Anxiety 3

Question 1

What is the average age of onset of GAD?

What is the average age of onset for Social anxiety disorder?

Agoraphobia?

Panic Disorder?

Answer 1

GAD = 30 years old.

Social anxiety disorder = 13 years old/middle school.

Agoraphobia = two peaks, late adolescence and then after 40.

Panic Disorder= Early 20s

(So the order goes SAD (13) , Agoraphobia (18), Panic(20s), GAD(30), then Agoraphobia(>40))

Question 2

What medication class is very effective for social anxiety disorder but reserved as last line?

Answer 2

MOIs.

Question 3

If social anxiety disorder is restricted to speaking or performing in public only…what would you call this?

Answer 3

Specifier Social anxiety disorder “Performance only”

Question 4

In Social Anxiety Disorder, what are the gender specific comorbidities?

Answer 4

MEN:
- Conduct Disorder, ODD, and Paruresis (can’t pee in public)

Women:
- MDD, BPAD

Question 5

What is the time frame criteria for Specific Phobia

Answer 5

> 6 months

Question 6

PANDAS is due to what infection?

Answer 6

Group A Strep.

Question 7

What is Khyal cap?

Answer 7

Culturally bound anxiety syndrome of Cambodians with panic like symptoms and catastrophic cognitions due to “Khyal” rising in body.

Question 8

What is the time criteria for separation anxiety disorder?

Answer 8

4 weeks in children/adolescents

6 weeks in adults.

Question 9

What is the diagnostic criteria for selective mutism?

Answer 9

1. Consistent mutism in SPECIFIC situations causing impairment. IE speaks to family but not in school.
2. Occurs >1 month

Question 10

What is the mainstay treatment for Separation Anxiety?

Answer 10

Don’t homeschool
CBT (cognitive distortion and exposure)
SSRI/SNRI

Tests to consider:

• Audiometry
• Peabody Picture vocabulary test (point to pictures when asked with a cue, verbal response is not necessary).

Question 11

What is the treatment approach for selective mutism?

Answer 11

1. Operant conditioning:
   - Stop negative reinforcement for remaining mute (teacher not placing focus on child for being mute which reinforces child’s desire to be left alone)
   - Increase positive reinforcement (for talking)
2. Modeling
   - Show child videos that model social behaviors
3. Response initiation
   - Child spends time with therapist and is not allowed to leave until speaks.
4. Adjunctive SSRI (if needed)