Anxiety

Question 0

• starting new job
• “worry-wart” from outside peers
• – losing friends, appearance, family
• constant muscle tension
• irritable
• not sleeping well: affecting work and friends comment
• OCD about work
• aware about her “worrying”

Answer 0

Generalized anxiety disorder (GAD)

Question 1

• worries about family, finances, house
• interferes w/ enjoying life
• feels restlessness
• muscle tension
• cannot take on more jobs because he is too worried
• afraid of failure
• cannot sleep well: sleeping pills
• panic attack
• incident triggered

Answer 1

Generalized anxiety disorder (GAD)

Question 2

Normal worry vs uncontrollable worry?

Answer 2

pt feels:

• people tell me I worry too much
• worrying when everything is ok
• keep myself busy and distracted
• hard to STOP worrying

Question 3

Anxiety disorder?

Answer 3

prominent
persistent
disruptive in daily life
more common than depression

Question 4

Types of anxiety disorder?

Answer 4

panic disorder
agoraphobia
social anxiety disorder/social phobia
generalized anxiety
specific phobia

Question 5

Triad of anxiety disorder?

Answer 5

emotional (fear, nervousness)-what you feel
physical (muscular tension, tachycardia, dizziness, insomnia)
cognitive (worry, sense of doom, derealization)-what you think about

Question 6

Anxiety-etiology?

Answer 6

biologic - GABA receptors, neurotransmitters, adrenergic system
psychological stressors
maladaptive cognitions - overestimate danger, underestimate coping
environmentally conditioned: ie) driving + stress + fear = fear of driving

Question 7

driving + stress + fear?

Answer 7

environmentally condition anxiety

Question 8

Anxiety - RF?

Answer 8

female
younger age
single/divorced
low socioeconomic
poor social support
low education
white
stressful life event
childhood maltreatment
modeling
genetics

Question 9

Anxiety- comorbidities?

Answer 9

other anxiety disorders
personality disorders
substance use
physical disorders (CV, respiratory, arthritis, migraines)

Question 10

Generalized Anxiety Disorder GAD?

Answer 10

has ALL triad
involves multiple domains of worry (school, work, relationship, travel, health)
AT LEAST 6mo
20-30yo

Question 11

GAD tx?

Answer 11

SSRI
SNRI
Benzo for ACUTE management - orally (Diazapam 5-10mg) NOT IV

Question 12

• severe palpitations, shakes when meeting people/presentation
• anxious w/ people
• he is aware
• avoiding travel
• otherwise, everything else is unremarkable
• worrying about job
• worrying about how people view him

Answer 12

social anxiety disorder

Question 13

Social anxiety disorder?

Answer 13

fear of social and performance situations –> avoids the situations
fear of doing or saying something to result in embarrassment or humiliation

Question 14

Social anxiety disorder - PE?

Answer 14

blush
profuse sweating
trembling
nausea
difficulty talking

Question 15

Social anxiety disorder - hx?

Answer 15

situations are avoided or endured

present in adolescence or before

Question 16

Social anxiety disorder - duration?

Answer 16

continuous and lifelong

Question 17

shyness vs social anxiety disorder?

Answer 17

**

Question 18

Social anxiety disorder - tx?

Answer 18

short acting benzodiaezpines (alprazolam - 0.25-.5mg)
Cognitive behavioral therapy
SSRI/SNRI (sertraline, paroxetine, venlafaxine)
Beta blocker (usually used just before)

Question 19

• extreme heart palpitation; cannot find trigger

- nausea, sweating, tingling in arm, hot flashes

Answer 19

Panic disorder

Question 20

Panic disorder?

Answer 20

foundation is panic attack
recurrent, uncued panic attacks:
-worry about future attacks
-avoidance or behavior changes to avoid attacks
-pervasive phobic avoidance (agoraphobia): trying to prevent panic attacks by avoiding situations

Question 21

Panic attack?

Answer 21

has a beginning and end
has abrupt cognitive and somatic sx
INTENSE FEAR
less than 30 min

Question 22

Panic disorder - cognitive sx in panic attack?

Answer 22

racing thoughts
preoccupation w/health
catastrophic misinterpretation of somatic sx
believing one is going insane

Question 23

Panic disorder - sx?

Answer 23

very much like a "heart attack" 
somatic sx
-choking sensation
-jelly legs
-feeling detached or unreal
-chest pain

Question 24

What makes panic disorder worse?

Answer 24

MVP
meniere’s
migraines
sleep apnea

Question 25

Avoiding driving on bridges b/c of previous panic attacks?

Answer 25

agoraphobia

Question 26

Higher risk for suicide?

Answer 26

• panic disorder and depression

- panic disorder and anxiety/depression

Question 27

Agoraphobia-dx?

Answer 27

anxiety about 2 or more:

• using public transportation
• being in open spaces
• being in enclosed spaces
• standing in line/crowds
• being outside of home alone

Question 28

Panic disorder - tx?

Answer 28

low dose SSRI and titrate (paroxetine 10mg) - NO TCA
MAOI
SSRI (4-6wks for clinical effect; 12-16wks for optimal relief)
cognitive behavioral therapy
adjunct benzo or other anti-anxiety

Question 29

Specific phobias-dx?

Answer 29

least disabling
episodic, marked fear or anxiety about a specific object or situation
-predictable-always or nearly always provoked
-actively avoided or endured: with significant fear or anxiety
-fear/anxiety out of proportion to actual danger
-persistent over 6mo or more

Question 30

Specific phobias - sx?

Answer 30

heart racing
tremors
SOB
vasovagal (ie blood injection injury)

Question 32

Specific phobia - tx?

Answer 32

cognitive behavioral therapy
pharmacology not established
short acting benzo prior to exposure if no performance requirements

Question 33

Illness anxiety disorder?

Answer 33

pt complains: no one has worked up thoroughly and is not worried about POSSIBILITY not illness
absence of significant sx
unlikely alleviated by neg testing and ressurance

Question 34

Illness anxiety disorder-timeline?

Answer 34

at least 6 mo

Question 35

Illness anxiety disorder - tx?

Answer 35

early referral to psych- NOT substitute for medical care
+/- SSRI
schedule PE so pt feels that she is being taken seriously
AVOID invasive tests