Anxiety Disorder

Question 1

• Characterized by excessive and persistent worrying that is hard to control, causes significant distress, and occurs more days than not for at least six months
• Very common
• Lifetime prevalence between 5.1 and 11.9%
• Twice as common in women

Answer 1

Anxiety Disorder

Question 2

Generalized anxiety disorder goes “hand in hand” with which psychiatric conditions?

Answer 2

• Depression
• Specific phobias
• “medically unexplained” chronic pain

Question 3

Clinical manifestations:
- Most do not present with “excessive worry”
- If asked typically will admit to worrying excessively about minor matters
- Hyperarousal and muscle tension common
- Poor sleep
- Fatigue
- Difficulty relaxing
- Headaches
- Pain in the neck, shoulder, and back

Answer 3

Anxiety Disorder

Question 4

GAD-7 questions

Answer 4

• Feeling nervous, anxious or on edge?
• Not being able to stop or control worrying?
• Worrying too much about different things
• Trouble relaxing
• Being restless that it is hard to sit still
• Feeling afraid as if something awful might happen

Question 5

Treatment of Generalized Anxiety

Answer 5

• CBT, medication, or both
• SSRI or SNRI are the typical medication classes used as first line

Question 6

What is Panic disorder?

Answer 6

People who experience multiple panic attacks

Question 7

What is a panic attack?

Answer 7

• Spontaneous, discrete episode of intense fear that begins abruptly and lasts for several minutes to an hour
• Multiple recurrent episodes with panic disorder

Question 8

Dx criteria of panic attack

Answer 8

• four or more of the following 13 symptoms occur:
• Palpitations, pounding heart, or accelerated heart rate
• Sweating
• Trembling or shaking
• Sensations of shortness of breath
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal distress
• Feeling dizzy, unsteady, light-headed, or faint
• Chills or heat sensations
• Paresthesias (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (feeling detached from oneself)
• Fear of losing control or “going crazy”
• Fear of dying

Question 9

Somatic sx of panic attack

Answer 9

• Chest pain, shortness of breath, abdominal pain, dizziness
• Leads to multiple tests to exclude organic cause of symptoms

Question 10

Treatment of panic attacks

Answer 10

• Panic attacks require anxiolytics
  Benzodiazepines
  Clonazepam, lorazepam, diazepam, alprazolam
• Tend to avoid chronic use of Benzos due to addiction risk
• Risk of withdrawal if stopped abruptly after chronic use
• Antihistamines such as hydroxyzine may also be tried

Question 11

Long term treatments for panic attacks

Answer 11

SSRIs
SNRI, Venlafaxine

Question 12

How can SSRIs/SNRI treat panic attacks

Answer 12

Reduce frequency of panic attacks
Severity of anxiety
Degree of phobic avoidance

Question 13

Will SSRI/SNRI break an active panic attack

Answer 13

Will not break an active panic attack