anxiety and adjustment disorders Flashcards
1
Q
anxiety NTs
A
- increase NE
- decreased GABA
- decreased 5HT
2
Q
medical causes of anxiety
A
- hyperthyroidism
- B12 deficiency
- hypoxia
- neurological d/os
- CV disease
- anemia
- pheo
- hypoglycemia
3
Q
mx/substances causing anxiety
A
- caffeine
- theophylline
- amphetamines
- alcohol/sedative w/drawal
- mercury/arsenic toxicity
- organophosphate or benzene toxicity
- PCN
- sulfonamides
- sympathomimetics
- antidepressants
4
Q
panic attacks
A
- peak w/in 10 min, last < 25 min
- at least 4 of: palpitations, sweating, shaking, SOB, choking sensation, chest pain, nausea/abdominal distress, light-headedness, depersonalization/derealization, fear of losing control, fear of dying, numbness/tingling, chills, hot flushes
- 1st attack often follows pd of stress/physical exertion
- assoc with medical conditions: MVP, asthma, PE, angina, anaphylaxis
5
Q
panic d/o: diagnosis
A
- spontaneous recurrent panic attacks
- avg 2x per week, but range to only few times per year
- at least 1 attack followed by minimum 1 mo of: persistent concern about another attack, worry about implications of attack, change in behavior related to attack
- specify whether WITH or W/O agoraphobia
6
Q
pt with chest pain and nl angiogram
A
- 40% may have panic disorder
7
Q
panic d/o: pathophys
A
- biological, genetic, psychosocial
- dysregulation of ANS, CNS, cerebral blood flow
- increased NE, decreased 5HT and GABA
- may be induced by caffeine, nicotine, hyperventilation
8
Q
panic d/o: epidemiology
A
- 2-5% lifetime prevalence
- females 2-3x more than males
- 4-8x risk if first degree relative affected
- onset late teens to early 30s
9
Q
panic d/o: prognosis
A
- variable course, often chronic
- relapses common with d/c of mx
- 10-20% have significant sx interfering with fn
- 50%: mild, infrequent sx
- 30-40%: free of sx after d/c
10
Q
panic d/o: tx
A
- SSRIs are best long-term tx; esp paroxetine and sertraline
- start at low dose and increase slowly
- BZOs effective immediately, only short-term tx
- tx for at least 8-12 mos
- relaxation, biofeedback, cognitive tx, psychotherapy
11
Q
agoraphobia
A
- anxiety –> avoidance
- often develops 2ary to panic attacks
- dx alone or as panic d/o with agoraphobia (50-75% of panic d/o have agoraphobia)
- usually resolves with tx of coexistent panic d/o
- chronic and debilitating if not assoc with panic d/o
12
Q
specific phobia diagnosis
A
- persistent excessive fear by specific situation/object
- exposure to situation bringing about immediate anxiety response
- patient recognizes that fear is excessive
- situation avoided when possible
- if under age 18, must be at least 6 mos duration
13
Q
social phobia
A
- same criteria as specific phobia
- situation related to social settings
14
Q
phobias: epidemiology
A
- most common mental d/os in US
- 5-10% of population
- specific phobia more common than social phobia
- women 2x than men
- social phobia equal in men and women
- substance d/os often comorbid
- 1/3 have assoc major depression
15
Q
phobias: tx
A
- specific phobias: pharmacotherapy not found effective; behavior therapy (systemic desensitization) effective + short BZO/betaB course as necessary
- social phobia: paroxetine, betaBs (performance anxiety) + cognitive/behavioral therapy adjuncts
16
Q
OCD: diagnosis
A
EITHER obsessions or compulsions (75% have both)
- recurrent intrusive thoughts that increase anxiety; relieved by compulsions
- ego-dystonic
- obsessions: recurrent/persistent cause anxiety, attempt to suppress, pt realizes they are products of own mind
- compulsions: repetitive behaviors in response to obsession, aimed at reducing distress
17
Q
OCD: epidem
A
- 2-3% lifetime prevalence
- onset early adulthood
- men = women
- assoc with MDD, eating do, anxiety do, OCPD
- higher rate in pts with 1st degree relatives with Tourette
18
Q
OCD: pathophys
A
- abnl serotonin regulation
- genetics
- assoc with head injury, epilepsy, basal ganglia, dos, postpartum conditions
- 60% of pts: triggered by stresful life event
19
Q
OCD: prognosis
A
- 30% pts show significant improvement with tx
- 40-50% moderate improvement
- 20-40%: same or worse
20
Q
OCD: tx
A
- SSRIs are 1st line, may require high dose
- TCAs: CLOMIPRAMINE
- behavioral therapy + pharmacotherapy best bet - exposure and response prevention
- ECT or surgery in severe refractory cases
21
Q
PTSD: diagnosis
A
- presence of traumatic experience
- persistent avoidance
- hyperarousal or increased psychological/physiological tension
- reexperiencing traumatic event
- MORE THAN 1 MONTH
- high incidence of assoc substance abuse and depression: AVOID BZOs for tx
22
Q
PTSD: prognosis
A
- 50% symptom free after 3 mos tx
23
Q
PTSD: tx
A
- SSRIs, TCAs (imipramine, doxepin), MAOIs
- anticonvulsants (for flashbacks/nightmares)
- therapy, relaxation, support groups
24
Q
acute stress do: diagnosis
A
- patients experience major traumatic event but experience sx for < 1 mo and w/in 1 mo of trauma
- similar sx and tx to PTSD
25
GAD: diagnosis
- persistent, excessive hyperarousal and anxiety about daily events
- AT LEAST 6 MONTHS
- assoc with 3+ of: restlessness, fatigue, difficulty concentrating, irritability, mm tension, sleep disturbance
26
GAD: epidemiology
- 45% lifetime prevalence
- women 2x as men
- onset before age 20
- 50-90% have coexisting mental d/o, esp MDD, phobia, panic do
27
GAD: prognosis
- chronic, lifelong, fluctuating in 50%
| - other 50% completely recover with several years of therapy
28
GAD: tx
- SSRIs, buspirone, venlafaxine
| - BZOs for acute episodes byt should be TAPERED WHEN POSSILBE
