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Psychiatry > Anxiety disorders > Flashcards

Anxiety disorders Flashcards

1
Q

pathophysiology of anxiety (in terms of neurotransmitters)

A

increased NE

decreased GABA, serotonin

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2
Q

∆ btwn panic attacks and panic disorders

A

panic ATTACK - discrete periods of heightened anxiety and fear that either comes on spontaneously OR provoked by triggers; must have at least 4 symptoms that peak within 10 min and last <25 min; present in Panic d/o, Phobic d/o, PTSD

panic DISORDER - recurrent spontaneous panic attacks w/o obvious precipitant for 1 mo

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3
Q

symptoms of panic attack

A 
PANICS
Palpitations
Abdominal distress
Numbness, N
Intense fear of death
Choking, chills, CP
Sweating, shaking, SOB
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4
Q

DSM criteria (and duration) for panic disorder and specifiers?

A

attack + 1 mo. of anticipatory anxiety about having another attack

with agoraphobia
without agoraphobia

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5
Q

panic attacks may be induced by these 3 common factors

A

caffeine
nicotine
hyperventilation

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6
Q

Immediate treatment of panic disorder? long term?

A

immediate: benzodiazepines

long-term: low-dose SSRI (paroxetine, sertraline)

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7
Q

definition of agoraphobia?

A

fear of being alone in public places
in psychiatry, it is the anxiety-induced avoidance of being in places or situations from which escape or help might be difficult

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8
Q

∆ btwn specific phobia vs social phobia

common pathophysiological cause of these two?

A

both have increased amygdala and insula activity

specific phobia - strong, exaggerated fear of a specific object or situation

social phobia - fear of social situations in which embarrassment may occur

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9
Q

DSM criteria (and duration) for social/specific phobia?

A

> 6 months of

1) persistent excessive fear brought on by a specific social situation or object
2) exposure to the social situation/object causes immediate anxiety and can precipitate a panic attack
3) recognition that the fear is excessive (ego-dystonic)
4) avoidance of social situation/object

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10
Q

treatment of performance anxiety

A

ß blockers

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11
Q

treatment of specific phobia

A

behavior therapy + systemic desensitization

if needed, short course of benzodiazepines or ß blockers to help control autonomic symptoms

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12
Q

treatment of social phobia

A

Paroxetine, buspirone, venlafaxine
ß blockers (atenolol, propranolol)
cognitive + behavioral therapies

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13
Q

What type of Axis disorder is OCD?

A

Axis I

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14
Q

What is unique about patients with OCD vs those with OCPD?

A

OCD - egodystonic; they realize their thoughts and behaviors are irrational (insight)

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15
Q

DSM criteria (and duration) for OCD?

A

either obsessions or compulsions that one recognizes are unreasonable and excessive
obsessions cause marked distress, are time consuming, or significantly interfere with daily functioning

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16
Q

OCD is usually comorbid with which 2 psychiatric disorders?

A 
Tourette
ADHD
MDD
eating disorder
anxiety disorders
OCPD
17
Q 
neurochemical etiology of OCD
(bonus: what class of Rx would you use to treat this?)
A

abnormal regulation of serotonin

Treatment: SSRIs (fluoxetine, sertraline, fluvoxamine)
TCAs (clomipramine)

18
Q

psychosocial etiology of OCD

A

triggered by a stressful life event in 60% of patients

19
Q

infectious etiology of OCD

A

Pediatric Autoimmune Neuropsychiatric D/o Associated w. Strepococcal infections

20
Q

treatment of OCD - 2 classes

A

SSRIs (fluoxetine, sertraline, fluvoxamine)
TCAs (clomipramine)

*requires higher doses of SSRI compared to treatment of depression)

21
Q

DSM criteria (and duration) for PTSD? 5

A

presence of the following symptoms for at least 1 month

1) traumatic event or experience
2) re-experiencing the traumatic event
3) persistence avoidance of stimuli associated w. trauma
4) numbing of responsiveness (limited affect, detachment, withdrawing from others)
5) hyperarousal (hypervigilance)

22
Q

3 common comorbidities of PTSD

A

MDD
anxiety d/o
substance dependence

23
Q

2 main SSRI treatment of PTSD and why

A

SSRI - sertraline and paroxetine - both decrease symptom clusters of PTSD (re-experiencing the traumatic event, avoidance, and hyperarousal)

24
Q

Why would you use TCA/MAOi for treatment of PTSD?

A

both work to reduce re-experiencing of the traumatic event

25
Q

Why would you use trazodone for treatment of PTSD?

A

used at night to facilitate sleep

26
Q

Why would you use antipsychotics for treatment of PTSD?

A

augmentation therapy of SSRI
or
SNRI or treatment associated with psychotic sx

27
Q

Why would you use prazosin for treatment of PTSD? MoA?

A

a1 antagonist - used to decrease nightmares

28
Q

∆ btwn PTSD and ASD (acute stress d/o) in terms of when the event occurred and how long the symptoms last

A

PTSD: event occurred at any time in the past; symptoms last > 1 mo

ASD: event occurred < 1 mo ago; symptoms last < 1 mo

29
Q

Why should you avoid giving benzodiazepines to PTSD patients?

A

high rate of substance abuse in these patients

30
Q

DSM criteria (and duration) for Acute Stress D/o?

A

1) experiencing a traumatic event

2) PTSD-like sx (must occur within 1 month of the trauma and last for a maximum of 1 month

31
Q

DSM criteria (and duration) for GAD?

A

excess anxiety/worry about daily events/activities that is difficult to control for >3 months (DSMV)

associated with at least 3 of the following sx: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance

interferes with daily ADL because anxiety/worries are difficult to control

32
Q

common comorbid sx of GAD

A

MDD or dysthymia
social/specific phobia
panic disorder

33
Q

1st line treatment for GAD

A

SSRI, buspirone, venlafaxine

34
Q

Why should benzodiazepines be avoided in patients with GAD?

A

patients grow to like the immediate relief they feel after taking a benzo; can quickly develop withdrawal or rebound anxiety when the Rx is ceased, which increases the patient’s resistance to stopping the Rx

35
Q

What are some medical conditions that cause GAD?

A

Graves
Pheochromocytoma

Hypothyroidism
Hypoparathyroidism
Hypoglycemia

Cardiomyopathy awaiting cardiac transplant

Parkinson’s disease
Multiple sclerosis
Sjogrens
COPD

PANDAS

B12 deficiency

36
Q

What psychiatric disorder should you consider in a woman with tachycardia (160bpm), hypotension (104/64), and tachypnea with a history of MDD + GAD?

A

RULE OUT ORGANIC CAUSES FIRST because even if she does have a psychiatric history, these are also classic signs of PE

Psychiatry (12 decks)

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