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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
What criteria need to be met to diagnois a specific phobia?
1. Phobic stimulus 2. (Almost) Always fear or anxiety 3. Avoidence or endurance 4. Out of proportion
26
What is the specific time period for specific phobia?
> 6 months
27
What is the 12 month prevalence of specific phobias?
9%
28
Which sex are specific phobias more common?
Women (2:1)
29
What distinguishes specific phobia from agoraphobia?
Agoraphobia requires 2 different situations (POE LOC)
30
What distinguishes specific phobia from social phobia?
1. Social situations 2. Social scrutiny 3. Fear of embarrasment or humiliation
31
What distinguishes specific phobia from GAD?
GAD - Global - Worry over numerous activites or events
32
What two psychiatric conditions are patients with separation anxiety at risk fo developing?
``` Depression - MDD (32%) Anxiety - Panic disorder (12%) - Agoraphobia (18%) - GAD (26%) ```
33
What is the best treatment for separation anxiety?
1. Multisystemic therapy - School, church, families, and peers 2. SSRI (adjunct) 3. Relaxation techniques 4. Gradual separation ("exposure"/CBT)
34
What type of schooling should be avoided in a child with separation anxiety?
Home schooling
35
What are the peak ages for separation anxiety disorder?
9 to 10
36
What critera must be met to make a diagnosis of separation anxiety disorder?
1. Developmentally inappropriate anxiety about separation
37
How long do the symptoms need to be present to make a diagnosis of separation anxiety disorder?
4+ weeks
38
By what age must the symptoms start to make a diagnosis of separation anxiety disorder?
Prior to 18
39
What commonly precipitates separation anxiety disorder?
Life-threatening disease of a parent
40
What is the main "fear" involved in separation anxiety disorder?
That their parent will die while they are gone
41
What type of symptoms often accompany separation anxiety disorder?
Difficult to diagnose somatic complaints
42
What are some second line agents that can be used to treat separation anxiety disorder?
SNRI- Venlafaxine TCAs Buspirone
43
What medications have shown no efficacy in childhood anxiety disorders?
Benzos
44
What should you do if the patient meets critera for both separation anxiety disorder and MDD?
Diagnose both
45
What type of MDD symptoms are present in patients with separation anxiety disorder?
Vegitative symtpoms - insomina - anorexia
46
What is a key aspect of getting good outcomes when treating separation anxiety disorder?
Early recognition and intervention
47
What is a commonly prescribed medication that induces anxiety?
Levothyroxine
48
What is the best treatment for socail anxiety disorder?
Behavior or Cognitive behavioral therapy | - Relaxation followed by desensitization
49
What pharmacological therapies can be used as short term adjuncts for social anxiety disorder?
Benzos and beta blockers - Atenolol - Propranolol
50
What pharmacological therapies are availabe for long term adjunctive treatment of social anxiety disorder?
``` SSRIs - Sertraline or fluoxetine SNRIs - Venlafaxine Buspirone - Best as adjunct with SSRIs ```
51
What critera must be met to make a diagnosis of social anxiety disorder?
1. Fear of social or performance situation 2. Fear of embarrassment 3. Recognition that the fear is unreasonable 4. Change in behavior
52
What is anxiety?
Fear of future events
53
What are the general symptoms of anxiety?
Verbal-subjective (worry) Overt motor acts (Avoidance) Somato-visceral activity (Palpitations)
54
What is the goal of relaxation training?
Reduce arousal levels | Increase sense of control
55
What fears are included in social phobias?
Embarrassed in public Speaking in public Eating in public
56
What is the most common metanl disorder in the US?
Phobias (5 to 10% of the population)
57
What sex is most often affected by phobias?
Females
58
What therapy has been showed to have one of the best outcomes in treating social anxiety disorder?
Cognitive behavior therapy - Group or individual - Exposure therapy
59
What other disorders need to be on the differential for social anxiety disorder?
All anxiety disorders Substance/Medications Medical conditions
60
What is the default diagnosis if no specific critera can be met?
Anxiety disorder not otherwise specified
61
What anxiety disorders present similar to social anxiety disorder?
Performance anxiety Stage fright Shyness
62
What is the timeframe required to make a diagnosis of social anxiety disorder?
6+ months
63
What type of behaviorl therapy can help with social anxiety disorder?
Rehearsal
64
Which parts of the brain appear to be most involved in anxiety?
Limbic and paralimbic areas | - Amygdala
65
When is the typical onset of social anxiety disorder?
Late childhood to early adulthood
66
What time critera must be met to make the diagnosis of GAD?
6+ months
67
What are the critera for GAD?
1. Persistent, excessive, uncontrollable anxiety/worry 2. Stuggle with control 3. 3+ somatic symptoms
68
What are the somatic symptoms associated with GAD?
MS. FRIC Muscle tension Sleep disturbance Fatigue Restlessness Irritablity Concentration issues
69
What are the two components that define anxiety?
1. Worry about a future event 2. Physical symptoms - Muscle tension is most common
70
What is fear?
Fear is an emotional response with hyperarousal due to a perceived impending threat
71
What is the most basic definition of GAD?
1. Persistent, excessive, & uncontrollable anxiety | 2. Involves various domains of life
72
What type of condition is GAD?
Chroinc
73
How would a person with GAD respond to life stressors?
It would make the symptoms worse
74
What should be othe differentail when considering GAD as a diagnosis?
All anxiety disorders - Substance/medication - Medical condition
75
What is the key to diagnosing GAD over other anxiety disorders?
Broad base of anxiety generalized across VARIOUS domains
76
What medical conditions superced GAD?
All of them | - GAD is a diagnosis of exclusion
77
What is the most effective treatment for GAD?
Pmarmacotherapy & Psychotherapy
78
What psychotherapy is the best treatment for GAD?
CBT Psychodynamic psychotherapy - Helps understand the maladaptive patterns and unconscious reasons for anxiety
79
What pharmacological agents show the most promise when treating GAD?
1. SSRIs 2. Another SSRI 3. SNRI or TCA
80
What pharmacological agents can be used to augment treatment for GAD?
``` Benzos - Smallest does, shortest duration Hydroxyzine Buspirone Mirtazapine ```
81
What are the main concerns when using benzos?
``` Addiction Oversedation Cognitive impairment Falls- Elderly Withdrawal Rebound anxiety ```
82
What is the alogrithm for approaching anxiety disorders?
1. R/O substance or medications 2. R/O Medical disorders 3. Characterize the anxiety disorder
83
What work-up may be requried to R/O substances or medications?
Blood-alcohol Urine drug Serum drug
84
What work-up may be required to R/O medical condition?
``` Blood glucose UA CBC CMP Ammonia TSH UPT ```
85
What critera must be present to make a dx of anxiety disorder secondary to a medical condition?
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
What is the key component of making a dx of anxiety disorder secondary to a medical condition?
Clinical data indicating a medical etiology
87
What are some common medical conditions that can induce anxiety?
1. Systemic conditions 2. Endocrinopathies 3. Metabolic distrubances 4. Immune system disorders 5. Neurologic disease- Major neurocognitive disorders
88
List some diseases that are associated with anxiety disorder secondary to a medical condition?
``` Graves Hypothyroidism Hypoparathyroidism Carcinoid syndrome B12 def Pheochormocytoma Seizures COPD ```
89
What work-up is indicated when considering a dx of anxiety disorder secondary to a medical condition?
``` CBC CMP- Electrolytes, Cr, BUN, Blood glucose, hepatic markers Urinalysis TSH Urine drug screen Medications UPT ```
90
What medications are know to cause anxiety?
Steroids Anticholinergics Sympathomimetics SSRIs
91
What is the basis for treating an anxiety disorder secondary to a medical condition?
Treat the underlying illness
92
If a patient presents with sudden onset dyspnea, heart palpitations, and intense anxiety what should be on your DDX regardless of her psychiatric history?
Pulmonary emoblus | - Especially if patient is a smoker and has history of OTC
93
What atypical presentations decrase the likelihood of a primary anxiety disorder?
Older age Salient somatic symptoms Lack of personal or family history of psychiatric illness
94
A prior diagnosis of psychiatric illness should not preculde what?
Careful evaluation for a medical cause of symptoms

Case Files Psychiatry (10 decks)

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