Anxiety Flashcards
Cessation of diazepam after chronic use may cause all of the following except A. Depersonalization and derealization B. Perceptual disturbances C. Anxiety D. Constipation E. Rhinorrhea
E. Rhinorrhea
Benzodiazepine withdrawal causes withdrawal symptoms that can last for many days. Apart from anxiety and delirium, it can also cause depression and seizures. Both constipation and diarrhea are recognized features of benzodiazepine withdrawal. Rhinorrhea is a feature of opiate withdrawal.
A 54-year-old man is prescribed buspirone for generalized anxiety disorder. One of the important facts the patient should know about buspirone is that it
A. Does not cause dependence
B. Acts rapidly to give symptomatic relief
C. Causes sedation
D. Can cause agitation
E. Is effective in low dosages
A. Does not cause dependence
Buspirone, an azaspirodecanedione, is a nonbenzodiazepine anxiolytic and doesn’t cause any sedation or dependence. However, it takes up to 4 to 6 weeks to work, and the dose has to be titrated up to 30 mg per day.
A 26-year-old woman presents who appears to have generalized anxiety disorder with panic attacks. Terrified by the panic attacks, she requests medication, saying: “I need something to control them immediately.” She is otherwise fit and healthy and has no history of any substance abuse or dependence. A reasonable approach would be to
A. Start the patient on intensive psychotherapy
B. Start the patient on a combination of bupropion and clonazepam
C. Start the patient on any SSRI
D. Start the patient on an SSRI and refer the patient to cognitivebehavorial therapy
E. Start the patient on a combination of an SSRI for the long term and low-dose clonazepam for a short duration
E. Start the patient on a combination of an SSRI for the long term and low-dose clonazepam for a short duration
Although SSRIs on their own may be effective in anxiety disorders, it takes a while before they can be effective, and therefore clonazepam is often used for symptomatic relief until the SSRIs become effective. Bupropion is activating and can make the anxiety worse.
A 28-year-old female patient is diagnosed with generalized anxiety disorder and substance abuse. A trial of SSRIs fails, and the physician is reluctant to prescribe any benzodiazepines for symptomatic relief in view of the patient's history of substance abuse. He prescribes buspirone. Buspirone acts as a A. 5HT2C agonist B. 5HT1A agonist C. 5HT1A antagonist D. GABA agonist E. Serotonin reuptake inhibitor
B. 5HT1A agonist
Buspirone decreases the symptoms of anxiety by 5HT1A agonistic action. However, it takes a few weeks to act and the dose might have to be titrated up to 30 mg twice a day.
Which of the following is true about specific phobias? A. More common in men B. More common in women C. Phobic avoidance uncommon D. Onset in adult life E. Treatment usually not effective
B. More common in women
Specific phobias are the most common phobias and more common in women than men. By definition, avoidance should be present for the condition to be called a phobia. Systematic desensitization, exposure, and response prevention are found to be effective treatments.
People with anxiety disorders have all of the following cardiac abnormalities EXCEPT:
A. Decreased deceleration after stress B. High beat-to-beat fluctuation C. Higher baseline heart rate D. Higher subjective awareness of heartbeats E. Increased deceleration after stress
E. Increased deceleration after stress
Patients with anxiety disorders have higher baseline heart rates than the norm. The rates continue to be higher after stress; hence, they have decreased deceleration after stress.
All of the following neurotransmitter abnormalities are detected in anxiety disorders EXCEPT:
A. Increased platelet MAO activity
B. Increased activity of central noradrenaline
C. Increased central GABA activity
D. Increased circulating adrenaline
E. Increased circulating noradrenaline
C. Increased central GABA activity
Patients with anxiety disorders have increased levels of activating neurotransmitters like adrenaline and noradrenaline and decreased GABA activity.
In patients with anxiety spectrum disorders, all of the following are observed EXCEPT:
A. Decreased skin conductance
B. Panic in response to sodium lactate infusion
C. Increased cutaneous blood flow
D. Decreased splanchnic blood flow
E. Decreased habituation following electrodermal stimulation
A. Decreased skin conductance
Patients with anxiety spectrum disorders have numerous electrodermal abnormalities, including increased skin conductance, decreased habituation, and higher spontaneous fluctuations.
All of the following statements are true about mitral valve prolapse (MVP) and panic attacks EXCEPT:
A. The incidence of MVP in the general population is 5-20%.
B. The incidence of MVP in panic-disorder patients is up to 40-50%.
C. MVP causes panic attacks.
D. No evidence suggests MVP causes panic attacks.
E. MVP and panic may represent part of primary autonomic syndrome.
C. MVP causes panic attacks.
Numerous studies have been done to see if there is any causal relationship between MVP and panic but, to date, there is no evidence to prove MVP causes or predisposes patients to have panic attacks.
A 34-year-old female patient is referred by her psychiatrist for systematic desensitization therapy because of a specific phobia. However, before she starts therapy, the patient wants to know if there are any factors that would result in a less-than-ideal response in her case. All of the following are predictors of good response EXCEPT: A. Good relaxation response B. Free-floating anxiety C. Good motivation D. No secondary gain from the phobia E. No obsessions
B. Free-floating anxiety
Presence of free-floating anxiety is a predictor of a poor response, as it does not allow the patient to relax or divert attention from the phobic stimulus.
A 24-year-old woman is diagnosed with social phobia. All of the following are effective treatments EXCEPT: A. SSRIs B. Flooding C. Modeling D. Systematic desensitization E. ECT
E. ECT
Regarding phobias, all of the following are true except
A. The phobia is associated with major depressive disorder.
B. Patients come from stable families.
C. Traits are anxiety and dependency.
D. People with phobias are no different from the general population in terms of education and social class.
E. Phobias are usually triggered by major life events.
A. The phobia is associated with major depressive disorder.
Major depressive disorder is no more common in phobia patients than in the general population. There is also an association between phobias and childhood enuresis.
All of the following have higher incidence in women than men EXCEPT: A. Needle phobia B. Social phobia C. Animal phobia D. Hospital phobia E. Claustrophobia
B. Social phobia
All anxiety-related problems are more common in women, except social phobia, where the prevalence is equal.
All of the following theories have been put forward to explain phobias EXCEPT: A. The concept of “preparedness” B. Classic conditioning C. Neurodevelopmental theory D. Operant conditioning E. Observational learning
C. Neurodevelopmental theory
Neurodevelopmental theory is often used to explain the etiology of schizophrenia.
Pathological anxiety is distinguished from a normal emotional response by all of the following characteristics EXCEPT: A. Autonomy B. Physical health status C. Intensity D. Duration E. Behavior
B. Physical health status
Pathological anxiety is autonomous; that is, it may or may not have a trigger. Intensity and duration are out of proportion to real or imagined stressors, and behavior is impaired. Physical health status is not a criterion used to distinguish normal fear from pathological anxiety.
