Anxiety and Adjustment Disorders

Question 1

NT imbalances of anxiety?

Answer 1

1) High NE

2) Low GABA and serotonin

Question 2

What are panic attacks assoc with?

Answer 2

1) MVP
2) Asthma
3) PE
4) Angina
5) Anaphylaxis

Question 3

Chest pain with normal angiograms?

Answer 3

Panic disorder 40% of time

Question 4

Panic disorder tx?

Answer 4

1) Long term = SSRIs (paroxetine and sertraline)
2) Maybe clomipramine or imipramine
3) Immediate tx = BZDs (watch for tolerance and dependency)

Question 5

How long must you tx panic disorder?

Answer 5

8-12 months (relapse is common)

Question 6

How do you tx agoraphobia?

Answer 6

Tx the panic disorder

Question 7

What do you watch for in phobic pts?

Answer 7

1) Alcohol dependence

2) MDD

Question 8

Tx for specific phobia?

Answer 8

Behavior therapy (NOT drugs) and systemic desensitization; short course of BZDs or beta blockers to control autonomic sxs

Question 9

Tx for social phobia?

Answer 9

1) Paroxetine
2) Propranolol for performance anxiety
3) Assertiveness training

Question 10

Comorbid with OCD?

Answer 10

Tourette’s and ADHD, eating disorders

Question 11

Neurochemical imbalances in OCD?

Answer 11

Abnormal serotonin (which is why SSRIs work for tx)

Question 12

Medical conditions assoc with OCD?

Answer 12

Head injury, epilepsy, basal ganglia disorders, postpartum conditions

Question 13

OCD tx?

Answer 13

1) SSRIs 1st line
2) Clomipramine
3) Behavioral therapy
4) Exposure and response prevention (ERP)
5) ECT or cingulotomy (last resort)

Question 14

PTSD tx?

Answer 14

1) Antidepressants = SSRIs, TCAs (imipramine or doxepin), MAOIs
2) Anticonvulsants (for flashback and nightmares)

Question 15

What meds must be avoided in tx PTSD?

Answer 15

Addictive meds (BZDs) due to high rate of substance abuse in these pts

Question 16

GAD tx?

Answer 16

1) SSRIs
2) SNRIs (venlafaxine)
3) Buspirone
4) BZDs (clonazepam or diazepam)

Question 17

How do you give BZDs when tx GAD?

Answer 17

Must be tapered off when possible due to risk of tolerance and dependence