Anxiety Disorders

Question 1

What are the major neurotransmitter changes in anxiety disorders?

Answer 1

Increased NE; decreased 5-HT and GABA

Question 2

Name one vitamin deficiency, one blood problem, one tumor of the adrenal gland, and one metabolic situation that can cause anxiety

Answer 2

Vitamin B12 deficiency; anxiety; pheochromocytoma; hypoglycemia

Question 3

When you suspect GAD, what is one prominent medical condition (hint - neck) that you should ask about, and one seemingly benign substance that apparently causes anxiety?

Answer 3

Hyperthyroidism; caffeine (I think this is total bullshit, caffeine has never done anything to anyone)

Question 4

P of PANICS criteria for panic attacks

Answer 4

Palpitations

Question 5

A of PANICS criteria for panic attacks

Answer 5

Abdominal distress

Question 6

N of PANICS criteria for panic attacks

Answer 6

Numbness, nausea

Question 7

I of PANICS criteria for panic attacks

Answer 7

Intense fear of death

Question 8

C of PANICS criteria for panic attacks

Answer 8

Choking, chills, chest pain

Question 9

S of PANICS criteria for panic attacks

Answer 9

Sweating, shaking, shortness of breath

Question 10

What is the typical peak time (in minutes) of a panic attack, and the typical time by which they finish

Answer 10

10 minutes; 25 minutes

Question 11

1 cardiac valvular problem, 2 respiratory problems, 1 coronary vascular problem, and 1 systemic problem that can cause panic attacks

Answer 11

Mitral valve prolapse; asthma; PE; angina; anaphylaxis

Question 12

To qualify for panic disorder, at least one attack must be followed by min 1 month of following:

Answer 12

Persistent concern about additional attacks; worry about implications of attack; significant change in behaviour related to attacks

Question 13

Sex breakdown of panic disorder?

Answer 13

2-3x more common in females

Question 14

How should you administer SSRIs in panic disorder?

Answer 14

Slowly increase the dose, as they may initially worsen anxiety

Question 15

Best treatment for panic disorder?

Answer 15

SSRIs - especially paroxetine (Paxil) and sertraline (Zoloft)

Question 16

What kind of doses are required for SSRIs in panic disorder?

Answer 16

Higher doses than for depression

Question 17

Agoraphobia is especially chronic and debilitating when it IS or IS NOT associated with panic disorder?

Answer 17

Especially debilitating when NOT associated with panic disorder

Question 18

Phobic patients frequetnly have comorbid problems with what?

Answer 18

Substances (especially alcohol)

Question 19

Diagnostic criteria for specific phonia:

Answer 19

Persistent excessive fear brought about by situation/object; exposure to situation brings about immediate anxiety response; patient recognizes that fear is excessive; situation is avoided when possible or tolerated with intense anxiety; in 6mo

Question 20

What is often a successful treatment for performance anxiety?

Answer 20

Beta-blockers

Question 21

Specific phobia tx?

Answer 21

Behaviour therapy (systemic densitization or flooding); pharma not effetive

Question 22

Social phobia tx?

Answer 22

Paroxtenine (Paxil); B-blockers for performance anxiety sx

Question 23

In OCD, do people attempt to suppress their obsessions?

Answer 23

Yes. Obsessions are unwanted and ego-dystonic

Question 24

Two other criteria for OCD other than O’s or C’s

Answer 24

Awareness that O/C is unreasonable/excessive; obsessions cause marked distress/functional interference

Question 25

Common patterns of O's/C's

Answer 25

Contamination; doubt; symmetry; intrusive thoughts (sexual/violent); somatic obsessions

Question 26

2 other psychiatric syndromes that are comorbid with OCD

Answer 26

Tourette's, ADHD

Question 27

Tx for OCD?

Answer 27

SSRIs (higher dose for depression, like panic disorder). TCA's (clomipramine) also effective

Question 28

How can you differentiate OCD with OC Personality Disorder?

Answer 28

OCD is ego-dystonic; OCPD is ego-syntonic (patients don't perceive problem)

Question 29

TRAUMA - PTSD Acronym

Answer 29

``` Traumatic Experience Re-experience Avoidance/emotional numbing Unable to function Month (1) + for symptoms to qualify as PTSD Arousal ```

Question 30

If you were in the passenger seat and watched your friend die in a gruesome car crash 30 days ago and have been experiencing symptoms generally consistent with PTSD, do you indeed have PTSD?

Answer 30

No. You have acute stress disorder, because symptoms have not lasted for 1 month. In a day, however, if sx are still present, you'll have PTSD.

Question 31

Why should addictive medications like benzos be avoided for PTSD patients?

Answer 31

Because they have high addictive potential, and the rate of substance abuse (and depression, for that matter) is high in PTSD patients

Question 32

What are the six symptoms of GAD which, 3 of which you must have for 6+ months to get the diagnosis?

Answer 32

Restlessness, fatigue, concentration difficulty, irritability, muscle tension, sleep disturbance (MISC RF)

Question 33

What's the prevalence of GAD in the general population?

Answer 33

45%

Question 34

Is there any way that previously cited number (45% of the population has GAD at some point) is true?

Answer 34

None at all.

Question 35

3 antidepressants recommended for GAD?

Answer 35

SSRIs, buspirone (BuSpar), Venlafaxine

Question 36

Random question: What is BuSpar's anxiolytic mechanism?

Answer 36

Partial agonism of the 5-HT1a receptor