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Board Certification 2 (Purple book) > Anxiety disorders > Flashcards

Anxiety disorders Flashcards

1
Q

Kyhal (wind) attacks

A

an asian culture syndrome where they get neck soreness and tingling

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2
Q

Level 1 mild anxiety

A

Normal level of anxiety that everyone experiences. It motivates us to function. Vital signs normal, pupils constricted, maybe a little increase in muscle tension. Perceptual field and awareness are heightened.

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3
Q

Level 2 moderate anxiety

A

Still a normal level of anxiety, but it’s an increased level in response to a significant stressor. Vitals are mostly the same, but the heart rate might be a little faster. A little more muscle tension.
Subjective feeling of worry and a narrowed perception.

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4
Q

Level 3 severe anxiety

A

This is a pathological level. Autonomic nervous system is activated (fight or flight response), pupils dilated, vitals increased, sweating, rigid muscles hearing decreases, pain tolerance increases, urinary frequency, diarrhea
Perception is greatly narrowed, difficulty with problem solving, distorted perception of time, selective inattention, dissociative sensations, automatic behavior

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5
Q

Level 4 panic anxiety

A

Pale, hypotensive, poor hand-eye coordination, muscle pains, hearing is very decreased, dizzy, short of breath.
Scattered perception, illogical thinking, hallucinations, delusions

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6
Q

Freud’s theory of anxiety

A

It starts at birth when the person must deal with the new environment. Anxiety continues because of unconscious conflicts (especially conflicts about the sexual drive). They fear they’ll be punished for doing something wrong. They overuse defense mechanisms, and this over use is the behaviors we see in anxiety disorders.

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7
Q

Interpersonal theory of anxiety

A

This theory comes from Harry Stack Sullivan. It explains that people are goal-directed, and work toward achieving satisfaction and security needs.
Satisfaction and security needs are normally achieved through interpersonal relationships, but when these needs are not met, you get anxiety.
Anxiety starts when needs are not met in the first relationship, which is child and mother.
When needs are not met, the person feels rejected, and inferior.

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8
Q

Neurobiological theory of anxiety

A

Deficits in the limbic system, midline brainstem, and sections of the cortex

There could also be a problem with the HPA. Normally, when there is stress the amygdala tells the hypothalamus to release CRH. The pituitary releases adrenocorticotropic hormone. The adrenal glands are then stimulated, which shuts off the alarm system. However, in anxiety disorders, the amygdala does not shut off the alarm because it’s overactive, or there might not be enough cortisol to stop the fight or flight response.

Another deficit could be low levels of GABA and high levels of NE.

Serotonin and GABA are the transmitters that are supposed to suppress the HPA axis.

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9
Q

Anxiety stats

A

28% of the population

Except for OCD and social phobia, anxiety disorders are more common in females

Most anxiety disorders start in the teens or early adulthood

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10
Q

Lab findings of anxiety

A

they may have results that reflect compensated respiratory alkalosis:

  • Decreased carbon dioxide levels
  • Decreased bicarbonate levels
  • Normal pH
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11
Q

Most medications known to improve symptoms of anxiety act directly or indirectly on the ___ system

A

GABA

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12
Q

SSRIs

A

First line med for chronic anxiety disorders.

They act on serotonin and indirectly on GABA

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13
Q

Benzos Use has been associated with a_____

A

alzheimer’s

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14
Q

Buspirone

A

20 to 60 mg

Must be taken regularly, not as a PRN

Dizziness, insomnia, tremor, akathisia, GI, dry mouth

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15
Q

Tiagabine

A

4 to 56 mg

Dizziness, somnolence, GI, tremors, dry mouth

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16
Q

Gabapentin

A

300 to 3600

Ataxia, decreased coordination, sedation, disequilibrium

Can also be used as an anti-craving medication

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17
Q

Propranolol

A

10 to 20 mg

Bradycardia, hypotension

18
Q

Clonidine

A

Can be used for anxiety for children.

.003 to .01 mg/kg/day

19
Q

Guanfacine

A

For anxiety for children

.015 to .05 mg/kg/day

20
Q

Y-BOCS

A

Yale-Brown Obsessive Compulsive Scale

21
Q

Panic disorder

A

They are often intolerant or overly concerned with medication side effects.

They’re ashamed that they can’t control their emotions

In 2/3 of the cases, major depression occurs first, follow by panic disorder

In 1/3, panic disorder precedes depression

22
Q

Panic disorder differential dx

A 
Hyperthyroid 
Hyperparathyroid
Pheochromocytosis 
Vestibular dysfunction 
Seizure disorders 
Arrhythmias
23
Q

If they appear to have a panic disorder, it may actually be a medical condition if

A

It starts after age 45

If they have symptoms like:
Vertigo
Loss of consciousness
Incontinence
Headache
Slurred speech 
Amnesia after the attack
24
Q

Agoraphobia

A

50% of them report panic attacks or had panic disorder before getting agoraphobia

25
Q

Specific phobias

A

In adults (but not children) they are aware that the fear is excessive.

Risk factors:
Trauma
Excessive information transmission (parents scaring you with too many warnings)
Genetics

The onset peaks in childhood, then peaks again in mid 20s

26
Q

Most common types of phobias for adults

A
  1. Situations (flying, driving, enclosed spaces)
  2. Natural/environmental (water, heights, lightening)
  3. Blood (they might have an increase in blood pressure and heart, followed by a drop in both)
  4. Animals
  5. Other
27
Q

Pharm management of phobias

A

SSRIs
TCAs
Short term benzos

28
Q

Social Anxiety (Phobia) disorder

A

3 to 13%

Symptoms must persist for more than 6 months

Onset is usually in the teens, after something embarrassing happens

The anxiety is not relieved by having a trusted friend with them in the situation

Common descriptions of them:
hypersensitive to criticism
negative self-evaluation
sensitive to rejection
low self esteem
lack of assertiveness

The distress can be so bad (dreading something) that it can be associated with SI

29
Q

Pharm management for Social Anxiety

A

SSRIs
Benzos
Beta blockers

30
Q

GAD

A

Worrying more days than not, for over 6 months

There’s a waxing and waning pattern

For children, anxiety can manifest as overly conforming or overly seeking approval

31
Q

Separation Anxiety Disorder

A

Occurs after age 4`

32
Q

OCD

A

Obsessions are an ego-dystonic experience and the obsession is an alien thought.

If a child has a sudden onset of OCD symptoms, consider that they may have PANDAS (pediatric autoimmune neuropsychiatric disorders associated with strep infections)

Only one or the other (O or C) is needed for dx.

The person has insight.

33
Q

Pharm treatment for OCD

A

SSRIs at a high dose
TCAs, especially clomipramine
2nd gens such as resperidone (off label)

34
Q

OCD in children

A

commonly associated with learning disorders, disruptive behavior disorders, tourette’s syndrome, Group-A beta hemolytic strep infections

More common in boys than girls

Washing, checking, and ordering are most common

35
Q

OCD in older adults

A

More obsessions than compulsions

Often obsess about dying

36
Q

PTSD

A

A 1st degree relative with MDD increases risk of PTSD.

There are 3 subtypes:
Acute- lasts less than 3 months
Chronic- lasts 3 months or longer
Delayed onset: Doesn’t start for at least 6 months

The symptoms have to last for at least a month.

37
Q

Pharm treatment of PTSD

A

SSRIs
TCAs

Benzo are not recommended

Antipsychotics may be used during flashbacks

38
Q

PTSD in children

A

They may have disorganized or agitated behavior

Repetitive play with trauma themes

Nightmares, but without specific content

39
Q

Dissociative disorders

A
  1. Dissociative amnesia
  2. Depersonalization
  3. Dissociative Identity disorder (like the others, it’s related to trauma)

Dissociating is a defense mechanism. It causes a gap in their memory.

Depersonalization and derealization can have physical or psychological cause.

40
Q

Body dysmorphic disorder and Hoarding disorder, how is their insight

A

Ranges from good to absent (fixed delusional)

Board Certification 2 (Purple book) (22 decks)

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