Anxiety and Adjustment Disorder

Question 1

Cardiac symptoms of anxiety

Answer 1

Palpitations, tachycardia and hypertension

Question 2

Pulm symptoms of anxiety

Answer 2

SOB, choking sensation

Question 3

Neuro symptoms of anxiety

Answer 3

Dizziness, light headedness, hyper reflexia, mydriasis, tremors, tingling in extremities.

Question 4

Psychological symptoms of anxiety

Answer 4

Restlessness, butterflies

Question 5

Anxiety

Answer 5

Subjective experience of fear and its physical manifestations. Typically a normal response but can be pathologic

Question 6

MEdical causes of anxiety

Answer 6

Hyperthyroidism, B12 def, Hypoxia, Neurologic disorders, CVD, Anemia, Pheochromocytoma, Hypoglycemia

Question 7

Substance abuse related anxiety disorders

Answer 7

Caffeine intake, theophylline, amphetamines, alcohol, mercury and arsenic poisoning, penicillin, sulfonamides, sympathomimetics, anntidepressants

Question 8

Panic Attakc

Answer 8

Discrete exacerbations of anxiety and fear that often occur in patients with anxiety disorder
Attacks occur within 10 minutes of stimulus and last less than 25 mins
Must have at least 4 of the following: palpitations, sweating, shaking, SOB, choking sensation, chest pain, nausea or abdominal distress, light-headedness, depersonalization.

Question 9

Comorbid conditions associated with panic attack:

Answer 9

Mitral Valve prolapse 
Asthma
Pulmonary embolus
angina
anaphylaxis

Question 10

Panic Disorder

Answer 10

Spontaneous and recurrent panic attacks with no obvious precipitant
Suffer on average 2 per week (last 20-30 minutes)

Question 11

Treatment of Panic Disorder

Answer 11

SSRIs: Paroxetine and Sertaline
Benzodiazepines: For abortion of anxiety, use temp

Question 12

Agoraphobia

Answer 12

The fear of being alone in public spaces ( fear is that help or escape are difficult to find)

Question 13

Phobia

Answer 13

Irrational fear that leads to the avoidance of the feared object or situation
Patient knows that the fear is excessive and duration of this fear must be at least 6 months.
The fear must interfere with their daily living

Question 14

Treatment of Specific Phobia

Answer 14

Behaviour therapy

Question 15

Treatment of Social Phobia

Answer 15

Paroxetine (and other SSRIs) , beta-blockers are often used for performance anxiety

Question 16

Obsessive Compulsive Disorder

Answer 16

Obsession: a recurrent and intrusive thought, feeling or idea that is egodystonic (against the goals of the ego ?)

Compulsion: conscious repetitive behavior linked to an obsession that helps relieve anxiety caused by the obsession when performed

AXIS I DISORDER: Generally aware of the problem and realize their obsession and compulsions are irrational. There is significant distress in their lives.

Question 17

Treatment of OCD

Answer 17

SSRI: First line, may require higher than normal doses
TCA’s
BEHAVIORAL TREATMENT (Exposure and Response prevention_
ECT

Question 18

What are the classification of Obsessions

Answer 18

Contamination –> Excessive Hand Washing
Doubt –> Repetitive task like turning lights off
Symmetry:
Intrusive (often violent or sexual)
Somatic: View parts of body etc as abnormal

Question 19

Obsessive Compulsive Personality Disorder

Answer 19

Patient is excessively preoccupied with detail, lists and organization

Question 20

PTSD

Answer 20

1. Witnessed or Experienced a traumatic Event (really Asante said you must experience a near death event) which caused intense fear and anxiety .
2. Persistent re-experiencing of the event
3. Avoidance of stimuli associated with the event
4. Hypervigilence with increased arousal.

SYMPTOMS MUST BE FOR AT LEAST ONE MONTH.
Often abuse and depression are comorbid

Question 21

Treatment of PTST

Answer 21

SSRI, TCA and MAOi . Anticonvulsants also

Behavioral therapy is useful

Question 22

Acute Stress Disorder

Answer 22

Stressor occurred less than a month previously and Symptoms last less than 1 month

Symptoms otherwise are similar to

Question 23

Generalized Anxiety Disorder

Answer 23

Excessive anxiety and worry about daily events and activities (many aspects of daily life) for at least 6 MONTHS

Must be associated with 3 of the following : Restlessness, Fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance. `

Question 24

Treatment of Generalized Anxiety Disorder

Answer 24

Antidepressants :SSRI , buspirone, venlafexine

Benzodiazepines: Clozepam and Diazepam. Should be tapered off due to risk of dependence.