anxiety disorders

Question 1

1. Summarize the available knowledge concerning the etiology and pathophysiology of panic disorder, generalized anxiety disorder, social phobia, and obsessive-compulsive disorder.

Answer 1

Sympathetic system
-simple auto dysreg unlikely
-locus coeruleus, adrengergic issues
GABA system
-decreased BDZ receptor binding in hippocompus and prefrontal cortex during panic attacks
Fear circuit-fear generation amygdala, fear extinction prefrontal and orbitofrontal cortex

Question 2

2. Discuss the diagnosis and management of panic disorder

Answer 2

Dx- sudden random overwhelming episodes of anxiety that include both somatic and psychic elements, along with worry about either the implication of the attack or about having future attacks, typically occurs early adulthood
Tx- BDZ short term, MAOI watch for tyramine rxn, SSRI best option, SNRI, cog behavioral therapy (breathing, progressiv emuscle relax

Question 3

3. List the common general medical and substance-induced causes of anxiety, and assess for these causes in evaluating a person with an anxiety disorder.

Answer 3

Thyroid issues
Parathyroid issues- more paranoia
mitral valve prolapse
cardiac arrythmias
coronary insufficiency
Pheochromocytoma
hypoglycemia
true vertigo
drug/etoh withdrawal
cannabis intox

Question 4

5. Discuss the role of anxiety and anxiety disorders in the presentation of general medical symptoms, the decision to visit a physician, and health care expenditures.

Answer 4

intitial somatizer is the most common patient, with psychologic presentation the least common. OCD long time before its DX, 1-2% seek treatment in social phobia

Question 5

OCD- Dx, Tx

Answer 5

you can have either obsessions, or compulsions or both
the obsessions are recurrent persistent thoughts or images or impulses and cause anxiety
compulsions are mental acts that are performed in order to reduce anxiety, can be caused by strep in children, highly comorbid with tourettes.

Tx- SSRI’s augment with atypical antipsychotics
extinction therapy works just as well as Rx

Question 6

Dx and Tx agoraphobia,

Answer 6

fear of the market place a subtype of panic attack

Question 7

Dx and Tx social phobia

Answer 7

overwhelming anxiety is situations where one would have to interact with others, be center of attention, or perform in front of others (not shyness) most common form of anxiety
Tx- BDZ, BB, MAOI, SSRI, COgnitive behavioral therapy particularly group therapy

Question 8

Dx and Tx of generalized anxiety disorder

Answer 8

Dx- excessive worry and more generalized somatic symptoms (worry, anxiety, tension), high comorbidity with other psychological issues, chronic, more female than male