anxiety and stress disorders Flashcards

Question

Vistaril

Answer 1

hydroxyzine

Answer 2

hydroxyzine

Answer 3

**drowsiness**, dizziness, dry mouth, rash, fatigue, respiratory depression

Answer 4

**potassium**, MAOIs, CNS depressants

Answer 5

allergy to med 1st trimester of pregnancy, administration via SC, IV, or intra-arterial routes

Answer 6

Buspirone (Buspar) ## Footnote No abuse/dependence potential, no withdrawal

Answer 7

Buspirone ## Footnote Less anxiolytic effects than BZDs

Answer 8

1. **dizziness**, drowsiness, nausea, headache 2. Concern over potential for *Serotonin Syndrome*

Answer 9

other psych meds, CNS depressants

Answer 10

women (2x) 35+ comorbidities - MDD, substance abuse, other anxiety disorders, chronic unexplained pain

Answer 11

1. **Excessive anxiety and worry** (apprehensive expectation) more days than not - about **multiple things** - for at least **6 months** - Patient finds it **difficult to control** 2. Anxiety/worry associated with **3+** of the following: - Restlessness or feeling keyed up/on edge - Being easily fatigued - Difficulty concentrating 3. Syndrome causes *distress* and/or *functional impairment* 4. Syndrome is *not* due to substance abuse or medical condition

Answer 12

**persistent worry** + **hyperarousal** - More worry over minor matters - Somatic s/s - muscle tension, headaches, neck and back pain

Answer 13

1. _Generalized Anxiety Disorder-7 (GAD-7)_ - **Initial screening** for GAD - Monitor severity of s/s and response to tx 2. _Beck Anxiety Inventory_ - **21-question self-reported** inventory of s/s - Can be used for GAD or other anxiety disorders - No overlap with depressive s/s

Answer 14

1. First-Line - **SSRI/SNRI, CBT, or both** - BZDs - short-term for severe s/s 2. second-line - **TCAs, buspirone** - BZDs have been used for long-term tx in some patients - Mirtazapine, 5HT modulators, Pregabalin (Lyrica), 2nd gen antipsychotics 3. Adjunct - Relaxation techniques, acupuncture, exercise | Therapy continued for 6-12 months

Answer 15

panic attacks

Answer 16

Agoraphobia ## Footnote Separate diagnosis in DSM-V

Answer 17

1. **Abrupt surge of intense fear/discomfort that peaks within minutes** 2. Accompanied by **4+** of the following: * Palpitations, pounding heart, or accelerated heart rate * Sweating * Trembling or shaking * Sensations of shortness of breath, choking, or smothering * Chest pain or discomfort * Nausea or abdominal distress * Feeling dizzy, unsteady, lightheaded, or faint * Chills or heat sensations * Paresthesias * Derealization or depersonalization * Fear of losing control, dying, or "going crazy" 2. Recurrent unexpected panic attacks 3. **1+ attacks** have been followed by **1+ months** *of one or both* of the following: * Persistent concern or worry about additional panic attacks * or their consequences * Significant maladaptive change in behavior due to the attacks 4. Syndrome is not due to substance or medical condition 5. Syndrome is not better explained by other mental disorder * Panic attacks do not occur only in response to specific triggers

Answer 18

Somatization Disorder

Answer 19

Anxiety Disorders, Depressive Disorders

Answer 20

1. **_First-Line - CBT, SSRI, or combination_** - **Paroxetine** - *sedating effects*, can help calm patients 2. _Second-Line - SNRIs; TCAs_ 3. _Adjunct - BZDs (short-term/PRN use)_ - **Alprazolam** - FDA approved, treats panic disorder, MC for _short time to onset_ - *Risk of dependency, rebound anxiety* - **Clonazepam** - FDA-approved for panic disorder -*Less risk of rebound anxiety*, fewer doses/day - **Lorazepam** and **diazepam**

Answer 21

1. Persistent (**6+ months**) of marked **fear/anxiety** about **2+** of the following: * Using public transportation * Being in open spaces (e.g., parking lots, marketplaces, bridges) * Being in enclosed places (e.g., shops, theaters, cinemas) * Standing in line or being in a crowd * Being outside of the home alone 2. Pt fears/avoids these situations due to **fear that escape might be difficult or help might not be available** in the event of developing incapacitating or embarrassing s/s 3. Syndrome causes distress or functional impairment 4. Syndrome is not better explained by another mental disorder

Answer 22

SSRI, CBT, or both Current guidelines are to treat as one would for panic disorder

Answer 23

1. Persistent (**6+ months**) of marked **fear/anxiety** about **1+ social situations** in which the pt is exposed to **possible scrutiny by others** 2. Pt fears acting in a way or showing anxiety s/s that will be negatively evaluated 3. The social situations almost always provoke fear or anxiety * In children - crying, tantrums, freezing, clinging, shrinking, failing to speak 4. The social situations are **avoided or endured with intense fear or anxiety** 5. Fear/anxiety is **out of proportion** to the actual threat posed 6. Fear/anxiety or avoidance causes **distress or functional impairment** 7. *Not* due to substance use, medical condition, or another psych disorder

Answer 24

If only related to performance and not general social interaction, may use modifier “**performance-only**” (versus “generalized”)

Answer 25

1. _Generalized Social Anxiety Disorder_ * **_First-Line - CBT, SSRI or SNRI, or both_** * May choose to augment with PRN BZD * Continue tx for at least 6-12 months 2. _Performance-Only Social Anxiety Disorder_ * **_PRN BZD_** - 30-60 min before performance * **_PRN beta-blocker_** - Propranolol 20-60 mg, 30-60 min before performance 3. May augment with relaxation techniques

Answer 26

in timing of onset and duration

Answer 27

1. Exposure to **actual or threatened death, serious injury, or sexual violation in 1+** of the following ways: * Directly **experiencing** traumatic event(s) * **Witnessing**, in person, event(s) as it occurred to others * Learning that event(s) occurred to **close family/friend** * Experiencing **repeated or extreme exposure to aversive details** of traumatic event(s) 2. **9+** of the following symptoms from any category, beginning or worsening after event(s) occurred, lasting at least **3 days - 1 month** after trauma: * **Intrusion symptoms** - **Dissociative reactions** * **Negative mood** * **Dissociative symptoms** * **Avoidance symptoms** * **Arousal symptoms**

Answer 28

1. Goal - lessen stress response and reduce or prevent progression to PTSD 2. First-Line - Trauma-oriented **CBT** with incorporated exposure therapy * _Adjunct_ - short-term (~2 weeks) use of _BZDs_ in patients with severe s/s such as agitation or insomnia * May need suicide interventions and inpatient treatment * _Antidepressants_ - often limited due to time to onset of efficacy

Answer 29

2-4x more common * Substance abuse - to self-medicate * Somatization disorder - 90x MC in PTSD * TBI - 60% of TBI pts also have PTSD

Answer 30

1. Exposure to **actual or threatened death, serious injury, or sexual violation** in **1+** of the following ways: * Directly **experiencing** traumatic event(s) * **Witnessing**, in person, event(s) as it occurred to others * Learning that event(s) occurred to **close family/friend** * Experiencing **repeated or extreme exposure to aversive details** of traumatic event(s) 2. **1+ intrusion symptoms** associated with the trauma, beginning after trauma, lasting **1+ month:** * Recurrent, involuntary, and intrusive distressing **memories** of trauma * Recurrent distressing **dreams** related to the trauma * **Dissociative reactions** in which the individual feels or acts as if the trauma were recurring (e.g., flashbacks) * **Psychological distress and/or physiological reactions to cues** (internal or external) that symbolize or resemble the trauma 3. **Alterations in arousal/reactivity** associated with trauma, beginning or worsening after trauma, lasting **1+ months**, as evidenced by **2+** of the following: - Irritable behavior and angry outbursts - Reckless or self-destructive behavior - Hypervigilance - Exaggerated startle response - Problems with concentration - Sleep disturbance 4. Persistent avoidance of stimuli associated with trauma, beginning after trauma and lasting 1+ months, as evidenced by one or both of: - Efforts to avoid distressing memories, thoughts, or feelings about the trauma - Efforts to avoid external reminders that arouse memories, thoughts, or feelings about the trauma 5. Negative changes in cognition/mood, associated with trauma, beginning or worsening after trauma, lasting 1+ months, as evidenced by 2+ of: - Inability to remember an important aspect of the trauma - Exaggerated negative beliefs about oneself, others, or the world - Distorted thoughts about the cause or consequences of the trauma that lead the pt to blame himself/herself or others - Persistent negative emotional state - Markedly diminished interest or participation in significant activities - Feelings of detachment or estrangement from others - Persistent inability to experience positive emotions

Answer 31

1. First-Line -**_Trauma-oriented CBT_** with exposure therapies * Psychotherapy or combination often preferred over pharmacotherapy alone...but not always easy to implement 2. Medications - **SSRIs or SNRIs** * _Atypical antipsychotics_ - refractory cases * _Prazosin (Minipress)_ - α1-adrenergic blocker - insomnia * _BZDs_ - severe agitation, hyperarousal

Answer 32

Obsessive compulsive disorder Most patients suffer from both obsessions and compulsions Many patients recognize their thoughts and behaviors are abnormal and take avoidant actions to hide them

Answer 33

Obsessions - mental event

Answer 34

Compulsions - behavioral event | Not rationally connected or act is clearly excessive

Answer 35

1. Cleaning - fears of contamination; cleaning rituals 2. Symmetry - symmetry obsessions; repeating, ordering, and counting compulsions 3. Forbidden or taboo thoughts - Aggressive, sexual, and religious obsessions; related compulsions 4. Harm - thoughts about harm befalling oneself or others; checking and precautionary compulsions

Answer 36

1. _Good or fair insight_ - recognizes OCD beliefs are definitely or probably not true, or that they may or may not be true 2. _Poor insight_ - thinks OCD beliefs are probably true 3. _Absent insight/delusional beliefs_ - completely convinced that OCD beliefs are true

Answer 37

1. First-Line - **CBT with exposure therapy, SSRI, or combination** * Psychotherapy preferred for OCD alone * Due to high rate of comorbid psych disorders - using SSRI is often beneficial 2. often need higher maintenance doses of SSRI therapy 3. If no response to SSRI - may try other SSRI or SNRI

Answer 38

1. Persistent (**6+ months**) of marked fear/anxiety about a specific object or situation 2. Phobic object/situation **almost always causes** immediate fear/anxiety 3. Phobic object/situation is actively **avoided or endured with intense fear or anxiety** 4. Fear/anxiety is **out of proportion**to the actual danger posed by object/situation 5. Fear/anxiety or avoidance causes **distress or functional impairment** 6. Syndrome is not better explained by another mental disorder

Answer 39

1. _First-Line_ - **CBT with exposure therapy** 2. Second-Line: _Infrequently Encountered Stimulus_ - **PRN treatment with BZD** 3. Second-Line: _Frequently Encountered Stimulus_ - **SSRI, SNRI**

Answer 40

Oxazepam (Serax)

Answer 41

Lorazepam (Ativan)

Answer 42

Clonazepam (Klonopin)

Answer 43

diazepam (valium)