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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
What is the most effective combo for treatment of panic disorder?
Pharmacotherapy and CBT
26
What is first line for acute panic disorder?
Benzodiazepines (Alprazolam, Clonezepam)
27
If necessary, you can start _____ and ____ for panic disorder, and then taper and discontinue ______
SSRIs and Benzos Benzos
28
Define agoraphobia
Intense fear or anxiety about being in places or situations from which escape or obtaining help may be difficult
29
Agoraphobia may present as fear of ____
-Open spaces (such as bridges) -Enclosed spaces -Crowds -Public transit -Being away from home alone
30
Agoraphobia often presents with ____, but is now seen as a separate entity
Panic disorder
31
In agoraphobia, the triggering situation causes _______
fear or anxiety out of proportion to the potential danger
32
Agoraphobia symptoms must meet what three criteria
-At least six months -Significant social or occupational dysfunction -Not better explained by another disorder
33
What are risk factors for agoraphobia?
Strong genetic factor Possibly follows a traumatic event
34
How is agoraphobia managed?
CBT and SSRIs (similar to panic disorder)
35
General Anxiety Disorder is more common in (gender)
Females
36
Onset of GAD symptoms usually occurs in (age)
early 20s
37
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
anxiety or worry
38
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 majority of days, for at least six months
39
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
various aspects of life
40
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
out of proportion to the event
41
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
3
42
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
-Fatigue -Restlessness -Difficulty concentrating -Muscle tension -Sleep disturbance -Irritability -Shakiness -HA
43
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
episodic
44
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
occupational or socal dysfunction
45
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 ______
medical illness or substance abuse
46
What is first line tx for GAD?
SSRIs and CBT
47
What can be used as an alternative to SSRIs in GAD?
SNRIs
48
What med can be an adjunct to SSRIs in GAD?
Buspirone
49
What is a benefit of Buspirone in GAD?
It does not cause sedation or potentiate CNS depression of alcohol (almost no abuse or addiction potential)
50
What is the ideal combination treatment for GAD?
CBT + pharmacotherapy
51
What can be used for short term bridging in GAD?
Benzos
52
What alternative meds can be used in GAD?
Beta blockers or TCAs
53
What is the MOA of Buspirone?
Partial serotonin receptor (5HT-1A0 agonist and dopamine receptor agonist
54
How long does Buspirone take to become effective
1-2 weeks
55
What are adverse effects of Buspirone?
HA Nausea Dizziness RLS Extrapyramidal symptoms

Behavioral Health (19 decks)

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