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Anxiety 3 Flashcards

1
Q

Cognitive therapy focuses on helping manage anxiety by focusing on which negative thoughts/cognitive distortions ______ (3).

A
  1. Catastrophizing
  2. Generalization
  3. Overestimating (probability of negative outcome)
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2
Q

Lifetime prevalence of general anxiety disorder

A

Lifetime Prevalence: 4-7%

–12 mo prevalence 0.9% adolescents, 2.9% adults

(female:male = 2:1)

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3
Q

Age of onset general anxiety disorder

A

Early twenties

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4
Q

General anxiety disorder: genetics

A
  • SATB1 (chromo 3)
  • ESR 1 (chromo 6)
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5
Q

Course of general anxiety disorder

A

Chronic

(severity fluctuates)

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6
Q

Complications of general anxiety disorder (3)

A
  1. MDD
  2. Substance abuse
  3. Panic disorder
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7
Q

General anxiety disorders may be comorbid with MDD and this increases the likelihood of

A

(GAD shows significant impairment at an emotional and physical level)

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8
Q

General anxiety disorder is the excessive anxiety and worry occurring more days than not for at least_____about a number of events or activities

A

six months

(they have difficulty controlling a worry)

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9
Q

General anxiety disorder criteria: anxiety and worry associated with three or more of the following symptoms (or one for children): feeling restless/”keyed up”, easily fatigued _____ (4).

A
  1. Difficulty concentrating
  2. Irritability
  3. Muscle tension
  4. Sleep disturbance
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10
Q

In general anxiety disorder the worry and anxiety or physical symptoms cause significant distress or impairment in _____(3).

A
  1. Social
  2. Occupational
  3. Other areas of functioning
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11
Q

General anxiety disorder first-line treatment

A
  1. SNRIs
  2. SSRIs
  3. CBT
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12
Q

General anxiety disorder second-line treatment (4)

A
  1. Benzos
  2. Buspirone
  3. TCAs
  4. Antihistamines
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13
Q

Prevalence of separation anxiety disorder

A

3%

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14
Q

Separation anxiety disorder may be a precursor to _____

A

Panic disorder

(maybe related to academic, athletic problems or social skills)

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15
Q

Criteria for separation anxiety: developmentally inappropriate and excessive anxiety with three or more of the following: Distress about separation from attachment figure, _______(4).

A
  1. Fear of harm to or separation event from attachment figure
  2. Refusal to go to school
  3. Fear of being alone or sleeping
  4. Nightmares about separation
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16
Q

Separation anxiety duration

A

At least 4 weeks

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17
Q

Separation anxiety disorder does NOT occur exclusively during the course of a _______(3), and is not better accounted for by Panic Disorder with Agoraphobia.

A
  1. Pervasive Developmental Disorder
  2. Schizophrenia
  3. Other psychotic disorder
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18
Q

Separation anxiety management (2)

A
  1. Identify thoughts about anxiety
  2. Parental interventions
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19
Q

What’s parental interventions can you offer for parents of separation anxiety disorder?

A
  1. Education about anxiety (effective over protection in maintaining anxiety)
  2. Parental management techniques
  3. Application of exposure hierarchies
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20
Q

Define selective mutism

A

How to speak in specific social situations where there is an expectation for speaking

(interferes with occupation and social communication)

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21
Q

Duration of selective mutism

A

At least one month

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22
Q

Failure to speak in selective mutism is not attributed to ______ (2).

A

Lack of knowledge or comfort with the language spoken

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23
Q

Prevalence and course of selective mutism

A

Rare

Begins before the age of 5

24
Q

Use of benzodiazepine is linked to ____abuse

25
\_\_\_\_\_\_\_ are the most prescribed of the psychotropics
anxiolytics (most believe these are over-prescribed)
26
Anxiolytics are typically used for ________ (duration).
short periods (rarely abused)
27
List the long-acting benzodiazepines (5)
1. Lorazepam 2. Diazepam 3. Clonazepam 4. Chlordiazepoxide 5. Chlorazapate
28
List the short-acting benzodiazepines (2)
1. Alprazolam 2. Oxazepam
29
Benzodiazepine indications
1. anxiety 2. insomnia 3. musculoskeletal disorders 4. seizure disorders 5. alcohol withdrawal 6. anesthesia induction
30
Drug-drug interactions and toxicity with benzodiazepines
* Few drug-drug interactions * Little toxicity
31
Benzodiazepine mechanism of action
Bind to benzodiazepine receptors (part of GABA receptor complex) → potentiate effects of GABA
32
Indications & duration for benzodiazepine with general anxiety
* When severe * Usually short-term (months to weeks)
33
Indication for benzodiazepine with panic disorder
Second line behind SSRIs
34
Indication for benzodiazepine with anxiety and depression
* More effective for anxiety than antidepressants * BZD withdrawn when antidepressant becomes effective
35
Indication for benzodiazepine with adjustment disorder with anxiety
Treatment of Time limited
36
Benzodiazepines are _____ (tolerability) with alcohol during alcohol withdrawal.
cross-tolerant
37
Benzodiazepines: Pharmacokinetics
* Rapid onset * Lipophilic (facilitating crossing of the BBB)
38
Benzodiazepines should be avoided in \_\_\_\_(2)
1. Pregnancy (neonatal anxiety & withdrawal) 2. Caution with elderly
39
Discontinuation of benzodiazepines involves \_\_\_\_\_\_(2).
* Slow tapering * Change to longer acting med
40
Benzodiazepine side effects: drowsiness, reduced motor coordination, \_\_\_\_\_(3)
1. Memory impairment 2. Sleepwalking 3. Disinhibition
41
Physiologic dependence of benzodiazepines is more likely with \_\_\_\_\_\_\_\_
Longer drug exposure
42
Use benzodiazepines cautiously in patients with histories of _______ (2).
1. Drug or alcohol 2. Unstable personalities ## Footnote ***_(avoid combining with alcohol or opiates)_***
43
Patients should avoid combining benzodiazepines with ______ (2).
Alcohol or opiates
44
Benzodiazepine withdrawal symptoms include insomnia, agitation, ______ (3).
1. Anxiety rebound 2. GI distress 3. Seizures
45
Buspirone is indicationed for \_\_\_\_\_\_.
Generalized anxiety disorder (ineffective for panic attacks, phobias or Obsession and compulsion)
46
Buspirone is not effective for \_\_\_\_\_(3)
1. Panic attacks 2. Phobias 3. Obsessions and compulsions (indicated for general anxiety disorder)
47
Buspirone takes ______ for effect
1-2 weeks | (no withdrawal or alcohol potentiation)
48
Buspirone mechanism of action
5HT1A receptor Agonist (Does not interact with BZD receptor)
49
Buspirone has no ______ or ____ properties. (5HT1A receptor agonist, tx for GAD)
* Anticonvulsant * Muscle relaxing
50
Panic attacks are seen in panic disorder, GAD & SAD, which one is: * Initially unexpected? * Related to worry?
* Panic Disorder * GAD
51
What causes anticipatory anxiety in Panic Disorder, GAD, SAD?
* PD: having another panic attack * GAD: different types of situations * SAD: social or performance situations
52
What are the typical cognitions present in * GAD * SAD * PD
* GAD: money, safety, future, relationships * SAD: embarrassment, negative evals * PD: worry about dying, losing control, heart attack
53
Typical sx seen in panic attack?
1. Dyspnea 2. Palpitations 3. Lightheadedness (they think they're having a heart attack)
54
Typical SAD physical sx (3)
1. blushing 2. sweating 3. trembling (how you get when you do presentations in class)
55
Typical physical sx in GAD
1. Tension 2. Insomnia 3. Restlessness
56
What situations are avoided in patients with : * GAD * SAD * PD
* GAD: reminders of worry * SAD: public speaking, social situations * PD: closed spaces, being alone (GAD & PD seek reassurance)

Behavioral Medicine (35 decks)

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