Anxiety Disorders

Question 1

Food restrictions for MAOIs (tyramine-free diet)

Answer 1

No: Wine, Beer, Age cheese, Pickles, Aged Meats, Chocolate, etc.

*can cause hypertensive crisis

Question 2

Diffuse, unpleasant, vague sense of apprehension; often accompanied with headache, perspiration, palpitations and restlessness

Answer 2

Anxiety

Question 3

What draws the line between normal and pathologic anxiety? (4 total)

Answer 3

Autonomy: no trigger
Intensity: exceeds patient’s capacity
Duration: persistent
Behavior: disabling

Question 4

Common medical conditions that can MIMIC anxiety disorders

Answer 4

Endocrine: thyroid dysfunction, hyperadrenalism
Hypoxia (CHF, angina, COPD)
Metabolic acidosis
Seizures

Question 5

Parts of brain thought to be the etiologic agents for Anxiety

Answer 5

Locus Coeruleus (high NE)
Limbic system (low GABA)
*also low 5HT

Question 6

Treatments for Anxiety Disorders

Answer 6

• CBT (1st line); exposure therapy (graded vs flooding)
• SSRI/SNRIs (good prophylactic)
• Benzodiazepines (short term)

Question 7

Childhood anxiety disorder; developmentally appropriate from age 1-3, but NOT older kids or adults; recurrent, excessive distress when separated from home or attachment figures (clues: school refusal, somatic symptoms like headaches/stomachaches)

Answer 7

Separation Anxiety Disorder

Question 8

Discrete episodes of intense anxiety WITH a clear trigger; SUDDEN onset, peaks within minutes; associated with at least 4/13 symptoms of autonomic arousal (PANICC) (SOB, sweats, chills, trembling, nausea, palpitations, fear of going crazy, fear of dying

Answer 8

Panic Attacks

Question 9

Mnemonic for Panic Attack symptoms

Answer 9

PANICC
P: pulmonary (SOB)
A: autonomic arousal (sweats, chills, hot flashes)
N: neurologic (shaking, dizzy, faintness)
I: GI (nausea)
C: cardiac (palpitations, chest pain)
C: cognitive (fear of going crazy/dying)

Question 10

Syndrome of recurrent, unexpected panic attacks (at least 4 in one month); LACK a trigger; followed by at least 1 months of concern of having another attack and behavior changes b/c of the attacks

Answer 10

Panic Disorder

Question 11

How many panic attacks do you need in a month to qualify for Panic Disorder

Answer 11

at least 4

Question 12

Anxiety or avoidance of places where escape might be difficult or embarrassing (cars, buses, parking lots, shops, theaters, crowds); become extremely homebound as a consequence; usually have panic attacks before the onset

Answer 12

Agoraphobia (marked fear about at least 2/5 situations)

Question 13

Excessive anxiety and worry that occurs more day than not for 6 months (PERSISTENT rather than discrete like in panic attacks); difficult to control worry and causes impairment of function & significant distress; NO specific trigger

Answer 13

Generalized Anxiety Disorder

Question 14

Difference between Panic Disorder vs. Generalized Anxiety Disorder

Answer 14

PD: discrete attacks
GAD: persistent anxiety, but can fluctuate

Question 15

Treatment for GAD

Answer 15

• CBT
• Antidepressants (SSRI/SNRI)
• Benzodiazepines
• Buspirone (partial agonist for serotonin 5HT receptors; NO ABUSE potential)

Question 16

drug used for GAD; partial agonist for serotonin 5-HT1 receptor (autoreceptor); useful for those with anxiety due to substance abuse issues

Answer 16

Buspirone

Question 17

Marked and persistent fear that is excessive and unreasonable of a specific object or situation; actively avoids the phobic stimulus; causes significant impairment in function and distress

** 2/3 of phobia patients have >1 phobia

Answer 17

Specific Phobia

Question 18

Therapy for those with specific phobias; gradual exposure to the phobia to help alleviate the anxiety and dysfunction

Answer 18

Graded Exposure (aka. systemic desensitization)

• could be imaginary or in vivo

Question 19

Marked fear or anxiety about social situations in which the individual is exposed to POSSIBLE SCRUTINY BY OTHERS (meeting new people, public restrooms, performances, etc.) –> leads to hyperarousal and avoidance

Answer 19

Social Anxiety Disorder

Question 20

Social anxiety disorder is frequently comorbid with

Answer 20

depression and substance abuse

Question 21

Treatment for Social Anxiety Disorder

Answer 21

• CBT
• Antidepressants (SSRI/SNRI/MAOI)
• Benzodiazepine or beta-blocker (propranolol) for INFREQUENT events/before public speaking