anxiety disorders

Question 1

difference between normal anxiety and pathologic anxiety

Answer 1

normal: diffuse, unpleasant, vague sense of apprehension, often accompanied by autonomic symptoms (ex sweating, palpitations, etc)
pathologic: sense of danger becomes prominent

Question 2

what is a panic attack?

Answer 2

episode of intense fear or discomfort with 4 or more of the following sx developing abruptly, reaching a peak in 10 min

• palpitations
• sweating
• dizziness
• trembling
• SOB
• fear of dying, losing control, being detached
• choking feeling
• chest pain
• Nausea/abdominal distress
• parasthesias
• chills or hot flashes

Question 3

treatment for panic attacks

Answer 3

benzodiazepines for acute attack

*not a disorder in and of itself, just a feature of many different anxiety disorders

Question 4

criteria for panic disorder

Answer 4

sx not due to substance, medical condition or other mental disorder

recurrent, unexpected expected panic attacks (@ least 2) not related to trigger. familial trait

panic attack followed by concern about more attacks, worry about the implication of the attacks, significant change in behavior related to the attacks

Question 5

anxiety about being in a certain place or situation (fear of crowds, wide open spaces, avoidance of these situations)

Answer 5

agoraphobia

Question 6

management of panic disorder

Answer 6

SSRIs: 1st line long-term tx. : paroxetine, sertraline, fluoxetine

benzos for acute attacks (watch for abuse), TCA’s (imipramine)

CBT: psycho-treatment that focuses on thinking and behavior (ex. relaxation, desensitization, examining behavior consequences etc)

Question 7

what is PTSD?

Answer 7

1. exposed to a traumatic event and actual or threatened death or serious injury/violation to self or others AND
2. the response may involve helplessness, dissociative sx, avoidance of associated stimuli, emotional numbing, increased autonomic arousal

Question 8

criteria for PTSD

Answer 8

trauma is re-experienced: > 1 month as RECOLLECTIONS, distressing dreams, acting/feeling as if event were recurring, physiologic distress AND AVOIDANCE OF RELATED STIMULI: thoughts, feelings, conversations, disinterest in activities, memory lapse, etc

Question 9

management of PTSD

Answer 9

1. antidepressants: SSRIst 1st line tx: paroxetine, sertraline, fluoxetine, TCA’s, MAOIs
2. CBT: psychotherapy (individual or group tx), counseling

Question 10

what is acute stress disorder

Answer 10

similar to PTSD but sx

Question 11

management of acute stress disorder

Answer 11

counseling/psychotherapy. if persistent, tx as PTSD

Question 12

mean onset of OCD

Answer 12

20y (rare after 50y)

men=women but men present earlier

Question 13

what are obsessions?

Answer 13

recurrent/persistent thoughts; thoughts are NOT excessive worries about real life problems.

pts often try to suppress thoughts (often have an understanding that the obsessions are a product of their own mind and the obsessions are unreasonable)

Question 14

what are compulsions?

Answer 14

repetitive behaviors the person is driven to perform. these behaviors are aimed at reducing or preventing stress

Question 15

4 major patterns/clinical manifestations of OCD

Answer 15

contamination, doubt, symmetry/precision, and intrusive thoughts without compulsion

Question 16

excessive anxiety or worry a majority of days in a 6 month period associated with 3 or more: fatigue, restlessness, difficulty concentrating, muscle tension, sleep disturbance, irritability, shakiness, headaches

Answer 16

generalized anxiety disorder

Question 17

management of generalized anxiety disorder

Answer 17

1. antidepressents: SSRIs (paroxetine and escitalopram); SNRIs: venlafaxine
2. buspirone (buspar): stimulates serotonin receptors and blocks dopamine receptors. may take several weeks before improvement. DOESN’T CAUSE SEDATION
   s/e: dizziness, nervousness, nausea
3. benzos (short term use only), beta blockers
4. psychotherapy

Question 18

this is marked or persistent fear of social or performance situations in which the person is exposed to scrutiny of others (fear of embarrassment)

Answer 18

social anxiety disorder (social phobia) - exposure to social situation provokes anxiety and may cause panic attack (expected panic attacks)

Question 19

management of social anxiety disorder

Answer 19

1. antidepressants: SSRIs (paroxetine, citalopram)
2. beta-blockers : proponal, atenolol, (especially for performance anxiety)
3. benzodiazepines: if treatment is needed infrequently

Question 20

what are all the anxiety disorders?

Answer 20

panic disorder
PTSD
acute stress disorder
OCD
generalized anxiety disorder
social anxiety disorder

Question 21

what are the mood disorders?

Answer 21

major depressive disorder
dysthymic disorder
adjustment disorder