Anxiety disorders Flashcards
pathophysiology of anxiety (in terms of neurotransmitters)
increased NE
decreased GABA, serotonin
∆ btwn panic attacks and panic disorders
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
symptoms of panic attack
PANICS Palpitations Abdominal distress Numbness, N Intense fear of death Choking, chills, CP Sweating, shaking, SOB
DSM criteria (and duration) for panic disorder and specifiers?
attack + 1 mo. of anticipatory anxiety about having another attack
with agoraphobia
without agoraphobia
panic attacks may be induced by these 3 common factors
caffeine
nicotine
hyperventilation
Immediate treatment of panic disorder? long term?
immediate: benzodiazepines
long-term: low-dose SSRI (paroxetine, sertraline)
definition of agoraphobia?
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
∆ btwn specific phobia vs social phobia
common pathophysiological cause of these two?
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
DSM criteria (and duration) for social/specific phobia?
> 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
treatment of performance anxiety
ß blockers
treatment of specific phobia
behavior therapy + systemic desensitization
if needed, short course of benzodiazepines or ß blockers to help control autonomic symptoms
treatment of social phobia
Paroxetine, buspirone, venlafaxine
ß blockers (atenolol, propranolol)
cognitive + behavioral therapies
What type of Axis disorder is OCD?
Axis I
What is unique about patients with OCD vs those with OCPD?
OCD - egodystonic; they realize their thoughts and behaviors are irrational (insight)
DSM criteria (and duration) for OCD?
either obsessions or compulsions that one recognizes are unreasonable and excessive
obsessions cause marked distress, are time consuming, or significantly interfere with daily functioning
OCD is usually comorbid with which 2 psychiatric disorders?
Tourette ADHD MDD eating disorder anxiety disorders OCPD
neurochemical etiology of OCD (bonus: what class of Rx would you use to treat this?)
abnormal regulation of serotonin
Treatment: SSRIs (fluoxetine, sertraline, fluvoxamine)
TCAs (clomipramine)
psychosocial etiology of OCD
triggered by a stressful life event in 60% of patients
infectious etiology of OCD
Pediatric Autoimmune Neuropsychiatric D/o Associated w. Strepococcal infections
treatment of OCD - 2 classes
SSRIs (fluoxetine, sertraline, fluvoxamine)
TCAs (clomipramine)
*requires higher doses of SSRI compared to treatment of depression)
DSM criteria (and duration) for PTSD? 5
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)
3 common comorbidities of PTSD
MDD
anxiety d/o
substance dependence
2 main SSRI treatment of PTSD and why
SSRI - sertraline and paroxetine - both decrease symptom clusters of PTSD (re-experiencing the traumatic event, avoidance, and hyperarousal)
Why would you use TCA/MAOi for treatment of PTSD?
both work to reduce re-experiencing of the traumatic event
Why would you use trazodone for treatment of PTSD?
used at night to facilitate sleep
Why would you use antipsychotics for treatment of PTSD?
augmentation therapy of SSRI
or
SNRI or treatment associated with psychotic sx
Why would you use prazosin for treatment of PTSD? MoA?
a1 antagonist - used to decrease nightmares
∆ btwn PTSD and ASD (acute stress d/o) in terms of when the event occurred and how long the symptoms last
PTSD: event occurred at any time in the past; symptoms last > 1 mo
ASD: event occurred < 1 mo ago; symptoms last < 1 mo
Why should you avoid giving benzodiazepines to PTSD patients?
high rate of substance abuse in these patients
DSM criteria (and duration) for Acute Stress D/o?
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
DSM criteria (and duration) for GAD?
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
common comorbid sx of GAD
MDD or dysthymia
social/specific phobia
panic disorder
1st line treatment for GAD
SSRI, buspirone, venlafaxine
Why should benzodiazepines be avoided in patients with GAD?
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
What are some medical conditions that cause GAD?
Graves
Pheochromocytoma
Hypothyroidism
Hypoparathyroidism
Hypoglycemia
Cardiomyopathy awaiting cardiac transplant
Parkinson’s disease
Multiple sclerosis
Sjogrens
COPD
PANDAS
B12 deficiency
What psychiatric disorder should you consider in a woman with tachycardia (160bpm), hypotension (104/64), and tachypnea with a history of MDD + GAD?
RULE OUT ORGANIC CAUSES FIRST because even if she does have a psychiatric history, these are also classic signs of PE
