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Psychiatry > Anxiety > Flashcards

Anxiety Flashcards

1
Q

Lifetime prevalence of anxiety?

A

25%

  • Pts w/anxiety 3-5x more likely to seek medical care
  • Majority present to non-Psychiatrist doctors
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2
Q

What is a Panic Attack?

- How many sx must be present?

A

An ubrupt surge of intense fear or discomfort that peaks w/in minutes and during which time 4+ of the following sx occur:

  • Palpitations/tachycardia
  • Sweating
  • Trembling
  • Paresthesias
  • Derealization/depersonalization
  • Fear of losing control/”going crazy”
  • Nausea/abdominal distress
  • Dizziness/lightheadedness
  • SOB
  • Chills or heat sensation
  • Chest pain
  • Sensation of choking
  • Fear of dying
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3
Q

Are panic attacks there own d/o or a specifier?

A

Specifier (can occur in context of any mental d/o or medical condition)

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4
Q

What are the requirements of a dx of Panic Disorder?

  • How many panic attacks?
  • How long must it last?
  • What 2 additional requirements must the attacks meet?
A
  • Recurrent, unexpected panic attacks
  • At least 1 of the panic attacks are following by 1 or both of the following for at least 1 MONTH:
    1. Persistent concern/worry about additional panic attack
    2. Significant maladaptive change in behavior
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5
Q

What must be r/o’d prior to dx of panic disorder?

A
  • Disturbance not 2/2 a substance or another medical condition
  • Not better explained by another mental d/o
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6
Q

Is Panic Disorder more common in M or F?

A

F:M 2:1

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7
Q

What is the age of onset of panic d/o?

A

Late teens - 20s

highly comorbid w/other Psych d/o’s

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8
Q

What medical problems are at higher risk in Panic d/o?

A

Stroke & CV death

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9
Q

What is the best non-pharmacological tx for Panic Disorder?

A

CBT
- Techniques: Breathing Retraining, Cognitive Restructuring, Exposure to Feared Situations

(can be used alone or w/meds)

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10
Q

What is the 1st-line pharm tx for panic d/o?

A

SSRI’s/SNRI’s

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11
Q

Besides SSRI’s/SNRI’s, what other pharm tx can be used for panic d/o?

A
  • Benzos (short-term)

- TCAs, MAO-i’s

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12
Q

What are the requirements of a dx of Agoraphobia?

  • Duration?
  • How many requirements must be met?
A

At least 6 MONTHS of marked fear/anxiety about 2 or more of the following situations:

  • Using public transport (even cars)
  • Open spaces
  • Enclosed spaces
  • Standing in line; crowds
  • Being outside or home alone
  • Also fear/anxiety due to avoiding these situations and out of proportion to actual danger. Causes significant distress/fcnal impairment
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13
Q

What are the requirements of a dx of GAD?

  • Duration of sx?
  • How many sx must be present?
A

Excessive anxiety/worry occurring more days than not for at least 6 MONTHS about a # of events/activities
- Difficulty controlling the worry
- Anxiety/worry a/w 3+ of the following sx:
1. Muscle tension
2. Restlessness, feeling keyed up/on edge
3. Sleep disturbance
4. Fatigued
5. Irritability
6. Concentration difficulties or mind going blank
(MRS FIC)

(causes sig impairment in social/job fcning)
(not 2/2 med or medical condition)
[WWARTS: Wound up, Worn out, Absentmindedness, Restlessness, Touchy, Sleepless]

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14
Q

Is GAD more common in F or M?

A

Females

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15
Q

What is the lifetime prevalence of GAD?

Median age of onset?

A

~5%

31 y/o

*HIGHLY comorbid w/other psych dx (90%)

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16
Q

GAD is a/w increased mortality in _____________ pts.

A

cardiac

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17
Q

What is the relapse rate of GAD sx 1 year s/p stopping pharmacotherapy?

A

60-80%

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18
Q

*What pharmacotherapy is available for GAD?

8 categories listed

A
  • SSRIs/SNRIs
  • Benzodiazepines
  • Buspirone
  • Pregabalin
  • Mirtazapine/trazodone
  • TCA’s
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19
Q

Brand name of pregabalin?

A

Lyrica

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20
Q

What are the requirements of a dx of PTSD?

  • Duration?
  • How many of the criteria categories must they have?
A

Exposure to actual or threatened death, serious injury, or sexual violence, experienced in 1+ of the following ways: Direct experience, Witness, Learning it occurred to family/friend, Repeated exposure to extreme trauma

  • Duration of sx is 1 MONTH +
  • Must also have 2/4:
    1. Hyperarousal
    2. Avoidance
    3. Re-experiencing
    4. Negative alterations in mood and cognition

(HARN)

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21
Q

In PTSD, how is Re-experiencing of the traumatic event defined?

A

(1 or more of the following):

  • Recurrent memories/recollections
  • Recurrent distressing dreams/nightmares
  • Dissociative reactions/flashbacks (feels/acts as if trauma recurring)
  • Intense or prolonged psychological distress at exposure to internal/external cues
  • Marked physiological reactions to internal/external cues
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22
Q

In PTSD, how is Avoidance defined?

A

(1 or both of the following):

  • Efforts to avoid distressing memories, thoughts or feelings about trauma
  • Efforts to avoid external reminders (e.g. people, places, conversations, objects) that arouse memories, thoughts or feelings about trauma
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23
Q

In PTSD, how is Hyperarousal defined?

A

(2 or more of the following):

  • Irritability or angry outbursts
  • Reckless or self-destructive behavior
  • Hypervigilance
  • Exaggerated startle response
  • Problems with concentration
  • Sleep disturbances
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24
Q

How is Acute Stress Disorder defined?

  • Duration?
  • What sx clusters?
  • How many sx must they have? (__/14)
A
  • Duration of sx is 3 DAYS TO 1 MONTH w/in onset of stressor.
  • Same sx clusters of re-experiencing, avoidance, negative mood, and hyperarousal, also includes symptom cluster of dissociative sx.
  • Must meet 9 of 14 sx listed in any of theses categories
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25
Q

What are the dissociative sx in acute stress d/o?

A
  • Altered sense of reality of one’s surroundings or self (e.g. seeing self from another’s perspective, being in a daze, time slowing)
  • Dissociative amnesia related to trauma
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26
Q

Lifetime prevalence of PTSD?

A

8%

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27
Q

Is PTSD more prevalent in M of F?

A

Females

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28
Q

What are the r/f’s for PTSD?

A
  • Female
  • Prior trauma
  • H/o mood/anxiety d/o
  • Fam hx of mood/anxiety d/o
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29
Q

What does PTSD increase risk for?

A
  • Alcohol/drug problems
  • Aggression/violence
  • Suicidal ideation/attempts
  • Work problems
  • Marital/relationship problems
  • Homelessness
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30
Q

W/r/t PTSD, what are some considerations for military vets?

A
  • TBI
  • Military sexual trauma (MST)
  • Multiple deployments/re-exposure
  • Readjusting to civilian life s/p deployment/discharge
  • Substance abuse
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31
Q

What are some therapeutic modalities to treat PTSD?

A
  • CBT
  • Exposure therapy
  • EMDR (eye movement desensitization and reprocessing)
  • Anger management classes
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32
Q

What is the first-line pharmacologic tx for PTSD?

A
  • SSRIs (for all sx cluster)
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33
Q

Besides SSRIs, what other pharmacological tx is available for PTSD?

What meds for symptomatic tx?

A
  • SNRIs
  • TCAs
  • Mood-stabilizers/anticonvulsants (mood lability)
  • Atypical antipsychotics (mood lability/anger/irritability)
  • Clonidine (hyperarousal sx), a2 agonist
  • Propranolol (hyperarousal sx)
34
Q

Why are benzos risking for treating PTSD?

A
  • Limited evidence of efficacy

- Can treat acute anxiety short-term, but risk of disinhibition PTSD and dependency

35
Q

How is Obsessive-Compulsive Disorder defined?

- What time criteria is used?

A
  • Presence of obsessions, compulsions, or both
  • Obsessions are compulsions are time-consuming (take > 1 HOUR / DAY), or cause clinically significant distress or impairment in ability to function
36
Q

What are obsessions?

A
  1. Recurrent, persistent thoughts, urges, images that are experienced as intrusive or unwanted and cause marked anxiety or distress.
  2. Individual attempts to ignore/suppress such thoughts, urges, or images or to neutralize them w/some other thought or action (i.e. compulsion)
37
Q

What are compulsions?

A
  1. Repetitive behaviors or mental acts that individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
  2. Compulsions are aimed at preventing or reducing anxiety/distress or presenting some dreaded event or situation. Compulsions are not realistically connected w/what they are designed to neutralize or prevent.
38
Q

What is the lifetime prevalence of OCD?

A

2-3%

chronic waxing and waning course, worse w/stress

39
Q

What is the M:F ratio of OCD?

A

1:1

40
Q

What are some conditions OCD may be comorbid with?

A

Highly Comorbid with Other Conditions

  • Major Depression (60% lifetime prevalence)
  • Tourette’s (7% of OCD patients have Tourette’s)
  • Anorexia (7‐17%)
  • Substance Dependence (14%)
  • Schizophrenia (11%)
41
Q

What is the first-line pharmacological tx for OCD?

A

SSRIs (higher doses needed vs other anxiety d/o’s)

42
Q

What is the 2nd-line pharmacological tx for OCD?

A

Clomipramine (TCA)

- Consider Rx after 2 failed trials of SSRIs

43
Q

What is a good 3rd-line pharmacological tx for OCD besides SSRIs, clomipramine?

What else can be used?

A

SNRIs

Atypical antipsychotics ‐ some data supporting as augmenting agent to antidepressant

44
Q

What therapy modalities can be used to treat OCD?

A
  • CBT

- Exposure and Response Prevention

45
Q

What is Hoarding Disorder?

A

Persistent difficulty discarding/parting with possessions, regardless of their actual value.
● Due to perceived need to save items and avoid distress
associated with discarding them.
● Results in accumulation of possessions that clutter active living areas and compromises their intended use. If living areas uncluttered, it is only because of interventions by 3rd parties.
● Causes significant distress/impairment in ability to function (including maintaining a safe environment for self and others).

46
Q

What medical diseases can cause hoarding?

What mental disorders can mimic it?

A

Brain injury, cerebrovascular disease, Prader‐Willi

Decreased energy in MDD, delusions in Schizophrenia, etc.

47
Q

What is required for the dx of social anxiety disorder?

A
  • Marked fear/anxiety about one or more social situations where individual exposed to possible scrutiny by others (e.g. having a conversation, meeting new people, eating or drinking, giving a speech)
  • Fear of acting in a way that will be negatively evaluated (being humiliated or embarrassed, being rejected by others, offending others).
  • Fear/anxiety out of proportion to actual threat of social situation.
  • Fear, anxiety, avoidance persistent and lasts at least 6 MONTHS
48
Q

What is the tx of social anxiety disorder similar to?

  • What are the pharmacological tx options?
  • What is the therapeutic tx option?
A

Panic disorder

  • Pharmacotherapy: SSRI’s, SNRI’s, benzodiazepines, Propanolol (good for performance anxiety)
  • Psychotherapy: CBT
49
Q

What is required for the dx of a specific phobia?

A

Marked fear/anxiety about specific object or location

  • Object/location can provoke immediate fear/anxiety
  • Object/location actively avoided or is endured with intense fear/anxiety
  • Fear/anxiety out of proportion to actual threat of social situation.
  • Fear, anxiety, avoidance persistent and lasts at least 6 MONTHS
50
Q

What is the tx for specific phobia?

A

Exposure therapy (systematic desensitization)

51
Q

What is “ataque de nervios”?

- What global areas is it typically found in?

A

Different from a panic attack. Uncontrollable screaming, crying, sensations of heat rising in chest and head, dissociative symptoms, sometimes verbal/physical aggression. Sx usually in response to a stressful event - Caribbean, Latin America

52
Q

What is “Dhat syndrome”?

- What global area is it typically found in?

A

Males suffer from premature ejaculation or impotence, loss of semen contributes to fatigue, low mood, anxiety, insomnia, guilt, palpitations
- India

53
Q

What is “Khyal cap”?

- What global area is it typically found in?

A

‘Windlike’ substance in body causing serious illness

- Cambodia

54
Q

What is “Kufingisisa”?

- What global area is it typically found in?

A

Illness involving thinking too much

- Zimbabwe

55
Q

What is “Susto”?

- What global area is it typically found in?

A

Chronic somatic suffering stemming from emotional trauma characterized by nervousness, insomnia, listlessness, fever,
depression, anorexia, and diarrhea
- Latin America

56
Q

What is “Taijin kyofusho”?

- What global area is it typically found in?

A

Interpersonal fear disorder

- Japan

57
Q

What is “Maladi moun”?

- What global area is it typically found in?

A

Human‐caused illness by enemies because of one’s success

- Haiti

58
Q

What are some organic causes of anxiety?

A
  • Endocrine: Cushing’s, Hypoglycemia, Hyperthyroid, Hypoparathyroid, Hyperadrenalism
  • CV: MI, Angina, PE, COPD, Asthma
  • Metabolic: Electrolyte Abnormalities, Acidosis, Hyperthermia
  • Neurological: Parkinson’s, Seizure disorders, Migraines, Vestibular dysfunction, MS, Postconcussive syndrome, Meniere’s
  • Zebras: Pheochromocytoma, Insulinoma
59
Q

What drug intoxications can cause anxiety?

A

Cocaine, Amphetamines, Caffeine, Corticosteroids, Hallucinogens, Cannabis, PCP, Inhalants, Theophylline, Thyroid hormones

60
Q

What drug withdrawals can cause anxiety?

A

ETOH, Benzos/sedative‐hypnotics, narcotics

61
Q

Brand name for fluoxetine?

A

Prozac

62
Q

Brand name for sertraline?

A

Zoloft

63
Q

Brand name for paroxetine?

A

Paxil

64
Q

Brand name for citalopram?

A

Celexa

65
Q

Brand name for escitalopram?

A

Lexapro

66
Q

Brand name for fluvoxamine (SSRI)?

A

Luvox

67
Q

What are the common side effects of SSRIs?

A
  • *GI: N/V/D, dyspepsia
  • Sexual: v libido, inability to orgasm
  • Weight gain
  • Headache
  • Dry mouth
  • Sedation
  • Can induce mania/hypomania in those w/bipolar disorder
68
Q

What sx can be a/w SSRI discontinuation?

A

*Flu-like sx:

Nausea, headache, dizziness, lethargy

69
Q

What are the s/s of serotonin syndrome?

A

Triad:

  • AMS
  • Autonomic instability
  • Neuromusclar hyperactivity (eg myoclonus)

(also can have fever, etc.)

70
Q

What are potential culprit drugs that can cause serotonin syndrome?

A
  • Tramadol
  • Triptans
  • Linezolid
  • MAO-i’s
  • Ondansetron
  • Metoclopramide
71
Q

What is the tx of serotonin syndrome?

A
  1. Stop offending/ppt’ing agents!

2. Serotonin antagonists like Cyproheptadine in severe cases

72
Q

What is the first-line tx for anxiety disorders?

A

SSRIs

73
Q

Brand name for venlafaxine?

A

Effexor

74
Q

Brand name for duloxetine?

A

Cymbalta

75
Q

Brand name for desvenlafaxine?

A

Pristiq

76
Q

Are benzos safe in pregnancy?

A

No-class D

77
Q

What is the MoA of buspirone (Buspar)?

  • When is it generally used?
A

5HT-1A partial agonist

  • Non-habit-forming anxiolytic
  • Usually used in conjunction w/antidepressant
  • Generally well-tollerated
78
Q

What receptors do TCAs act on?

A

NE, 5-HT, DA, histamine, muscarine

79
Q

Benzos: MoA?

A
  • Bind BZ1 and BZ2 sites.
  • Positive allosteric modualtors of GABA-A receptors (inaffective unless GABA present; alpha/beta interface). Increases frequency of Cl- channel opening –> hyperpolarization/IPSP.
  • Lipophilic.
80
Q

Benzos: indications?

A
  • Common: anxiety, insomnia, anesthesia, alcohol withdrawal, seizures. Used as muscle relaxant.
  • Less common: night terrors, sleep walking, parasomnia in children.
    Midazolam (Versed)® has a very short T1/2 and is often used in anesthesia (IV).
81
Q

Benzos: adverse effects?

A 
Frequent: 
- Sedation + drowsiness (most common). 
- Ataxia, dizziness, cognitive impairment, amnesia (while on drug).
Occasional:
- Confusion.
Rare
- Paradoxical aggression
- Possibly teratogenic: cleft lip/palate
  • Tolerance for sedating effects but not for anxiolytic or muscle relaxant effects. Also, cross-tolerance to ethanol.
82
Q

What are the withdrawal sx from benzodiazepine dependence?

- Can it be fatal?

A

Anxiety, insomnia, loss of appetite, HA, myalgias, twitches, nausea, tremor, sweating, irritability.
- Can be fatal.

Psychiatry (16 decks)

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