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Psychiatry > Anxiety + Adjustment Disorders > Flashcards

Anxiety + Adjustment Disorders Flashcards

1
Q

Adjustment disorder

A

Develops 3 mo after nontraumatic event

  • Distress in excess after stressful life event OR
  • significant impairment in function

Sx resolve in 6 mo after stressor terminated

Stressful event is not divorce, death, loss of job. In PTSD it is.

2x more common in females

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2
Q

Tx adjustment disorder

A

Supportive psychotherapy most effective

Group therapy

Pharm for associated sx (insomnia, anxiety, depression)

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3
Q

Most common association with panic disorder

A

Depression

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4
Q

Social anxiety disorder (social phobia)

A

Anxiety about >=1 social situations for > 6 mo

Fear of scrutiny by others, humiliation, embarrassment

Social situations avoided or endured w/ intense distress

Marked impairment (social, academic, occupational)

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5
Q

Generalized vs performance only social anxiety disorder

Tx?

A

Generalized = meeting new ppl, initiating convos, being observed by others

Performance only = public speaking or presentations

Tx:
- Generalized = SSRI/SNRI, CBT

  • Performance = Benzo or propanolol 30-60min before situation, CBT
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6
Q

Specific phobia

A

Marked anxiety about specific object or situation for > 6mo (need to be > 6 mo if less than 18 yo)

Types: Flying, heights, animals, injections, blood

Avoidance behavior

Common 10% population

Usually develops in childhood; can develop after traumatic event

Person recognizes fear is excessive

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7
Q

Tx specific phobia

A

Behavior therapy #1

Short acting benzos acutely

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8
Q

DDx of anxiety disorders

A

Social anxiety DO - fear of scrutiny

Panic DO - unexpected panic attacks

Specific phobia - anxiety with specific object

GAD - Chronic multiple worries

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9
Q

Neurotransmitter associations with anxiety

A

Increased norepi

Decreased GABA and serotonin

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10
Q

Medical causes of anxiety disorders

A 
Hyperthyroidism
Vit B12 defificency
Hypoxia
Neuro DO - epilepsy, brain tumors, MS, CVD
CV dz
Anemia
Pheo
Hypoglycemia
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11
Q

Panic attack criteria

A

PANICS

Palps
Ab distress
Numbness, nausea
Intense fear of death
Choking, chills, chest pain
Sweating, shaking, SOB
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12
Q

Panic attack association

A 
MItral valve prolapse
Asthma
PE
Angina
Anaphylaxis
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13
Q

Panic disorder criteria

A

Panic attacks followed by at least 1 mo of the following:

Persistent concern about having additional attacks

Worry about impolications of attack

Sig change in behavior to try and avoid attacks

ALWAYS SAY IF PANIC DO WITH or WITHOUT AGORAPHOBIA

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14
Q

Tx panic disorder

A
  • SSRIs: paroxetine, sertraline
  • –> need 2-4 weeks for effective, need higher doses than for depression
  • imipramine
  • TCAs, benzos, MAOIs

Tx should last for 8-12 mo at least as relapse common

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15
Q

Agoraphobia

A

Fear of being alone in public places

Ppl will avoid place or situations from which escape or help might be difficult
- can be 2/2 to panic attack apprehension

If 2/2 panic DO, once panic DO treated, agoraphobia usually resolves

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16
Q

Which one is dx more? Social vs. specific phobia

A

Specific phobia

Women 2x more likely to have specific phobia than men

Social phobia equal prevalence men and women

17
Q

Tx specific phobia

A

Pharm NOT effetive

Best: Behavior therapy
- systemic desensitization is common = gradual exposure of pt to feared object or situation

SSRI/SNRI - if freq exposure to stimulus + CBT not available

Benzo - if not frequent exposure to stimulus + CBT not available

18
Q

Tx social phobia

A

CBT or SSRI/SNRI (paroxetine) if generalized (frequent) form

Benzo or beta blocker if infrequent occurrence

19
Q

Shy vs social phobia

A

Social phobia complete avoidance of scrutiny and exaggerated fears in day to day life causing significant distress and/or disability

20
Q

OCD diagnosis

A

Either obsessions or compulsions as defined below:

  1. obsessions
    - -> lots of intrusive thoughts or impulses with more anxiety
    - -> person wants to SUPPRESS thoughts
    - -> person has insight
  2. compulsions
    - -> repetitive behaviors person feels needs to do in response to obsession
    - -> behaviors aimed at dec distress but no real link to do this

Person has insight

Obsession have lots of distress, time consuming, significantly interfere w/ daily functioning

Increased activity in caudate nucleus

Defense mechanism: UNDOING

21
Q

Rate of COD is higher in pts with…

A

first degree relatives for have TOURETTE

22
Q

Tx OCD

A

Behavioral tx + Meds
- Exposure and response prevention (ERP)

SSRIs (need higher doses than in depression)

  • fluoxetine
  • fluvoxamine**
  • paroxetine
  • sertraline

TCAs
- Clomipramine

Can use amitriptyline if have corresponding pain sydnrome

ECT is last resort

23
Q

Exposure and response prevention

A

prolonged exposure to ritual eliciting stimulus and prevention of the relieving compulsion

24
Q

Dx PTSD

A

witness traumatic event

persistent avoidance

hyperarousal

Reexeriencing traumatic event

ALL FOR MORE THAN 1 MONTH

25
Q

Tx PTSD

A

SSRIs
TCA (imipraine, doxepin)
MAOI

Anticonvulsants for flashbacks and nightmares

CBT, support groups

AVOID addictive meds (eg benzos) because of high rate of substance abuse in these pts

26
Q

PTSD vs. Acute stress disorder

A

PTSD

  • event occurred at any time in past
  • sx > 1 mo

Acute stress DO

  • event < 1 mo ago
  • sx < 1 mo
27
Q

Generalized anxiety disorder dx

A

Excessive anxiety and worry about daily events >= 6 mo
- must cause significant distress

3/6 of sx:
restlessness
fatigue
difficult concentrating
irritability
muscle tension
sleep distrubance

Anxiety is free floating vs being fixed on specific person, event, or activity

28
Q

Always ask about when dx GAD

A

Hyperthyroidism (med conditions producing anxiety)

Caffeine intake

29
Q

Tx GAD

A

CBT + pharm most effective

SSRIs, buspirone, venlafaxine

Benzos (clonazepam, diazepam) should be tapered off when possible to avoid dependence

Psychiatry (9 decks)

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