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Case Files Psychiatry > Anxiety Disorders > Flashcards

Anxiety Disorders Flashcards

1
Q

What test should you order for a patient taking levothyroxine in order to rule out medication induced anxiety?

A

Thyroxine levels

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2
Q

What is the recommended treatment for panic attack disorders?

A

SSRI and CBT

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3
Q

What can be used for immediate control of symptoms associated with a panic attack? How long should this medication be used?

A
  1. Short acting benzo
    - Alprazolam
  2. Only several weeks
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4
Q

What situations are included in agoraphobia?

A

POE LOC

Public transporation
Open spaces
Enclosed spaces

Lines
Outside alone
Crowds

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5
Q

How many symptoms need to be present to meet critera for panic attack?

A

4+

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6
Q

What are the possible symptoms of a panic attack?

PANICS

A

Palpitations & Paresthesias
Abdominal distress
Nausea
Intesnse fear of dying & Light-headedness
Chest pain & Chills & Choking & disConnectedness
Sweating & Shaking & SOB

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7
Q

What critera need to be present to meet critera for panic disorder?

A
  1. Recurrent & Unexpected
  2. 1+ month of worry (additonal attacks or consequences) &/or maladaptive behavior
  3. Not a substance, medication, or condition
  4. No other medical disorder
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8
Q

What is the median age of onset for panic disorder?

A

20 to 24

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9
Q

What should be on the differential for panic disorder?

A
  1. Medical conditions that cause panic attacks
  2. Substances
  3. Medications
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10
Q

What are the broad catagories of medical conditions that can cause panic attacks?

A
  1. Cardiac
  2. Endocrine
  3. Neoplastic
  4. Neurologic
  5. Pulmonary
  6. Other- Anaphylaxis & Porphyria
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11
Q

What are some common substances that can lead to panic attacks?

A
  1. Ampehtamines
  2. Cocaine
  3. Hallucinogens
  4. Withdrawal- Alcohol or benzos
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12
Q

What are some medications that can cause panic attacks?

A
  1. Steroids
  2. Anticholinergics
  3. Theophylline
  4. Levothyroxine
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13
Q

If a patient presents with panic attacks, but also has DIFFICULT TO TREAT HTN, a headache, and muscle tension. What medical condition should be ruled out first?

A

Pheochromocytoma

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14
Q

If a patient presents with panic attacks, but also has tachycardia, heat intolerance, and weight loss. What medical condition should be ruled out?

A

Hyperthyroidism

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15
Q

What are the only two physical exam findings that should be present for someone just experiencing a panic attac?

A

Elevated BP & tachycardia

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16
Q

What is the “hallmark” of panic disorder?

A

Unexpected panic attacks not provoked by any particular stimulus

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17
Q

What is the “fear” in panic disorder?

A

Having another attack

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18
Q

What are the most effective pharmacological treatment for panic disorder?

A

SSRIs & SNRI (Venlafaxine) & TCAs

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19
Q

Which benzo are FDA approved for the treatment of panic disorder?

A

Alpraxolam

Clonazepam

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20
Q

If the patient has a specific fear about any social or performance situation, what is the most appropriate diagnosis?

A

Social anxiety disorder (Social phobia)

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21
Q

What is the KEY feature about the panic attacks associated with panic disorder?

A

They are UNPROVOKED

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22
Q

What psychatric disorder is also often present with panic disorder?

A

MDD

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23
Q

What is the best treatment for specific phobias?

A

CBT with exposure

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24
Q

What are the pharmacological therapies avaliable for specific phobias?

A

Benzos (CBT is unavalable or exposure will be rare)

SSRI (limited data)

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25
Q

What criteria need to be met to diagnois a specific phobia?

A
  1. Phobic stimulus
  2. (Almost) Always fear or anxiety
  3. Avoidence or endurance
  4. Out of proportion
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26
Q

What is the specific time period for specific phobia?

A

> 6 months

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27
Q

What is the 12 month prevalence of specific phobias?

A

9%

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28
Q

Which sex are specific phobias more common?

A

Women (2:1)

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29
Q

What distinguishes specific phobia from agoraphobia?

A

Agoraphobia requires 2 different situations (POE LOC)

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30
Q

What distinguishes specific phobia from social phobia?

A
  1. Social situations
  2. Social scrutiny
  3. Fear of embarrasment or humiliation
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31
Q

What distinguishes specific phobia from GAD?

A

GAD

  • Global
  • Worry over numerous activites or events
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32
Q

What two psychiatric conditions are patients with separation anxiety at risk fo developing?

A 
Depression
- MDD (32%)
Anxiety
- Panic disorder (12%)
- Agoraphobia (18%)
- GAD (26%)
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33
Q

What is the best treatment for separation anxiety?

A
  1. Multisystemic therapy
    - School, church, families, and peers
  2. SSRI (adjunct)
  3. Relaxation techniques
  4. Gradual separation (“exposure”/CBT)
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34
Q

What type of schooling should be avoided in a child with separation anxiety?

A

Home schooling

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35
Q

What are the peak ages for separation anxiety disorder?

A

9 to 10

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36
Q

What critera must be met to make a diagnosis of separation anxiety disorder?

A
  1. Developmentally inappropriate anxiety about separation
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37
Q

How long do the symptoms need to be present to make a diagnosis of separation anxiety disorder?

A

4+ weeks

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38
Q

By what age must the symptoms start to make a diagnosis of separation anxiety disorder?

A

Prior to 18

39
Q

What commonly precipitates separation anxiety disorder?

A

Life-threatening disease of a parent

40
Q

What is the main “fear” involved in separation anxiety disorder?

A

That their parent will die while they are gone

41
Q

What type of symptoms often accompany separation anxiety disorder?

A

Difficult to diagnose somatic complaints

42
Q

What are some second line agents that can be used to treat separation anxiety disorder?

A

SNRI- Venlafaxine
TCAs
Buspirone

43
Q

What medications have shown no efficacy in childhood anxiety disorders?

A

Benzos

44
Q

What should you do if the patient meets critera for both separation anxiety disorder and MDD?

A

Diagnose both

45
Q

What type of MDD symptoms are present in patients with separation anxiety disorder?

A

Vegitative symtpoms

  • insomina
  • anorexia
46
Q

What is a key aspect of getting good outcomes when treating separation anxiety disorder?

A

Early recognition and intervention

47
Q

What is a commonly prescribed medication that induces anxiety?

A

Levothyroxine

48
Q

What is the best treatment for socail anxiety disorder?

A

Behavior or Cognitive behavioral therapy

- Relaxation followed by desensitization

49
Q

What pharmacological therapies can be used as short term adjuncts for social anxiety disorder?

A

Benzos and beta blockers

  • Atenolol
  • Propranolol
50
Q

What pharmacological therapies are availabe for long term adjunctive treatment of social anxiety disorder?

A 
SSRIs
- Sertraline or fluoxetine
SNRIs
- Venlafaxine
Buspirone
- Best as adjunct with SSRIs
51
Q

What critera must be met to make a diagnosis of social anxiety disorder?

A
  1. Fear of social or performance situation
  2. Fear of embarrassment
  3. Recognition that the fear is unreasonable
  4. Change in behavior
52
Q

What is anxiety?

A

Fear of future events

53
Q

What are the general symptoms of anxiety?

A

Verbal-subjective (worry)
Overt motor acts (Avoidance)
Somato-visceral activity (Palpitations)

54
Q

What is the goal of relaxation training?

A

Reduce arousal levels

Increase sense of control

55
Q

What fears are included in social phobias?

A

Embarrassed in public
Speaking in public
Eating in public

56
Q

What is the most common metanl disorder in the US?

A

Phobias (5 to 10% of the population)

57
Q

What sex is most often affected by phobias?

A

Females

58
Q

What therapy has been showed to have one of the best outcomes in treating social anxiety disorder?

A

Cognitive behavior therapy

  • Group or individual
  • Exposure therapy
59
Q

What other disorders need to be on the differential for social anxiety disorder?

A

All anxiety disorders
Substance/Medications
Medical conditions

60
Q

What is the default diagnosis if no specific critera can be met?

A

Anxiety disorder not otherwise specified

61
Q

What anxiety disorders present similar to social anxiety disorder?

A

Performance anxiety
Stage fright
Shyness

62
Q

What is the timeframe required to make a diagnosis of social anxiety disorder?

A

6+ months

63
Q

What type of behaviorl therapy can help with social anxiety disorder?

A

Rehearsal

64
Q

Which parts of the brain appear to be most involved in anxiety?

A

Limbic and paralimbic areas

- Amygdala

65
Q

When is the typical onset of social anxiety disorder?

A

Late childhood to early adulthood

66
Q

What time critera must be met to make the diagnosis of GAD?

A

6+ months

67
Q

What are the critera for GAD?

A
  1. Persistent, excessive, uncontrollable anxiety/worry
  2. Stuggle with control
  3. 3+ somatic symptoms
68
Q

What are the somatic symptoms associated with GAD?

A

MS. FRIC

Muscle tension
Sleep disturbance

Fatigue
Restlessness
Irritablity
Concentration issues

69
Q

What are the two components that define anxiety?

A
  1. Worry about a future event
  2. Physical symptoms
    - Muscle tension is most common
70
Q

What is fear?

A

Fear is an emotional response with hyperarousal due to a perceived impending threat

71
Q

What is the most basic definition of GAD?

A
  1. Persistent, excessive, & uncontrollable anxiety

2. Involves various domains of life

72
Q

What type of condition is GAD?

A

Chroinc

73
Q

How would a person with GAD respond to life stressors?

A

It would make the symptoms worse

74
Q

What should be othe differentail when considering GAD as a diagnosis?

A

All anxiety disorders

  • Substance/medication
  • Medical condition
75
Q

What is the key to diagnosing GAD over other anxiety disorders?

A

Broad base of anxiety generalized across VARIOUS domains

76
Q

What medical conditions superced GAD?

A

All of them

- GAD is a diagnosis of exclusion

77
Q

What is the most effective treatment for GAD?

A

Pmarmacotherapy & Psychotherapy

78
Q

What psychotherapy is the best treatment for GAD?

A

CBT
Psychodynamic psychotherapy
- Helps understand the maladaptive patterns and unconscious reasons for anxiety

79
Q

What pharmacological agents show the most promise when treating GAD?

A
  1. SSRIs
  2. Another SSRI
  3. SNRI or TCA
80
Q

What pharmacological agents can be used to augment treatment for GAD?

A 
Benzos
- Smallest does, shortest duration
Hydroxyzine
Buspirone
Mirtazapine
81
Q

What are the main concerns when using benzos?

A 
Addiction
Oversedation
Cognitive impairment
Falls- Elderly 
Withdrawal
Rebound anxiety
82
Q

What is the alogrithm for approaching anxiety disorders?

A
  1. R/O substance or medications
  2. R/O Medical disorders
  3. Characterize the anxiety disorder
83
Q

What work-up may be requried to R/O substances or medications?

A

Blood-alcohol
Urine drug
Serum drug

84
Q

What work-up may be required to R/O medical condition?

A 
Blood glucose
UA
CBC
CMP
Ammonia
TSH
UPT
85
Q

What critera must be present to make a dx of anxiety disorder secondary to a medical condition?

A
  1. Anxiety or panic attacks are the main symptoms
  2. H&P + labs suggest direct physiological connection to condition
  3. No other condition
  4. Not delirium
86
Q

What is the key component of making a dx of anxiety disorder secondary to a medical condition?

A

Clinical data indicating a medical etiology

87
Q

What are some common medical conditions that can induce anxiety?

A
  1. Systemic conditions
  2. Endocrinopathies
  3. Metabolic distrubances
  4. Immune system disorders
  5. Neurologic disease- Major neurocognitive disorders
88
Q

List some diseases that are associated with anxiety disorder secondary to a medical condition?

A 
Graves
Hypothyroidism
Hypoparathyroidism
Carcinoid syndrome
B12 def
Pheochormocytoma
Seizures
COPD
89
Q

What work-up is indicated when considering a dx of anxiety disorder secondary to a medical condition?

A 
CBC
CMP- Electrolytes, Cr, BUN, Blood glucose, hepatic markers
Urinalysis 
TSH
Urine drug screen
Medications
UPT
90
Q

What medications are know to cause anxiety?

A

Steroids
Anticholinergics
Sympathomimetics
SSRIs

91
Q

What is the basis for treating an anxiety disorder secondary to a medical condition?

A

Treat the underlying illness

92
Q

If a patient presents with sudden onset dyspnea, heart palpitations, and intense anxiety what should be on your DDX regardless of her psychiatric history?

A

Pulmonary emoblus

- Especially if patient is a smoker and has history of OTC

93
Q

What atypical presentations decrase the likelihood of a primary anxiety disorder?

A

Older age
Salient somatic symptoms
Lack of personal or family history of psychiatric illness

94
Q

A prior diagnosis of psychiatric illness should not preculde what?

A

Careful evaluation for a medical cause of symptoms

Case Files Psychiatry (10 decks)

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