ANXIETY

Question 1

If someone comes to the ER with a panic attack, what must we do?

Answer 1

we MUST work it up!!

Question 2

What type of drug is not found on a drug tox screen?

Answer 2

Bath salts

Question 3

If a patient has anxiety due to a medical condition, how do you document it?

Answer 3

Anxiety disorder due to [hypothyroidism]

Question 4

10-yr-old boy with previous interpersonal issues refuses to attend a 2-week summer camp away from home with his peers, but he is forced by his parents to go; it is the first time he has been away from home. After the first day, a staff member calls and tells the parents that the child stayed in his bunk all day complaining of stomach cramps and dizziness. What do you do? What diagnosis?

Answer 4

Rule out medical issues. Ask them to stay a few more days.

Separation Anxiety Disorder

Behavioral therapy

Question 5

If a child begins attending a new school, her teaching informs her parents that she never raises her hand to answer questions in class and refuses to speak to anyone, even if she is called on. The girl interacts normally with others at home, but she often wakes in the middle of the night crying. What diagnosis?

Answer 5

Selective mutism – fear of speaking

Must be present for 1 month

Question 6

If a person has a phobia of something very specific (animals, small spaces, blood, water, storms, heights), what diagnosis?

Answer 6

Specific phobia

Question 7

How can you treat specific phobia?

Answer 7

Flooding & systemic desensitization (pair the spider with something relaxing)

Question 8

If a person has a problem with performing public speaking, eating or writing in public, urinating in public bathrooms, and attending social events – what diagnosis?

Answer 8

Social anxiety disorder

Question 9

How do you treat social anxiety disorder?

Answer 9

Cognitive behavioral therapy (assertive training) – remember the person might not be able to leave their house due to fear!

Pharm = SSRI, SNRI’s (take several weeks) benzo’s prn (to treat acutely, but weigh addiction possibility)

Propranolol for stage freight

Question 10

What other condition can manifest into social phobia?

Answer 10

avoidant personality disorder

Question 11

A 28-yo-woman complains of being lonely. She says that she longs to have a close circle of friends, but is terrified in social situations and avoids all invitations from co-workers to attend social events. She worries that others will notice her social withdrawal and talk about her. What diagnosis?

Answer 11

Social anxiety disorder (because she DOES have insight into herself, and desires friends)

*Remember avoidant personality – they have NO insight into their own actions

Question 12

If a patient has SOB, tremulous, sweating, palpitations, chest pain, and nausea that came on abruptly (took about a minute to begin) while shopping. EKG, PE, and cardiac enzymes/labs are all normal – what disorder should you consider?

Answer 12

Panic disorder

Question 13

What must you ask about for a panic disorder?

Answer 13

If they have any concern over these episodes & for recurrence → that’s what leads to the diagnosis of a panic disorder

Question 14

How do you treat panic disorder?

Answer 14

Benzo’s, SSRI, SNRI’s, PAIRED WITH THERAPY (cognitive behavioral)

They will diminish in frequency, they won’t go away right away

Question 15

If a student presents with excessive worrying about their school performance, stating that he can’t turn his brain off – what diagnosis?

Answer 15

GAD

Question 16

What two things does a person need to be diagnosed with GAD?

Answer 16

Impact daily function for 6 months

Question 17

How do you treat GAD?

Answer 17

SSRI’s. If extremely acute you can use a benzo (but MUST have a plan to down titrate & get them off them)

Relaxation training/behavioral therapy

Question 18

What else does a person with GAD have on PE?

Answer 18

Trouble concentrating, muscle tension, and being easily fatigued

Question 19

How do you diagnose obsessive compulsive disorder?

Answer 19

Recurrent obsessions (recurrent intrusive thought), compulsions (recurrent intrusive action) – that interferes with daily functioning

Question 20

If a person is older with a sudden onset of OCD – what do you need to do?

Answer 20

Look for acute medical or drug-related infections

Question 21

How do you treat OCD?

Answer 21

SSRI’s! Cognitive behavioral therapy is hit-or-miss

Question 22

What is different about treatment for anxiety/OCD when compared to depression?

Answer 22

Anxiety = HIGH DOSE (but titrate to the effective amount)

Depression = low dose

Question 23

How do we differentiate OCD from OCPD?

Answer 23

OCD has compulsions & obsessions that they cannot control

Question 24

45-yr-old man refuses to cut his shoulder-length hair for a new job and his employer threatens to dismiss him. The man admits to the employer that he wears his hair so long because he wants to cover his excessively large and pointy ears. Physical examination reveals mildly prominent ears that would not attract attention. The man fears being made fun of if the public was able to see his ears. What diagnosis? How do you treat it?

Answer 24

Body dysmorphic disorder

SSRI’s; CBT (but need to be on meds beforehand)

Question 25

Body dysmorphic disorder is difficult to treat, why?

Answer 25

Because it is ego-syntonic (they don’t know they have a problem)

Question 26

If a patient has a hard time of parting with possessions that really have no value. You notice that she has scabies and is not well kept – what diagnosis?

Answer 26

Hoarding disorder

Question 27

What does ego-syntonic mean?

Answer 27

The person doesn’t know they have a problem

Question 28

How do you treat hoarding disorder?

Answer 28

SSRI’s, CBT*** primarily (often some type of trauma in the person’s history)

Question 29

If a patient has a problem with pulling one hair, often twirling it until it falls out – what diagnosis?

Answer 29

Trichotillomania

Question 30

How do you treat trichotillomanis?

Answer 30

SSRI’s & CBT

Question 31

If a patient picks at their skin until they bleed, or picks at their calluses and scabs – what diagnosis?

Answer 31

Excoriation disorder

Question 32

If a child was emotionally withdrawn behavior toward adult caregivers, the child seeks minimal comfort when distressed, and limited positive affect – what diagnosis?

Answer 32

Reactive attachment disorder

Question 33

What must a child have in order to diagnose reactive attachment disorder?

Answer 33

Insufficient care & disturbance occurs before age 5, and has a developmental age of at least 9 months

Question 34

What must a patient have in order to diagnose a posttraumatic stress disorder?

Answer 34

1+ intrusion symptoms = recurrent memories, dreams, feeling of recurrence, distress of re-exposure, physiological reactivity

1+ Avoidance symptoms = Memories, thoughts, feelings

2+ negative cognitions = Poor memory, self-concept, cause/consequence, emotional state, interest/participation, detachment, loss of positive thoughts.

2+ arousal symptoms = Irritability, recklessness, hypervigilance, exaggerated startle, poor concentration, sleep disturbance

Question 35

How do you treat posttraumatic stress disorder?

Answer 35

group therapy; pharmacology (SSRIs); don’t debrief – just begin immediate therapy/counseling

Question 36

How do you treat the nightmares in PTSD?

Answer 36

Prazosim (alpha blocker)

Question 37

Which SSRI is best for PTSD?

Answer 37

Sertraline

Question 38

What is the timeline for PTSD?

Answer 38

greater than 1 month

Question 39

What is the timeline for acute stress disorder?

Answer 39

It’s just like PTSD but lasts from 3 days to 1 month (with an acute episode)

Question 40

If a patient presents with a “nervous breakdown” what do you think of?

Answer 40

adjustment disorders

Question 41

What are the triggers for an adjustment disorder?

Answer 41

Divorce, job loss, medical issues (cancer), etc → occurs within 3 months of stressor

Question 42

What are the subtypes of adjustment disorders?

Answer 42

Adjustment disorder WITH… depression, anxiety, disturbance of conduct, mixed disturbances

Question 43

How do you treat an adjustment disorder?

Answer 43

Removing the etiologic stressor; CBT; supportive psychotherapy (coping skills, strengthening defense mechanisms).

Anti-anxiety meds can be helpful too