Anxiety Disorders

Question 1

When kids worry about bad things happening to their parents, and as a result are reluctant to leave the home, fearing never seeing them again; Will often fake illness to avoid having to leave home. Look for a trigger!

Answer 1

Separation anxiety disorder

Question 2

Treatment for separation anxiety disorder

Answer 2

Identifying trigger and using therapy to help the child understand the trigger and learn to cope; May need medication (anxiolytic or antidepressant), but ONLY in combo with behavioral psychotherapy and family therapy

Question 3

Very common disorder (9% of pop); Presence of phobias involving objects or situations that invoke anxiety. Individual may have a restricted lifestyle as a result of this disorder.

Answer 3

Specific phobia

Question 4

Treatment for specific phobia

Answer 4

Systematic desensitization (feared stimuli are paired with relaxation training) and flooding of the feared stimulus in massive exposure

Question 5

What disorder can result from avoidant personality traits?

Answer 5

Social anxiety disorder (social phobia)

Question 6

Patients will have a fear of speaking or performing in public (“stage fright”), public speaking, speaking in classrooms, eating or writing in public, urinating in public restrooms, and attending social events; May socially isolate themselves and have a low self-esteem

Answer 6

Social anxiety disorder

Question 7

How do you treat social anxiety disorder?

Answer 7

CBT, pharmacotherapy (SSRI, buspirone, benzos, beta blockers for social phobias)

Question 8

Recurrent, unexpected panic attacks of abrupt surges of intense fear and discomfort that peaks in 1 minute or so, and during which the patient experiences 4 of the 13 symptoms listed in the DSM (sweating, palpitations, chest pain, nausea); This person also has to exhibit either persistent concern or worry of the recurrence of these attacks, or a significant maladaptive change in behavior as a result of the disorder

Answer 8

Panic disorder

Question 9

Excessive, poorly controlled anxiety about routine life circumstances that continues for more than 6 months, where the person finds it difficult to control the worry an the worry impairs daily functioning. The anxiety is associated with three or more symptoms of restlessness, easily fatigued, poor concentration, irritability, muscle tension, and sleep disturbance

Answer 9

Generalized anxiety disorder

Question 10

Treatment for GAD

Answer 10

Medication based with antidepressant therapy as well as anxiolytics being very important, as well as some forms of behavioral therapy such as relaxation training and biofeedback

Question 11

Is there a genetic component to OCD?

Answer 11

Yes

Question 12

4th most common psychiatric diagnosis?

Answer 12

OCD

Question 13

OCD is ____-mediated

Answer 13

Serotonin

Question 14

Recurrent obsessions and/OR compulsions that are disruptive to the patient’s life, and greatly interferes with daily functioning (must be at least 1 hour/day per DSM)

Answer 14

Obsessive compulsive disorder

Question 15

Do individuals recognize OCD as unreasonable and bothersome? What is this called?

Answer 15

YES - this is egodystonic

Question 16

What other diagnoses are often associated with to OCD?

Answer 16

Tourette’s and ADHD

Question 17

How do you treat OCD?

Answer 17

Seratonergic antidepressants at max dose, clomipramine, and behavioral therapies

Question 18

A normal appearing individual has excessive preoccupation with an imagined physical defect. There may be a minor physical defect that is perceived with massive issue; there may be a co-morbid delusional disorder present

Answer 18

Body dysmorphic disorder

Question 19

Treatment for body dysmorphic disorder

Answer 19

Seratonergic drugs (as used in OCD at max dose); CBT; antipsychotic medications may be used when there are delusions of psychotic proportions

Question 20

Persistent difficulty in discarding or parting with possessions regardless of actual value, an accumulation of possessions that congests living areas, and it causes clinically significant distress or impairment; Insight may be good or poor - can be a delusional content

Answer 20

Hoarding disorder

Question 21

Treatment for hoarding disorder

Answer 21

Same as OCD and body dysmorphia; CBT primarily

Question 22

This is “Hair pulling” disorder, which is recurrent hair pulling that results in hair loss; there are attempts to decrease or stop the hair pulling - there is significant distress or impairment

Answer 22

Trichotillomania - Treatment the same as other anxiety disorders

Question 23

Recurrent skin picking and there are attempts to decrease the skin picking which are often met with failure; this causes clinically significant distress or impairment

Answer 23

Excoriation Disorder - treatment the same as other anxiety disorders

Question 24

Recurrent memories, recurrent dreams, feeling of recurrence, distress at re-exposure, physiological reactivity

Answer 24

“Intrusion” symptoms for PTSD 1+

Question 25

Memories, thoughts, feelings; External reminders

Answer 25

Avoidance symptoms for PTSD 1+

Question 26

Poor memory, self-concept, cause/consequences, emotional state, interest/participation, detachment, loss of positive emotions

Answer 26

Negative cognitions for PTSD 2+

Question 27

Irritability, recklessness, hyper vigilance, exaggerated startle, poor concentration, sleep disturbance

Answer 27

Arousal symptoms for PTSD 2+

Question 28

Most cases of PTSD resolve within?

Answer 28

3 months

Question 29

Relieve the patient of intrusive recollections and decrease symptoms of anxiety and improve social relations and capacity for enjoyment

Answer 29

Mainstay of treatment for PTSD

Question 30

What are the 3 mainstays of treatment for PTSD?

Answer 30

• Group physchotherapy, pharmacology, and not debriefing but immediate therapy/counseling may help stave off PTSD from developing

Question 31

Anxiety related equivalent of brief-psychotic disorder; this is a disorder that is essentially early or acute PTSD: Has to last from 3 days to 1 month (Once it has lasted for more than 1 month, it reverts to PTSD)

Answer 31

Acute stress disorder

Question 32

Environmental stressors such as interpersonal issues (divorce), occupation issues (job loss), and medical issues (cancer) can be very trying and cause anxiety, depression,, or behavioral symptoms (erratic actions) that interfere with function

Answer 32

Adjustment disorders

Question 33

Do the symptoms of adjustment disorder ever remit?

Answer 33

yes, once the stressor resolves or new coping skills develop

Question 34

The risk of developing an adjustment disorder depends on what two things?

Answer 34

Person’s coping skills and emotional strength

Question 35

Patient presents with complaint of a “nervous breakdown”; unable to manage life problems, and is suffering from overwhelming anxiety or depression associated with life stressors. Patient had normal functioning before the onset of the stressor. MS exam shows anxiety, depression, or disturbed conduct.

Answer 35

Adjustment disorder

Question 36

Adjustment disorder must occur within ____ months of the onset of a stressor

Answer 36

3

Question 37

Adjustment disorder symptoms must resolve within ___ months of the termination of the stressor but may persist for longer period if they occur in response to long-term exposure

Answer 37

6

Question 38

Treatment for adjustment disorder

Answer 38

Removing stressor if possible, engaging in CBT or psychodynamic psychotherapy; supportive psychotherapy

Question 39

Do you use meds for adjustment disorder?

Answer 39

May be helpful adjunctively if patient suffers from anxiety, insomnia, depression, etc.