Anxiety disorders

Question 1

Panic disorder

Answer 1

Sudden, overwhelming episodes of anxiety that include somatic and psychic elements along with worry about the implications or having future attacks

Question 2

Generalized anxiety disorder

Answer 2

Excessive worry and more generalized somatic symptoms of anxiety (Worry, Anxiety, Tension)

Worry-cognitive (what if?)
Anxiety- physiologic response
Tension- tight neck, sore back

Often comorbid with depression or other psychiatric disorders

Question 3

Social phobia

Answer 3

Overwhelming anxiety in situations where one would have to interact with others, be the center of attention, or perform in front of others

Not “shyness”

Fear of:
Performing in front of others
Being the center of attention
Eating in public
Writing in public
Using public restroom (particularly in men)
Using telephone

Question 4

Obsessive-compulsive disorder

Answer 4

Obsessions or Compulsions

Obsessions: recurrent, persistent thoughts,
images, or impulses that are intrusive and cause
anxiety

Compulsions: repetitive behaviors or mental acts
that are performed in order to reduce anxiety

Question 5

Prevalence of panic disorder

Answer 5

1. 5-3.5% lifetime prevalence

2: 1 female:male

Question 6

Treatment of Panic Disorder

Answer 6

Pharmacologic treatment:

Benzodiazepines (good short term! never long-term)
Tricyclic antidepressants
Monoamine oxidase inhibitors
Serotonin specific reuptake inhibitors
Serotonin Norepinephrine reuptake inhibitors

Non-pharmacologic treatment:
Cognitive behavioral therapy

Question 7

Prevalence of GAD

Answer 7

Approximately 75-90% comorbid with other psychiatric disorders (most commonly depression)

Chronic condition with estimated lifetime prevalence = 5.1%

Female:Male = 2:1

Question 8

Treatment of GAD

Answer 8

Pharmacologic Treatment:

Benzodiazepines
Buspirone
TCAs
MAOIs
SNRIs
SSRIs

Non-pharmacologic Treatment:
Cognitive behavioral therapy

Question 9

Lifetime prevalence of social phobia

Answer 9

Lifetime prevalence = 13.5%

Question 10

Treatment of Social Phobia disorder

Answer 10

Pharmacologic Treatment:

Benzodiazepines
Beta blockers
MAOIs
SSRIs

Non-pharmacologic Treatment:
Cognitive behavioral therapy particularly group therapy

Question 11

Prevalence of OCD

Answer 11

2.5% lifetime

Question 12

Pathophysiology of OCD

Answer 12

Involves orbital frontal lobes, basal ganglia (most importantly the caudate) and the thalamus

Relative imbalance between direct and indirect basal ganglia pathways, with a tendency toward greater direct basal ganglia tone

Question 13

Treatment of OCD

Answer 13

Pharmacologic treatment:

Clomipramine
SSRIs
Augmentation with atypical antipsychotics

Non-pharmacologic treatment:
Behavioral therapy exposure response prevention
Neurosurgery