Anxiety

Question 1

Chronological age - development of anxiety disorders?

Answer 1

Separation Anxiety (age 3-6 years)
Selective Mutism (< age 5)
Specific phobia (age of onset age 7)
Social anxiety disorder (age of onset 13)
Panic disorder (age of onset 20)
Agoraphobia (age of onset 25)
Generalized anxiety disorder (age of onset 30)

Question 2

Risk factors for anxiety disorders

Answer 2

F> M (2:1 ratio)
Family history
ACE
Chronic medical illness: CVD, asthma, obesity

Question 3

Anxiety guidelines meds - Social Anxiety Disorder?

Answer 3

VPS PEF
Venlafaxine
Paroxetine
Sertraline
Pregabalin
Escitalopram
Fluoxetine

Question 4

Meds - Panic Disorder?

Answer 4

VPS CEFF
Venlafaxine
Paroxetine
Sertraline
Citalopram
Escitalopram
Fluoxetine
Fluvoxamine

Question 5

Meds - GAD ?

Answer 5

VESPPA D
Venlafaxine
Escitalopram
Sertraline
Paroxetine
Pregabalin
Agomelatine
Duloxetine

Question 6

Adjunctive therapy - Panic Disorder?

Answer 6

Second line: Alprazolam, Clonazepam

Third line: Aripiprazole, Divaloproex, Olanzapine, Pindolol, Risperidone

Question 7

Which phobias does virtual reality exposure work for ?

Answer 7

Specific phobias

heights, spiders, claustrophobia

Question 8

Adjunctive therapy - Social Anxiety Disorder?

Answer 8

Third line: Aripiprazole, Buspirone, Paroxetine, Risperidone

Question 9

Adjunctive therapy - GAD ?

Answer 9

Second line: Pregabalin

Third line: Aripiprazole, Olanzapine, Quetiapine, Risperidone

Question 10

GAD - prevalance/epi ?

Answer 10

Bimodal distribution (early 20s and 30/40 year olds)

Question 11

OCD - Meds ?

Answer 11

F2EPS
Fluxoetine
Fluvoxamine
Escitalopram
Paroxetine
Sertraline

Question 12

OCD - Adjunctive therapy ?

Answer 12

First line - aripiprazole, risperidone

Second line - memantine , quetiapine, topiramate

Question 13

What is not recommended in OCD ?

Answer 13

Clonazepam
Clonidine
Desimpramine

Question 14

PTSD - meds ?

Answer 14

VFPS
Venlafaxine
Fluxoetine
Paroxetine
Sertraline

Question 15

PTSD - Adjunctive therapy?

Answer 15

Second line - eszopiclone, Olanzapine, risperidone

Third line - aripiprazole, clonidine, gabapentin

Question 16

What is not recommended in PTSD ?

Answer 16

alprazolam, citalopram, clonazepam, desimpramine, divaloproex, olanzapine, tiagabine

Question 17

Most common- specific phobia

Answer 17

animal - adults

Question 18

In kids < age 10, most common phobia

Answer 18

natural env’t (hts, water, storms)

Question 19

Acute stress disorder ?

Answer 19

9 symptoms in 5 domains - any 9
timeline - between 3 days and 1 month after trauma
Exposure symptoms - experiencing trauma
Intrusion symptoms - flashbacks, etc
Negative Mood
Dissociative symptoms
Avoidance symptoms
Arousal symptoms

Question 20

Good prognosis for PTSD ?

Answer 20

rapid onset of symptoms
short duration (< 6 months)
good premorbid functioning
strong social supports

Question 21

Are all anxiety disorders more common in males or females?

Answer 21

females

Question 22

Lifetime prevalence of anxiety disorders?

Answer 22

All anxiety disorders - 28%
Social anxiety disorder - 12.1%
PTSD - 6.8%
GAD - 5.7%
Panic Disorders - 4.7%

Question 23

Recurrence rates over 12 year follow up - anxiety disorders?

Answer 23

60% panic
40% for SAD and GAD

33% convert to another anxiety disorder

Question 24

Risk factors for childhood anxiety disorder?

Answer 24

Age of onset (early = worse)
Divorced parents (no partner)
History of childhood trauma
Residual symptoms
Parental substance abuse
antidepressant discontinuation
comorbid mood disorder

Question 25

Psychological risk factors for developing anxiety disorders?

Answer 25

``` Neuroticism Introversion Behavioral Inhibition Anxiety sensitivity Harm avoidance Perfectionism Intolerance of Uncertainty ```

Question 26

Anterior Cingulate Cortext

Answer 26

role of integration of attention such as decision making, reward anticipation, decision making TOP DOWN INHIBITION

Question 27

Hippocampus

Answer 27

Important for forming storage - episodic memories | BOTTOM UP INHIBITION --> inhibit amygdala

Question 28

What is the lag time between the urge and reaction?

Answer 28

0.25 secs

Question 29

Anxiety Disorders in DSM5

Answer 29

``` Panic Disorder Generalized Anxiety Disorder Separation Anxiety Disorder Agoraphobia Specific Phobia Selective Mutism ```

Question 30

Obsessive Compulsive Related Disorders?

Answer 30

``` Obsessive Compulsive Disorder Body Dysmoprhic Disorder Hoarding Disorder Tricholitllomania Excoriation (skin picking) ```

Question 31

Trauma/Stressor Related Disorders

Answer 31

``` PTSD Acute Stress Disorder Adjustment Disorders Reactive Attachment Disorder Disinhibited Social Engagement Disorder ```

Question 32

Agoraphobia - DSM 5

Answer 32

``` Marked fear or anxiety about 2 or more of the following situations: Using public transportation Being in open spaces Being in enclosed spaces Standing in line or being in a crowd Being outside of the home alone ``` The fear, anxiety or avoidance: Is persistent, typically lasting 6 months or longer Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning Is clearly excessive, if another medical condition is present ( eg. IBD, Parkinsons)

Question 33

Neuroanatomical basis of worry?

Answer 33

Excitation of the cortico-striatal-thalamic-cortical loop

Question 34

Top risk factors for developing an anxiety disorder?

Answer 34

``` family history of anxiety being female childhood stressful life events/trauma chronic medical issues behavioral inhibition ```

Question 35

Social Anxiety Disorder - RF

Answer 35

lifetime prevalance 8-12% more common in women onset after 25 years is rare lower SES, unmarried

Question 36

Generalized Anxiety Disorder - RF

Answer 36

another anxiety disorder substance abuse MDD

Question 37

MOA - Gabapentin and Pregabalin

Answer 37

Alpha-2 delta ligands ( pregabalin and gabapentin) bind to voltage sensitive calcium channels which in turns blocks the release of excitatory neurotransmitters ( like glutamate). When this occurs in the amygdala or in the CSTC , then an anxiolytic effect may result.

Question 38

Childhood onset OCD - RF

Answer 38

associated with higher symptom severity higher rates of clinical obsessions and compulsions higher rates of co occurring tic disorders less chance of SRI response as adult

Question 39

How many more x likely is someone with first degree relative of OCD likely to have OCD ?

Answer 39

4x

Question 40

Obsessions and Compulsions in non clinical samples

Answer 40

80% obsessions | 55% compulsions

Question 41

What is the treatment for treatment resistant OCD?

Answer 41

cingulotomy or anterior capsulotomy

Question 42

What percentage of patients with OCD are treatment refractory?

Answer 42

At least 10% of patients with OCD are treatment refractory

Question 43

Prognostic indicators for poor prognosis in OCD?

Answer 43

``` early age of onset yielding to compulsions bizarre compulsions hospitalization comorbid depression lack of insight -delusions - overvalued ideas -schizotypal personality disorder ```