamies (dipenhydramine/hydroxyzine)

Question 4

pharmacotherapy for patients with depression and anxiety?

Answer 4

give SSRI and AVOID BENZOS bcz they worsen depression

Question 5

medical causes of anxiety?

Answer 5

neurologic: epilepsy, brain tumors, migraine
endocrine: hyperthyroid, pheocromocytoma, carcinoid syndrome, hypoglycemia
cardio: MI, angina
resp: PE

Question 6

role of b blockers? busripone?

Answer 6

*given for performance anxiety and panic attacks

*non-benzo anxiolytic used as short term augmentation therapy

Question 7

whats a panic attack and symptoms?

Answer 7

intense triggered or spontaneous fear that peaks within minutes and resolves within 30 min but some may be anxious for a while after

symptoms like anxiety but also depersonalization, derealization, feeling of going crazy, intense fear of death

Question 8

DSM-5 for panic disorder?

Answer 8

recurrent spontaneous panic attack associated with >1 month of continuous worry about developing another attack and maladaptive changes in behavior. NOT due to substance, medication, medical condition

Question 9

panic disorder etiology, course and prognosis

Answer 9

increased risk with first degree relative is affected (GENETIC), hx of stressors prior to onset, childhood abuse, smoking

chronic course with wax and waning of symptoms. 65% have comorbid depression. others have other anxiety disorders. screen for suicidality

Question 10

what life-threatening conditions should be ruled out in a patient presenting with new onset panic?

Answer 10

thyrotoxicosis, MI, arrythmias, hypoglycemia, electrolyte disturbance, PE