Anxiety Disorders

Question 1

How is an anxiety disorder different from normal anxiety?

Answer 1

anxiety in disorder is a prominent, persistent, and disruptive aspect of daily life

Question 2

How common is anxiety?

Answer 2

25% of US population

Question 3

Anxiety commonly comorbid with _______.

Answer 3

major depression

Question 4

Anxiety associated with increased risk of ______.

Answer 4

suicide

Question 5

triad of symptoms in anxiety

Answer 5

emotional (fear, nervousness)
cognitive (worry, sense of doom, derealization)
physical (muscle tension, tachycardia, dizziness, insomnia)

Question 6

Possible causes of anxiety

Answer 6

biologic: GABA receptors, neurotransmitters, adrenergic system

Psych stressors

Maladaptive cognitions (overestimate danger or underestimate coping)

Environmentally conditioned (ex: driving + stress + fear = fear of driving)

Question 7

Risk factors for anxiety disorders

Answer 7

female, young, single or divorced, low socioeconomic status, low education, white, stressful life events, childhood maltreatment, modeling stressful parents, genetics

Question 8

Comorbidities of anxiety disorder

Answer 8

other anxiety d/o, personality d/o, substance use d/o, physical problems (CV, respiratory, arthritis, migraines)

Question 9

Duration of generalized anxiety d/o

Answer 9

at least 6 months

Question 10

Generalized anxiety disorder symptoms

Answer 10

• anxiety triad
• multiple domains of worry (school, work, travel, relationships, health, etc.)
• often comes to clinic with somatic complaints

Question 11

Average age of dx’d generalized anxiety d/o

Answer 11

20-30s

Question 12

Generalized anxiety disorder treatment

Answer 12

1st line: SSRIs or SNRIs

Benzos for acute management
ex: Diazepam 5-10 mg PO BID prn or IV in ICU

Question 13

Main features of social anxiety disorder

Answer 13

Marked fear of social and performance situations, often resulting in avoidance

• Fear of saying or doing something to result in embarrassment or humiliation
• Core fear “not measuring up”

Question 14

Physical symptoms that can arise in social anxiety d/o

Answer 14

blushing, profuse sweating, trembling, nausea, difficulty talking

Question 15

Duration of social anxiety d/o

Answer 15

continuous and lifelong

Question 16

Social anxiety d/o treatment

Answer 16

• CBT to include desensitization
• SSRI/SNRIs (sertraline, paroxetine, venlafaxine)
• Short-acting benzos if infrequent causes (Alprazolam)
• Beta blockers sometimes useful (propranolol 1 hr prior to exposure)

Question 17

What is a panic attack?

Answer 17

Discrete period of intense fear accompanied by abrupt cognitive and somatic symptoms

Question 18

Diagnosis criteria of panic disorder

Answer 18

recurrent, uncued panic attacks along with either
1) worry about possibility of future attacks
OR
2) development of phobic avoidance, or other changes in behavior due to attacks

Question 19

Cognitive symptoms in a panic attack

Answer 19

racing thoughts, preoccupation with health concerns, catastrophic misinterpretation of somatic symptoms, believing one is going insane

Question 20

Somatic symptoms in panic attack

Answer 20

choking sensation, racing heartbeat, sweating, “jelly” legs, nausea, shaking, chest pain, numbness, feeling detached or unreal

Question 21

Panic disorder treatment

Answer 21

Start with low dose SSRI and titrate with gradual dose increase (Paroxetine)

• 4-6 weeks to clinically meaningful response
• 12-16 weeks for optimal response

If no response -> try another SSRI or try SNRI
If partial response -> consider adjunct with benzo or other anti-anxiety (Buspirone)

Benzos also possible

• Can use as adjunct to SSRI or SNRI for immediate relief; then taper as SSRI or SNRI takes effect
• High abuse potential, esp in patient with alcohol or drug history

CBT very effective in anxiety disorders

Question 22

Type of anxiety seen in agoraphobia

Answer 22

Anxiety about 2 or more of the following situations:

1) using public transportation
2) being in open spaces
3) being in enclosed places
4) standing in line or being in a crowd
5) being outside of the home alone

Question 23

Does agoraphobia occur with panic disorder?

Answer 23

common consequence of panic disorder, but can exist as own disorder

Question 24

Why is there anxiety in agoraphobia?

Answer 24

fear of being incapacitated, unable to escape, unable to get help if physical symptoms arise

Question 25

Least panic disabling of anxiety disorders

Answer 25

specific phobias

Question 26

specific phobia characteristics

Answer 26

• Predictability
• Actively avoided or endured
• Fear/anxiety
• Persistent (6+ months)
• Significant distress or impairment
• NOT better explained by another anxiety disorder

Question 27

symptoms of specific phobia

Answer 27

• Heart-racing, tremors, shortness of breath

- Vasovagal response seen in blood-injection-injury

Question 28

Treatment of specific phobias

Answer 28

• CBT with desensitization
• Pharmacotherapy not established
• Short-acting benzos prior to exposure if no complex performance requirements

Question 29

separation anxiety

Answer 29

childhood to adult; anxiety associated with separation or threat of separation

Question 30

selective mutism

Answer 30

person who is normally capable of speech does not speak in specific situations or to specific people

Question 31

Most common anxiety disorder

Answer 31

specific phobia

Question 32

Behavior Therapy

Answer 32

relaxation, stress reduction; directive therapy (may include homework)

good for: anxiety, somatic disorders

Question 33

Cognitive therapy (CBT)

Answer 33

Goal: change negative/distorted thoughts to reduce symptoms of depression or anxiety

Good for: depression, anxiety, substance abuse

Question 34

Supportive Therapy

Answer 34

Assumes improvement with someone to talk to who is validating. Avoids interpreting the unconscious or addressing “transference”

Good for: any emotional disorder or life problem

Duration: short-term

widely practiced, little research on effectiveness