Anxiety Flashcards
What is GAD?
Excessive and persistent worrying that is hard to control, causes significant distress or impairment
How long should a diagnosis of GAD last?
at least 6 mo
T/F is GAD inheritable?
True (moderately)
The pathognomic feature of GAD?
Excessive and persistent worrying
What are 4 symptoms seen in GAD?
Muscle tension
Headaches
Difficulty relaxing
Irritability
How many symptoms must be met for adults w/ GAD?
> 3
How many symptoms must be met for children w/ GAD?
> 1
Screening tool used for GAD?
General Anxiety Disorder 7 (GAD-7)
1st Treatment for GAD?
CBT + SSRIs
2nd line of txt for GAD?
TCA
Med for pt whom has limited or no response to 1st and 2nd line GAD therapy?
Benzodiazepine
At age 50yr what does GAD usually turn into?
undifferentiated somatization disroder
What is the association of GAD in CHD pts?
anxiety and mortality
What age is panic attack seen?
all ages, younger pts
25% have panic disorder when they present with ??? in the ER?
chest pain
What associated condition is seen with panic attack?
PTSD
What is panic attack?
abrupt surge of intense fear, reaching a peak within minutes
How many symptoms must be met for panic attack?
> 4
What are 4 symptoms of panic attack?
Sweating
palpitations
chest pain
fear of dying
What 2 manifestations must be met for panic disorder?
> 1 mo
Worry about additional attacks
Maladaptive change in behavior
What is the 1st line txt for panic attack?
CBT w/ SSRI
How should SSRI be dosed in a pt with bipolar?
go low and slow
Why special attention for bipolar pts on SSRI txt?
because they can develop manic disorder
2nd line txt for panic disorders?
SNRIs, TCA
Which TCA works best for panic attack?
Imipramine (Tofranil)
What drugs is FDA approved for panic disorder?
Benzodiazepines
What drugs drug or class doesn’t work for panic disorder?
Bupropion (NDR)
Panic disorder is a ….
diagnosis of exclusion
What is Agoraphobia?
fear of difficulty in escaping
What commonly occurs with panic disorder?
Agoraphobia
Extroversion or introversion is a symptoms of agoraphobia
Introversion
Screening tool for agoraphobia?
Fear questionnaire
1st line txt for agoraphobia?
CBT w/ SSRI, SNRI, TCA, Benzo
Which drug or class doesn’t work in agoraphobia?
Bupropion (NDR)
Fear of thunderstorms?
Brontophobia
Fear of animals?
Zoophobia
Fear of heights?
Acrophobia
Fear of disease?
Nosophobia
Fear of death?
Thanatophobia
Fear of animals
Zoophobia
Fear of storms, height?
Environmental type
Fear of blood or a shot
Blood-injection/ injury type
Fear of enclosed spaces, flying, crowds
Situational type
Fear of snakes, spiders
Animal type
What has a strong association w/ vasovagal rxn?
blood-injection/injury phobia
Most common psychiatric disorders among women?
Phobias
A specific phobia that runs in family, w/ very high familial tendency
blood injection/ injury type
Recognition that fear is completely ??? or ????
irrational or excessive
What are s/s of specific phobia?
unable to control response, often embarrassed, functional impairment
How long does a diagnosis of specific phobia last?
> 6 mo
1ST txt for specific phobias?
treat major psychiatric disorders… may resolve
The best txt for specific phobias?
Exposure- based treatment
What is NOT a first line txt for specific phobia?
medication
What is specific phobias are left untreated?
they can remain lifelong
How long does ASD occur for?
<1 mo after person is exposed to a traumatic event
The biggest risk factor for ASD?
witnessing a mass shooting
Presents with a flat or blunted affect, emotional numbing
ASD
MOST effective treatment for ASD?
CBT (trauma focused)
Med that hasn’t shown to be effective in ASD?
SSRI
Med that has mixed results in ASD?
TCA (Imipramine) (Tofranil)
40-80% of pts with ASD develop ?
subsequent PTSD
30-60% OF who develop PTSD meet what criteria
for ASD in acute phase
ASD diagnosis is a poor predictor for what?
subsequent PTSD
What is PTSD?
intrusive and avoidance symptoms, negative changes in thought or mood, and arousal/reactivity
How long does PTSD last?
> 1 mo
30% of men and women who have spent time in a war zone experiences?
PTSD
Childhood trauma can lead to
suicidal behavior
What diagnostic screening tool is used for PTSD?
Clinician- Administrated PTSD Scale for DSM-5
What screening tool is used initial by us for PTSD?
Primary care PTSD screen for DSM-5
What comes next after a positive brief PTSD screen?
a structured interview by experienced clinician.
Standard for care for PTSD?
CBT, including virtual exposure
Used to txt depression, panic attacks, startle response, sleep disruption in PTSD?
SSRI
Used to treat sleep disruption in PTSD?
Trazodone
Used to treat nightmares/nighttime hyperarousal in PTSD?
Prazosin
Used to txt anxiety in PTSD?
Benzodiazepines
Used to txt impulsivity/explosiveness in PTSD?
Valproic acid or carbamazepine
Used to txt reexperiencing/ intrusive thoughts in PTSD?
Aripiprazole
Prognosis of PTSD?
50% spontaneously remit after 3 mo
What are 4 factors associated w good prognosis in PTSD?
Rapid engagement of txt
Early and ongoing social support
Avoidance of retraumatization
Absence of other psychiatric disorders/ substance abuse