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Anxiety Disorders 1 Flashcards

1
Q

What is the definition of a panic attack?

A

A sudden, discrete episode of intense fear or discomfort

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2
Q

What is the usual timeline of a panic attack?

A

Usually peaks within ten mins, most end within 20-30 and rarely over an hour (but patients may feel anxious for hours after)

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3
Q

What is the hallmark sign of a panic attack?

A

Sense of impending fear or doom

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4
Q

What is the diagnostic criteria of a panic attack?

A

At least four of the following symptoms of sympathetic system overdrive
-Dizziness
-Trembling
-Choking feeling
-Parasthesias
-Sweating
-SOB
-CP/discomfort
-Chills or hot flashes
-Fear of losing control
-Fear of dying
-Palpitations / tachy
-Nausea or abd distress
-Depersonalization or derealization

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5
Q

Define depersonalization

A

Feeling detached from onself

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6
Q

Define derealization

A

Feeling of unreality

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7
Q

What is first line for panic attacks?

A

Benzos

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8
Q

What must you do in work up of panic attacks?

A

Rule out life threatening conditions (MI, thyrotoxicosis, etc)

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9
Q

Are panic attacks an anxiety disorder?

A

Not on their own, but are a feature of many anxiety disorders

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10
Q

What is the average age of onset of panic disorder?

A

Early to mid 20s

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11
Q

What adds to the risk of panic disorder

A

1st degree relative diagnosed

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12
Q

> 60% of patients with panic disorder also have ______

A

major depression

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13
Q

Panic disorder is more common in (gender)

A

Females

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14
Q

What are the diagnostic criteria for panic disorder?

A
  1. At least 2 recurrent, unexpected panic attacks (may or may not be related to a trigger)
  2. At least one of the following for at least one month:
    -Panic attacks are followed by concern about future attacks
    -Persistent worry about the implications of the attacks (loss of control)
    -Significant maladaptive behavior related to the attacks
  3. Symptoms are not due to substance use, medical condition or another mental disorder
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15
Q

Diagnostic criteria for panic disorder:

  1. At least ______________ (may or may not be related to a trigger)
  2. At least one of the following for at least one month:
    -Panic attacks are followed by concern about future attacks
    -Persistent worry about the implications of the attacks (loss of control)
    -Significant maladaptive behavior related to the attacks
  3. Symptoms are not due to substance use, medical condition or another mental disorder
A

2 recurrent, unexpected panic attack

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16
Q

Diagnostic criteria for panic disorder:

  1. At least 2 recurrent, unexpected panic attacks ____________________
  2. At least one of the following for at least one month:
    -Panic attacks are followed by concern about future attacks
    -Persistent worry about the implications of the attacks (loss of control)
    -Significant maladaptive behavior related to the attacks
  3. Symptoms are not due to substance use, medical condition or another mental disorder
A

(may or may not be related to a trigger)

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17
Q

Diagnostic criteria for panic disorder:

  1. At least 2 recurrent, unexpected panic attacks (may or may not be related to a trigger)
  2. At least ___ of the following for at least _____:
    -Panic attacks are followed by concern about future attacks
    -Persistent worry about the implications of the attacks (loss of control)
    -Significant maladaptive behavior related to the attacks
  3. Symptoms are not due to substance use, medical condition or another mental disorder
A

One, one month

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18
Q

Diagnostic criteria for panic disorder:

  1. At least 2 recurrent, unexpected panic attacks (may or may not be related to a trigger)
  2. At least one of the following for at least one month:
    -___________________
    -Persistent worry about the implications of the attacks (loss of control)
    -Significant maladaptive behavior related to the attacks
  3. Symptoms are not due to substance use, medical condition or another mental disorder
A

Panic attacks are followed by concern about future attacks

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19
Q

Diagnostic criteria for panic disorder:

  1. At least 2 recurrent, unexpected panic attacks (may or may not be related to a trigger)
  2. At least one of the following for at least one month:
    -Panic attacks are followed by concern about future attacks
    -___________
    -Significant maladaptive behavior related to the attacks
  3. Symptoms are not due to substance use, medical condition or another mental disorder
A

Persistent worry about the implications of the attacks (loss of control)

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20
Q

Diagnostic criteria for panic disorder:

  1. At least 2 recurrent, unexpected panic attacks (may or may not be related to a trigger)
  2. At least one of the following for at least one month:
    -Panic attacks are followed by concern about future attacks
    -Persistent worry about the implications of the attacks (loss of control)
    -_________
  3. Symptoms are not due to substance use, medical condition or another mental disorder
A

Significant maladaptive behavior related to the attacks

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21
Q

Diagnostic criteria for panic disorder:

  1. At least 2 recurrent, unexpected panic attacks (may or may not be related to a trigger)
  2. At least one of the following for at least one month:
    -Panic attacks are followed by concern about future attacks
    -Persistent worry about the implications of the attacks (loss of control)
    -Significant maladaptive behavior related to the attacks
  3. ____________________
A

Symptoms are not due to substance use, medical condition or another mental disorder

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22
Q

What medical conditions could cause panic attack-like presentation?

A

Thyroid
Hypoglycemia
Cardiac

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23
Q

What is first line for long term treatment of panic disorder?

A

-SSRIs (can also use SNRIs)
-CBT

24
Q

What is second line for long term management of panic disorder?

A

TCAs (if SSRIs are ineffective)

25
Q

What is the most effective combo for treatment of panic disorder?

A

Pharmacotherapy and CBT

26
Q

What is first line for acute panic disorder?

A

Benzodiazepines (Alprazolam, Clonezepam)

27
Q

If necessary, you can start _____ and ____ for panic disorder, and then taper and discontinue ______

A

SSRIs and Benzos
Benzos

28
Q

Define agoraphobia

A

Intense fear or anxiety about being in places or situations from which escape or obtaining help may be difficult

29
Q

Agoraphobia may present as fear of ____

A

-Open spaces (such as bridges)
-Enclosed spaces
-Crowds
-Public transit
-Being away from home alone

30
Q

Agoraphobia often presents with ____, but is now seen as a separate entity

A

Panic disorder

31
Q

In agoraphobia, the triggering situation causes _______

A

fear or anxiety out of proportion to the potential danger

32
Q

Agoraphobia symptoms must meet what three criteria

A

-At least six months
-Significant social or occupational dysfunction
-Not better explained by another disorder

33
Q

What are risk factors for agoraphobia?

A

Strong genetic factor
Possibly follows a traumatic event

34
Q

How is agoraphobia managed?

A

CBT and SSRIs (similar to panic disorder)

35
Q

General Anxiety Disorder is more common in (gender)

36
Q

Onset of GAD symptoms usually occurs in (age)

37
Q

GAD Diagnostic Criteria:

  1. Excessive_____ a majority of days for at least six months about various aspects of life
    -The anxiety is usually out of proportion to the event
  2. Associated with at least three symptoms:
    -Fatigue, restlessness, difficulty concentrating, muscle tension, sleep disturbance, irritability, shakiness, headaches
  3. Anxiety is not episodic
  4. Symptoms cause significant occupational or social dysfunction
  5. Not due to medical illness or substance abuse
A

anxiety or worry

38
Q

GAD Diagnostic Criteria:

  1. Excessive anxiety or worry_______ about various aspects of life
    -The anxiety is usually out of proportion to the event
  2. Associated with at least three symptoms:
    -Fatigue, restlessness, difficulty concentrating, muscle tension, sleep disturbance, irritability, shakiness, headaches
  3. Anxiety is not episodic
  4. Symptoms cause significant occupational or social dysfunction
  5. Not due to medical illness or substance abuse
A

a majority of days, for at least six months

39
Q

GAD Diagnostic Criteria:

  1. Excessive anxiety or worry a majority of days for at least six months about______
    -The anxiety is usually out of proportion to the event
  2. Associated with at least three symptoms:
    -Fatigue, restlessness, difficulty concentrating, muscle tension, sleep disturbance, irritability, shakiness, headaches
  3. Anxiety is not episodic
  4. Symptoms cause significant occupational or social dysfunction
  5. Not due to medical illness or substance abuse
A

various aspects of life

40
Q

GAD Diagnostic Criteria:

  1. Excessive anxiety or worry a majority of days for at least six months about various aspects of life
    -The anxiety is usually _______
  2. Associated with at least three symptoms:
    -Fatigue, restlessness, difficulty concentrating, muscle tension, sleep disturbance, irritability, shakiness, headaches
  3. Anxiety is not episodic
  4. Symptoms cause significant occupational or social dysfunction
  5. Not due to medical illness or substance abuse
A

out of proportion to the event

41
Q

GAD Diagnostic Criteria:

  1. Excessive anxiety or worry a majority of days for at least six months about various aspects of life
    -The anxiety is usually out of proportion to the event
  2. Associated with at least ___symptoms:
    -Fatigue, restlessness, difficulty concentrating, muscle tension, sleep disturbance, irritability, shakiness, headaches
  3. Anxiety is not episodic
  4. Symptoms cause significant occupational or social dysfunction
  5. Not due to medical illness or substance abuse
42
Q

GAD Diagnostic Criteria:

  1. Excessive anxiety or worry a majority of days for at least six months about various aspects of life
    -The anxiety is usually out of proportion to the event
  2. Associated with at least three symptoms:
    _______
  3. Anxiety is not episodic
  4. Symptoms cause significant occupational or social dysfunction
  5. Not due to medical illness or substance abuse
A

-Fatigue
-Restlessness
-Difficulty concentrating
-Muscle tension
-Sleep disturbance
-Irritability
-Shakiness
-HA

43
Q

GAD Diagnostic Criteria:

  1. Excessive anxiety or worry a majority of days for at least six months about various aspects of life
    -The anxiety is usually out of proportion to the event
  2. Associated with at least three symptoms:
    -Fatigue, restlessness, difficulty concentrating, muscle tension, sleep disturbance, irritability, shakiness, headaches
  3. Anxiety is not _____
  4. Symptoms cause significant occupational or social dysfunction
  5. Not due to medical illness or substance abuse
44
Q

GAD Diagnostic Criteria:

  1. Excessive anxiety or worry a majority of days for at least six months about various aspects of life
    -The anxiety is usually out of proportion to the event
  2. Associated with at least three symptoms:
    -Fatigue, restlessness, difficulty concentrating, muscle tension, sleep disturbance, irritability, shakiness, headaches
  3. Anxiety is not episodic
  4. Symptoms cause significant______
  5. Not due to medical illness or substance abuse
A

occupational or socal dysfunction

45
Q

GAD Diagnostic Criteria:

  1. Excessive anxiety or worry a majority of days for at least six months about various aspects of life
    -The anxiety is usually out of proportion to the event
  2. Associated with at least three symptoms:
    -Fatigue, restlessness, difficulty concentrating, muscle tension, sleep disturbance, irritability, shakiness, headaches
  3. Anxiety is not episodic
  4. Symptoms cause significant occupational or social dysfunction
  5. Not due to ______
A

medical illness or substance abuse

46
Q

What is first line tx for GAD?

A

SSRIs and CBT

47
Q

What can be used as an alternative to SSRIs in GAD?

48
Q

What med can be an adjunct to SSRIs in GAD?

49
Q

What is a benefit of Buspirone in GAD?

A

It does not cause sedation or potentiate CNS depression of alcohol (almost no abuse or addiction potential)

50
Q

What is the ideal combination treatment for GAD?

A

CBT + pharmacotherapy

51
Q

What can be used for short term bridging in GAD?

52
Q

What alternative meds can be used in GAD?

A

Beta blockers or TCAs

53
Q

What is the MOA of Buspirone?

A

Partial serotonin receptor (5HT-1A0 agonist and dopamine receptor agonist

54
Q

How long does Buspirone take to become effective

55
Q

What are adverse effects of Buspirone?

A

HA
Nausea
Dizziness
RLS
Extrapyramidal symptoms

Behavioral Health (19 decks)

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