Anxiety Disorders Flashcards
What are the major neurotransmitter changes in anxiety disorders?
Increased NE; decreased 5-HT and GABA
Name one vitamin deficiency, one blood problem, one tumor of the adrenal gland, and one metabolic situation that can cause anxiety
Vitamin B12 deficiency; anxiety; pheochromocytoma; hypoglycemia
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?
Hyperthyroidism; caffeine (I think this is total bullshit, caffeine has never done anything to anyone)
P of PANICS criteria for panic attacks
Palpitations
A of PANICS criteria for panic attacks
Abdominal distress
N of PANICS criteria for panic attacks
Numbness, nausea
I of PANICS criteria for panic attacks
Intense fear of death
C of PANICS criteria for panic attacks
Choking, chills, chest pain
S of PANICS criteria for panic attacks
Sweating, shaking, shortness of breath
What is the typical peak time (in minutes) of a panic attack, and the typical time by which they finish
10 minutes; 25 minutes
1 cardiac valvular problem, 2 respiratory problems, 1 coronary vascular problem, and 1 systemic problem that can cause panic attacks
Mitral valve prolapse; asthma; PE; angina; anaphylaxis
To qualify for panic disorder, at least one attack must be followed by min 1 month of following:
Persistent concern about additional attacks; worry about implications of attack; significant change in behaviour related to attacks
Sex breakdown of panic disorder?
2-3x more common in females
How should you administer SSRIs in panic disorder?
Slowly increase the dose, as they may initially worsen anxiety
Best treatment for panic disorder?
SSRIs - especially paroxetine (Paxil) and sertraline (Zoloft)
What kind of doses are required for SSRIs in panic disorder?
Higher doses than for depression
Agoraphobia is especially chronic and debilitating when it IS or IS NOT associated with panic disorder?
Especially debilitating when NOT associated with panic disorder
Phobic patients frequetnly have comorbid problems with what?
Substances (especially alcohol)
Diagnostic criteria for specific phonia:
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
What is often a successful treatment for performance anxiety?
Beta-blockers
Specific phobia tx?
Behaviour therapy (systemic densitization or flooding); pharma not effetive
Social phobia tx?
Paroxtenine (Paxil); B-blockers for performance anxiety sx
In OCD, do people attempt to suppress their obsessions?
Yes. Obsessions are unwanted and ego-dystonic
Two other criteria for OCD other than O’s or C’s
Awareness that O/C is unreasonable/excessive; obsessions cause marked distress/functional interference
Common patterns of O’s/C’s
Contamination; doubt; symmetry; intrusive thoughts (sexual/violent); somatic obsessions
2 other psychiatric syndromes that are comorbid with OCD
Tourette’s, ADHD
Tx for OCD?
SSRIs (higher dose for depression, like panic disorder). TCA’s (clomipramine) also effective
How can you differentiate OCD with OC Personality Disorder?
OCD is ego-dystonic; OCPD is ego-syntonic (patients don’t perceive problem)
TRAUMA - PTSD Acronym
Traumatic Experience Re-experience Avoidance/emotional numbing Unable to function Month (1) + for symptoms to qualify as PTSD Arousal
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?
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.
Why should addictive medications like benzos be avoided for PTSD patients?
Because they have high addictive potential, and the rate of substance abuse (and depression, for that matter) is high in PTSD patients
What are the six symptoms of GAD which, 3 of which you must have for 6+ months to get the diagnosis?
Restlessness, fatigue, concentration difficulty, irritability, muscle tension, sleep disturbance (MISC RF)
What’s the prevalence of GAD in the general population?
45%
Is there any way that previously cited number (45% of the population has GAD at some point) is true?
None at all.
3 antidepressants recommended for GAD?
SSRIs, buspirone (BuSpar), Venlafaxine
Random question: What is BuSpar’s anxiolytic mechanism?
Partial agonism of the 5-HT1a receptor
