Anxiety Disorders

Question 1

Panic Disorders

Answer 1

• recurrent unexpected panic attacks about which there is persistent concern
• at least one panic attack is followed by more than a month of : persistent concern about more attacks; worry about implications of attack and its consequences; significant change in one’s behavior related to the attacks

Question 2

Pain attacks =

Answer 2

discrete episodes of intense anxiety which develops abruptly and peak within 10 minutes

Question 3

Clinical features sx’s of pain attacks

Answer 3

• cardiac: palpitations, tachycardia, chest pain/discomfort
• pulm: SOB, choking feeling
• GI: nausea, abd discomfort
• Neuro: shakiness, dizziness, light-headedness, faintness, parasthesias
• Autonomic arousal: sweating, chills, hot flashes
• Psych: derealization, depersonalization, fear of losing control/going crazy/dying

Question 4

Management of Panic Disorders

Answer 4

• Benzos(for acute) and antidepressants (for chronic)
• Alpralozam, paroxetine, SSRIs
• psychotherapy

Question 5

Agoraphobia

Answer 5

• anxiety about or avoidance of places or situations from which escape might be difficult
• may lead to dependence on others or becoming housebound

Question 6

Agoraphobia management

Answer 6

-psychotherapy

Question 7

Specific phobias

Answer 7

• marked and persistent fear of circumscribed situations or objects
• exposure to these situations or objects leads to intense anxiety and avoidance which interferes with the patient’s life
• they recognize that the fear is excessive or unreasonable, stimulus is avoided or endured with dread
• fear and avoidance interfere with normal routine or cause marked distress

Question 8

Agoraphobia examples

Answer 8

-heights, closed spaces, animals, sight of blood

Question 9

Management of agoraphobia

Answer 9

• Benzos (acutely), adrenergic receptor antagonists

- psychotherapy: CBT, exposure and systematic desensitization

Question 10

Obsessive compulsive Disorder

Answer 10

• recurrent, intrusive, unwanted thoughts (obsessions) or compulsive behaviors or rituals
• time consuming ax’s (> 1 hr/day) or significantly interfere with normal routine

Question 11

Obsessive compulsive Risk factors

Answer 11

• mean age of onset = 20s
• chronic course
• Biological features, genetics, behavioral

Question 12

Obsessions

Answer 12

• recurrent, persistent thoughts, impulses or images characterized by 4 criteria:
  1) experienced as intrusive and inappropriate and cause marked anxiety/distress
  2) not simply worries about real life problems
  3) attempts are made to ignore obsessions or neutralize them with some other thought or action
  4) recognize the obsession as a product of our own mind

Question 13

Complusions

Answer 13

• complulsive behaviors (conscious, standardized, recurrent) take place in response to obsessions or rigid rules
• compulsions are aimed at reducing distress or preventing a dreaded event
• clearly excessive or unconnected in a realistic way with the event to be neutralized

Question 14

Obsessive compulsive disorder management

Answer 14

• meds: SSRIs, anripaychotics
• psychotherapy
• deep brain stimulation

Question 15

ambivalence

Answer 15

experience both love and hate toward something

Question 16

magical thinking

Answer 16

amipotence of thought; thinking about an event can cause it to occur

Question 17

Social phobia

Answer 17

• fear being exposed to public scrutiny
• fear of behaving in a way which will be humiliating or embarrassing
• persistent fear and avoidance or endurance of social situations with intense distress
• fear is recognized as excessive and unreasonable

Question 18

Social phobia management

Answer 18

behavior therapy

pharmacotherapy = SSRIs, Benzos, venlafaxine, buspirone, BBs

Question 19

PTSD

Answer 19

• experienced an event that involved the threat of death, injury or severe harm to themselves or others
• response to the event involved intense fear, helplessness to horror
• frequent re-experiencing trauma in nightmares, flashbacks, or marked arousal when exposed to situations that remind them of the event
• may avoid situations that remind them of the trauma
• sx’s last more than 1 month

Question 20

PTSD management

Answer 20

• meds = antidepressants, antipsychs, SSRIa, TCAs, MAOIs and anticonvulsants
• psychotherapy: exposure base CBT, family therapy
• eye mvmnt desensitization and reprocessing

Question 21

Generalized anxiety disorder

Answer 21

• excessive anxiety or worry that is out of proportion to situational factors
• occurs more days than not for 6 mnths
• anxiety associated with muscle tension, restlessness, insomnia, difficulty concentrating, easy fatigability, irritability

Question 22

GAD management

Answer 22

• meds: benzos, antidepressants (SSRIs)

- paychotherapy: CBT, supportive and insight-oriented