Anxiety disorders Flashcards
what are the features of GAD?
excessive worrying and anxiety occuring more days than not for at least 6 months, about a number of events or activities
the individual finds it difficult to worry
anxiety and worry manifest w/ symptoms: restlessness, easily tired, attention and concentration, feeling irritable, muscle tension, sleep disturbances
cause significant impairment in individual;s level of functioning
what is the first line treatment for GAD?
psychotherapy such as psychoeducation, stress management skills, CBT
what are the pharmacological treatment for GAD?
(first line) SSRI or duloxetine (SNRI) or venlafaxine
(second line) TCA or imipramine 25 mg oral
what are the pharmacological treatment for GAD?
(first line) SSRI or duloxetine (SNRI) or venlafaxine
(second line) TCA or imipramine 25 mg oral
what are clinical manifestations of panic attacks
autonomic arousal symptoms: palpitations, increase in heart rate, sweating, trembling, shaking, dry mouth
chest/abdominal symptoms: difficulty breathing, abdominal pain, chest pain, nausea, stomach churning
mental symptoms: giddiness, derealization, depersonalization, sudden fear of losing control/going crazy
general symptoms: hot flushes, cold chills, numbness and tingling
what are the clinical features of OCD
obsession: persistent and recurrent intrusive doubts, impulses, ruminations and thoughts
compulsions; repititive behaviour that is done to relief distress faced w/ the obssession despite knowing that it is a product of their own mind
what is the management of OCD?
combination of pharmacotherapy and psychotherapy:
CBT w/ aspect of mindfulness + SSRI (fluoxetine, citalopram, escitalopram, fluvoxamine, paroxetine)
what is the management of OCD?
combination of pharmacotherapy and psychotherapy:
CBT w/ aspect of mindfulness + SSRI (fluoxetine, citalopram, escitalopram, fluvoxamine, paroxetine)
what are the features of PTSD?
re-experiencing symptoms: intrusive thoughts, dreams, nightmares
hyperarousal symptoms; exaggerated startled response, irritability, anger, sleep disturbances, poor concentration and memory
avoidance and numbing; deliberate attempts to keep traumatic event out of head, loss of interest, detachment or estrangement from others, restricted emotional responses
what is the acute treatment of PTSD?
specialist administered trauma-focused psychotherapy
pharmacotherapy is rarely first line
what is the chronic treatmnet of PTSD?
psychotherapy techniques ot help patient cope better with symptoms such as: anger and anxiety management, stress reduction, relaxation therapy, advice on good sleep therapy
what are the features of phobias (or specific phobias)?
fear/anxiety about object/circumstnace beyond proportion of actual danger posed by the specific object/situation
provoke immediate fear or anxiety when exposed to situation
situation is actively avoided or endured w intense fear or anxiety
fear/anxiety lasts 6 months or more
what is the treatment for specific phobias?
pharmacotherapy has little role - unless diazepam is indicated in the short term to help in the short term
psychotherapy - CBT is indicated and first line
what are the features of a panic attack?
autonomic arousal symptoms: palpitations, sweating, trembling, shaking, dry mouth
chest/abdominal symptoms: chest, abdominal discomfort, nausea/vomting, shortness of breath
mental symptoms: giddiness, derealization, depersonalization, sudden fear of going crazy/losing control
general symptoms: flushing, cold chills, numbness, tingling
what is the feature of a panic disorder?
recurrent panic attacks w/o assoc with significant trigger, and not due to a physiological effect of a substance, medication, general medical condition, another psychiatric condition
what are the differential diagnoses for panic attacks?
hypoPTH hyperthyroidism hypoglycemia DM anemia MVP asthma/COPD phaechromocytoma
what are the differential diagnoses for panic attacks?
hypoPTH hyperthyroidism hypoglycemia DM anemia MVP asthma/COPD phaechromocytoma
what is the management of panic disorder?
(first line) use of psychotherapy such as: psychoeducaiton, breathing exercise, stress management and anxiety management, activity scheduling, problem solving, relaxation techniques AND CBT (TX of CHOICE)
other pharmacotherapy: SSRI, venlafaxine, MAO-I
what is the feature of agarophobia?
marked fear or anxiety about 2 out of 5 of the following:
using of public transport, being in open spaces, being in enclosed spaces, standing in line, being outside of the home alone
has thoughts of difficulty escaping or diffculty managing panic attack in public
persistently avoids or difficulty enduring w/ intense fear and anxiety
these situations always provoke fear and anxiety
out of proportion to the danger posed
what is a common assoc. of agarophobia?
panic disorder
what is the treatment of agarophobia?
if assoc w/ panic disorder, treat panic disorder w/ pharmaco before engaging in CBT
if not assoc w/ panic disorder, go for CBT no indication for pharmacotherapy
what is the treatment of social anxiety disorder?
generalized social anxiety:
(first line) CBT based exposure based therapy, social skills training
(second line) SSRI, venlafaxine, MAO-I
non generalized social anxiety:
bblocker for treatment of symptoms: tremors, palpitations, sweating,
what are some common obsessions in OCD?
fear of contamination doubting fear of illness, germs or bodily fear symmetry sexual/aggressive thoughts
what are some common compulsions in OCD?
washing
counting
checking
what is the psychotherapy of choice for OCD?
CBT w/ mindfulness including exposure therapy, prevention of ritual which are used to reduce anxiety
what is the place for pharmacotherapy in the treatment of specific phobia disorders?
no place, unless the use of diazepam for short term anxiolysis so that psychotherapy can take place
what is the place for pharmacotherapy in the treatment of specific phobia disorders?
no place, unless the use of diazepam for short term anxiolytic for severe distress so that psychotherapy can take place
what is the place for pharmacotherapy in the treatment of specific phobia disorders?
no place, unless the use of diazepam for short term anxiolytic for severe distress so that psychotherapy can take place
what are the classifications of social anxiety disorder?
generalized: afraid of many social situations - both performance and interactional
non generalized: afraid of 1 or few social situations - usually assoc. w/ the performance type
what are the classifications of social anxiety disorder?
generalized: afraid of many social situations - both performance and interactional
non generalized: afraid of 1 or few social situations - usually assoc. w/ the performance type
what are the classifications of social anxiety disorder?
generalized: afraid of many social situations - both performance and interactional
non generalized: afraid of 1 or few social situations - usually assoc. w/ the performance type
what are the classifications of social anxiety disorder?
generalized: afraid of many social situations - both performance and interactional
non generalized: afraid of 1 or few social situations - usually assoc. w/ the performance type
what to be aware of when prescribing benzodizaepine classes?
patient’s risk factor to being dependent on the medication - alcoholism, illicit drug use, etc.
what is conversion disorder?
acute non voluntary sudden appearance of 1 or more symptoms simulating acute neurological illness, in the context of severe psychological stresses.
what is factitious disorder and malingering?
factitious disorder occurs when the patient makes symptoms up to continue playing the sick role
malingering occurs when the patient makes symptoms up for a secondary gain (not going to work, not attending school etc.)
what is a non SSRI medication that can be used for OCD?
clomipramine (TCA)
what is a non SSRI medication that can be used for OCD?
clomipramine (TCA)
what is the TOC of ADHD?
CNS stimulants - detroamphetamine, methylphenidate
