Anxiety and Adjustment Disorders

Question 1

What are some classic symptoms of anxiety?

Answer 1

palpitations, tachycardia, hypertension
SOB, choking sensation
Dizziness, light-headed, hyperreflexia, mydriasis, tremors, tingling in the peripheral extremities
restlessness, seating, GI upset, urinary urgency and frequency

Question 2

What are some neurotransmitter imbalances associated with anxiety?

Answer 2

increased NE
decreased GABA
decreased 5HT

Question 3

What are some medical causes of anxiety disorders?

Answer 3

hyperthyroidism
vitamin B12 deficiency
hypoxia
epilepsy, brain tumors, MS, CVA
cardiovascular disease
anemia
pheochromocytoma
hypoglycemia

Question 4

What are some medication or substance induced anxiety disorders?

Answer 4

Caffeine intake/withdrawal
theophylline
amphetamines
alcohol and sedative withdrawal
mercury or arsenic toxicity
organophosphate or benzene toxicity
penicillin
sulfonamides
sympathomimetics
antidepressants

Question 5

What is the lifetime prevalence of anxiety in women? men?

Answer 5

30% in women and 19% in men

Question 6

True or false: anxiety is more common in lower socioeconomic groups.

Answer 6

false - actually worse in higher socioeconomic groups

Question 7

Describe a panic attack.

Answer 7

It’s a discrete period of heightened anxiety and fear, peaking within 10 minutes and usually less than 25 minutes

can be provoked or spontaneous

must have at least 4 of the following: palpitations, sweating, shaking, SOB, choking sensation, chest pain, nausea, lightheadedness, depersonalization, derealization, fear of losing control, fear of dying, numbness or tingling, chills or hot flushes.

Question 8

Panic disorder is characterized by spontaneous, recurrent panic attacks without an obvious precipitant. How often do panic attacks typically occur?

Answer 8

on average 2 times/week, but this can vary significantly

Question 9

What is the best long-term treatment for panic disorder?

Answer 9

SSRIs - especially paroxetine and sertraline (start low and then increase)

benzodiazepines are effective immediately, but can cause tolerance and dependency

Question 10

How long should treatment continue for panic disorder?

Answer 10

8-12 months because relapse is very common after discontinuation

Question 11

What is agoraphobia and how does it relate to panic disorder?

Answer 11

the fear of being alone in public places - often develops secondary to panic attacks due tot he apprehension about having subsequent attacks in a public place where escape may be difficult

Question 12

Which is more debilitating - agoraphobia with panic disorder or without panic disorder?

Answer 12

without panic disorder (if it’s associated with panic disorder, treating the panic will usually resolve the agoraphobia)

Question 13

What is the most common mental disorder in the US?

Answer 13

phobias (at least 5-10% of the population at any given time)

Question 14

What is the average age of onset for social phobias?

Answer 14

mid-teens

Question 15

What percentage of patients with a phobia will have comorbid depression?

Answer 15

a third

Question 16

What is the most effective treatment for a specific phobia?

Answer 16

Behavior therapy

Question 17

What is the difference between systemic desensitization and flooding?

Answer 17

desensitization is the gradual exposure of a patient to the feared object/situation, while flooding is directly confronting the patient with their full fear

Question 18

What is the most effective therapy for social phobia?

Answer 18

Paroxetine for social anxiety disorder

beta blockers for performance anxiety

Question 19

What’s the difference between an obsession and a compulsion?

Answer 19

an obsession is a recurrent and intrusive thought feeling or idea that is egodystonic

a compulsion is a conscious repetitive behavior linked to an obsession that functions to relieve the anxiety caused by the obsession

Question 20

True or false: people with OCD typically do not have insight into the irrationality of their behaviors.

Answer 20

false - they typically do have this insight and it causes them significant distress

Question 21

What neurotransmitter is linked to OCD?

Answer 21

abnormal serotonin regulation

Question 22

What percentage of individuals with OCD show significant improvement with therapy?

Answer 22

only 30%

450-50% have some improvement and 20-40% remain significantly impaired or experience worse symptoms

Question 23

Describe exposure and response prevention therapy for OCD.

Answer 23

It involves prolonged exposure to the ritual-eliciting stimulus and prevention of the relieving compulsion (like having the patient touch a dirty floor without washing his/her hands)

Question 24

What is the main difference between OCD and obsessive compulsive personality disorder?

Answer 24

Patient with OCD are distressed by their obsessions and compulsions - it’s egodystonic

Patients with obsessive compulsive personality disorder do not perceive a problem - egosyntonic

Question 25

What are the criteria for PTSD?

Answer 25

patient has experienced a witnessed a traumatic event

they persistently reexperience the event (dreams, flashbacks), avoid the stimuli associated with the trauma, and experiencing numbing of responsiveness (limited affect, estrangement) and persistently increased arousal (difficulty sleeping, hypervigilance, exaggerated startle response)

these symptoms need to be present for at least 1 month

Question 26

What are the typical treatments for PTSD?

Answer 26

antidepressants (esp SSRIs), anticonvulsants for the flashbacks and nightmakres, CBT, eye movement desensitization and reprocessing

Question 27

If someone is experiencing symptoms like PTSD, but these have been present for less than 1 month, what is the diagnosis?

Answer 27

acute stress disorder

Question 28

What are the criteria for generalized anxiety disorder?

Answer 28

at least 6 months of excessive anxiety and worry about daily events with three out of the following:
restlessness
fatigue
difficulty concentrating
irritability
muscle tension
sleep disturbance

Question 29

GAD is very common in the general population - what is the lifetime prevalence?

Answer 29

45%

Question 30

What is the typical therapy for GAD?

Answer 30

an SSRI, buspirone or venlafaxine with CBT