Anxiety disorders

Question 1

simple definition of adjustment disorder

Answer 1

symptoms within 3 months of a stressor

Question 2

simple definition of acute stress disorder

Answer 2

symptoms within 1 month of a trauma

Question 3

simple definition of PTSD

Answer 3

symptoms lasting more than a month after the trauma

Question 4

simple definition of social anxiety/specific phobia

Answer 4

Fear of social situations or specific object

Question 5

Panic disorder with or without agoraphobia

Answer 5

Recurrent unexplained panic attack and other symptoms

Question 6

simple definition of OCD

Answer 6

time consuming or interfering obsessions and compulsions

Question 7

Mnemonic for GAD symptoms: Watchers

Answer 7

Worry and can't stop 
Anxiety is excessive 
Tension in muscles
Concentration impaired
Hyperarousal (irritable)
Energy loss
Restlessness 
Sleep disturbance 

(Both of the first 2 must be present)

Question 8

Prevalence of GAD

Answer 8

Women to men is 2:1

Onset is late adolescence or early adulthood

Question 9

Course and prognosis of GAD

Answer 9

The patients often present with somatic complaints

The course/prognosis is hard to predict

Negative life events affect the onset

Question 10

Neurotransmitters involved in GAD

Answer 10

Serotonin, norepinephrine, GABA, glutamate

Question 11

Psychotherapy and GAD

Answer 11

therapy may be a first line treatment in some people who are psychologically minded.

CBT has the best evidence

Question 12

Medication and GAD

Answer 12

Be careful about prescribing medication on the 1st visit.

Good options are SSRIs, SNRIs, Buspar

Benzos may be used for the 1st 2 to 3 weeks

Some people will be on meds for 6 to 12 months, others for life

Question 13

Physical symptoms of panic attacks (besides the obvious ones)

Answer 13

Feeling of choking
Feeling faint
Paresthesias
Chills of hot flashes

Question 14

Criteria for panic disorder with or without agoraphobia

Answer 14

1. Recurrent/unexpected panic attacks
2. One or more of the following:
   - afraid of having another attack
   - afraid that the attacks will have a consequence (going crazy, having a heart attack, etc)
   - Significant change in behavior

Question 15

Criteria for agoraphobia

Answer 15

Fear about 2 or more of these:
-public transportation, open spaces, enclosed spaces, standing in lines/crowds, being outside alone

They’re afraid that they won’t be able to get help in that situation

The situations almost always cause fear and are avoided

causes clinically significant distress

Question 16

Panic disorder prevalence

Answer 16

Occurs 2 to 3 times more in women

Question 17

Course and prognosis of panic disorder

Answer 17

It’s usually chronic but the the course is variable

Question 18

panic disorder comorbidities

Answer 18

90% of people with panic disorder have another disorder

Question 19

Panic disorder etiology

Answer 19

Abnormal regulation of of the noradrenergic system; it involves NE, serotonin, and GABA.

Abnormalities in the temporal lobes, hippocampus, and amygdala

Involves the brainstem, limbic system, and prefrontal cortex

can involves genetic, substances, and psychologic triggers.

Question 20

Best psychotherapy for panic disorder

Answer 20

CBT and deep breathing/relaxation techniques

Question 21

Meds for panic disorder

Answer 21

first-lines are Venlafaxine and SSRIs (but be careful with fluoxetine because of agitation).

Second-line is clomipramine (TCA)

Adjunct meds are benzos and buspirone

In general, start low (half the normal dose). If you increase too quickly it can worsen panic.

Question 22

What are 2 very long acting benzos

Answer 22

clonazepam and diazepam (diazepam is the longest of the 2)

Question 23

Benzo withdrawal

Answer 23

Timing varies by individual (short acting meds are usually 1 to 2 day, long acting are usually 5 to 10 days)

Can be mild (insomnia, agitation, headache, muscle ache, diaphoresis, tachycardia) to severe (seizures, delirium, coma)