Anxiety and Related disorders

Question 1

What is the prognosis of the anxiety disorders?

Answer 1

• 1/3 sx free
• 1/3 sx improve
• 1/3 no improvement, poor life

Question 2

When does anxiety become pathological?

Answer 2

• fear out of proportion
• sx persist/are continuous (even after removal of threat)
• functional impairment
• comorbid mental conditions (eg. depression, substance use)

Question 3

What is the DSM-V criteria for GAD?

Answer 3

• excessive anxiety + worry
• difficult to control
• at least 6 months (more days that not)
• with 3 or more associated Sx (CFIRST)
• causing sig distress and/or fxn impairment
• not due to MMS

Question 4

List the associated sx for GAD

Answer 4

CFIRST

• concentration issues / mind blank
• fatigue
• irritability
• restlessness / on edge
• sleep disturbances
• tension (muscles, headaches)

Question 5

when is the usual age of onset for GAD

Answer 5

adolescence

Question 6

How do you treat GAD?

What is the time until sx improvement?

Answer 6

CBT

• cog restructuring
• exposure therapy
• relaxation and breathing techniques

Pharms

• SSRI (1st line) - 6-8wks until effect (can be 10-12)
• BZD (quick action, caution) - days
• Buspirone (refractory GAD)

Question 7

What are the adv + disadv of BZD?

Answer 7

Adv

• quick onset
• relieve sx quickly

Disadv

• habit forming
• tolerance + withdrawal
• cause resp depression in all
• cause paradoxical disinhibition (hyperactive, aggressive, suicidal) in kids and elderly

Question 8

Names + dosages of common SSRIs

Answer 8

• Escitalopram 10-20mg
• Citalopram 20-50mg
• Fluoxetine 20-60mg
• Paroxetine 20-60mg
• Sertraline 50-200mg

Question 9

What is a panic attack

Answer 9

• abrupt, unexpected
• surge of intense fear/anxiety
• peak within minutes (10-20)
• with 4 or more physical/psychologic sx of intense anxiety/autonomic arousal

Question 10

What is a limited sx attack

Answer 10

• same criteria as panic attack
  BUT
• less than 4 associated sx of intense anxiety/autonic arousal

Question 11

what are the associated sx in the criteria for panic and limited sx attacks?
- STUDENTS FEAR THE 3 C’s

Answer 11

• Sweating
• Trembling
• Unsteadiness, dizziness
• Depersonalization/derealization
• Excessive heart rate, palpitations
• Nausea
• Tingling
• Shortness of breath
• FEAR of dying, losing control, going crazy
• 3C’s - chest pains, chills, choking

Question 12

What is the DSM-V criteria for Panic DISORDER?

Answer 12

- Recurrent, unexpected panic attacks 
with 1/both of the following for at least 1 month
- continuous worries about the attacks 
- dysfxnal behav due to the attacks 
following at least 1 prev attack 
* pt sx free between attacks

Question 13

Psychotherapy for Panic disorder

Answer 13

• CBT (cognitive restructuring)
• exposure (desensitization)
• relaxation, breathing

Question 14

Pharmacotherapy for Panic disorder

Answer 14

SSRI
BZD
- prophylaxis = Alprazolam, Clonazepam
- acute = lorazepam 0.5-2mg + rx SSRI SE

Question 15

What is the duration of the fear of a Specific Phobic d/o?

Answer 15

> 6 months

Question 16

How do you treat a specific phobic disorder?

Answer 16

CBT

Question 17

What is social anxiety disorder?

Answer 17

• intense fear/anxiety (> 6 mo)
• in social and/or performance situations
• where unfamiliar people and possible scrutiny
• if act in embarassing or humiliating way

Question 18

What is unique about social anxiety disorder?

Answer 18

It is the only phobic disorder that responds to pharmacotherapy

• SSRI, B blocker
• avoid alcohol + BZD

Question 19

Which 5 situations can a person with Agoraphobia fear?

Answer 19

• using public transport
• wide open spaces
• enclosed spaces
• standing in line / being in a crowd
• being out of the house alone

Question 20

How does Agoraphobic affect pts life?

Answer 20

• situation are actively avoid / endured with great distress / always require company
• in the fear that escape may be difficult
• or no help available if they get panic attack sx or embarrassing sx (fall, incontinence)

Question 21

What are the specifier for Substance/medication induced anxiety disorder?

Answer 21

• specified according to onset

- during intoxication / withdrawal or shortly after exposure

Question 22

Explain the process of discontinuing Rx for anxiety disorders

Answer 22

- treatment is usually lifelong 
discontinuation can only be considered when 
- 1 yr full remission (sx free) 
- full functional restoration 
- pt has sense of well being 
- it is the right time in pts life 
- taper down slowly over months 
- if relapse, restart Rx immediately at effective dose