Anxiety

Question 1

Generalized anxiety disorder is defined as:

Answer 1

excessive uncontrolled worry (multiple issues) >6 months
must have >3 of the following:

restlessness, feeling on edge
fatigue
difficulty concentrating
irritability
muscle tension
sleep disturbance

Question 2

Treatment of anxiety

Answer 2

Cognitive behavioral therapy

SSRI and SNRI

Question 3

What are some somatic symptoms that pts experience with anxiety?

Answer 3

fatigue, muscle aches, insomnia, and memory impairment

Seen more with women and high association with depression, phobias panic disorder and substance abuse

Question 4

1st line treatment for anxiety is

Answer 4

SSRI or SNRI’s. Starting doses should be low to minimize initial agitation but can be uptitrated to doses to treat depression.

Question 5

Benzos are used in anxiety as

Answer 5

second line and these are with risks:

risk of dependence, tolerance, impaired psychomotor performance, potential withdrawal syndrome and rebound effects

Question 6

Does bupropion help with anxiety?

Answer 6

not effective in GAD and may worsen insomnia and anxiety due to it’s activating effects.

It’s stops NE and dopamine.

Question 7

clinical features of a panic disorder?

Answer 7

recurrent and unexpected panic attacks with >4 of the following:
chest pain, palpitations, SOB, choking
trembling, sweating, nausea, chills
dizziness and parethesias
derealization, depersonalization
fear of losing control or of dying
worry about additional attacks and avoidance behavior

Question 8

Treatment of panic disorder:

Answer 8

first line and maintenance: SSRI/SNRI or cognitive behavioral therapy

Acute distress: benzodiazepines

Question 9

abrupt onset short duration <10 minutes and prominent physical symptoms that prompt people to seek medical advice:

Answer 9

panic disorder

Question 10

panic disorder is different from anxiety and psychiatric disorder because of:

Answer 10

infrequent panic attacks - and these are unexpected panic attacks at some point in the illness.

Question 11

agoraphobia

Answer 11

avoidance of situations where pt fears having a panic attack

common complication of panic attack

Question 12

SSRIs and SNRI’s for treatment of panic attack start to work in

Answer 12

2-4 weeks

Question 13

how to treat people who have acutely symptomatic panic attacks

Answer 13

benzo clonazepam to help with acute rapid onset of action.

also helpful for while waiting for SSRI’s to take effect

Benzos should be avoided in those with active substance abuse

Question 14

Difference between anxiety and panic attacks is that

Answer 14

panic disorders focus on panic attacks or the presence of panic attacks and their avoidance of trigger

this is a core feature of the disorder

Question 15

a panic attack is

Answer 15

abrupt onset of extreme fever or discomfort accompanied by various psychic and autonomic symptoms (sweating, tachycardia, fear of dying, paresthesias, derealization

that have no specific trigger

Question 16

second major criteria for panic disorder is

Answer 16

panic attack has been followed by 1 month of persistent worry or concern for future panic attacks and their consequences

significant maladaptive changes in behavior related to the attack.

Question 17

buspirone vs bupropion

Answer 17

buspirone - buspar adjunctive

bupriopion - wellbutrin - antidepressant.