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Psychiatry / Addiction Medicine > Anxiety Disorders > Flashcards

Anxiety Disorders Flashcards

1
Q

____ is the emotional response to real or perceived imminent threat.

A

Fear

often associated with surges of autonomic arousal necessary for fight or flight, thoughts of immediate danger, and escape behaviors

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2
Q

______ is anticipation of future threat.

A

Anxiety

often associated with muscle tension and vigilance in preparation for future danger and cautious or avoidant behaviors

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3
Q

_____ _______ feature prominently within the anxiety disorders as a particular type of fear response.

A

Panic attacks

trigger of fear response without an actual reason

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4
Q

Panic Disorder prevalence ?

A

Men = Women ~4.7% of US and 44.8% classified as “severe”

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5
Q

Panic Disorder etiology and risk factors ?

A

Men = Women average of onset 24 yrs old

Unknown etiology ( it just happens)

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6
Q

Panic Disorder genetics ?

A

High correlation (20-40%) with 1st degree relatives

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7
Q

Panic Disorder DDx ?

A

Metabolic (i.e. hyperthyroidism, ( makes heart beat fast and makes reactions sharp and quick, eye stick out, hot) hypoglycemia ( sweaty palms and shaky and vomiting ), many medical causes)

Seasonal Affective Disorder (SAD)

Agoraphobia or specific phobia ( scared of something)

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8
Q

Panic Disorder prognosis ?

A

Very good with treatment

**check TSH

chest pain - get an EKG**

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9
Q

Panic Disorder medications ?

A

SSRI (i.e. Paxil, Zoloft) possibly benzodiazepines (i.e. Xanax- short term), Hydroxyzine (Vistaril)

** if they have a shit ton of panic attacks then meds and therapy but only once in a while then just therapy or maybe benzos

prozac can make the anxiety worse in some people

non addictive - hydroxyzine - AH that worse well for anxiety ( non addictive sleep aid) **

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10
Q

Panic Disorder procedures / therapy / surgery ?

A

Avoid stimulants (i.e. caffeine and nicotine and sports supplements)

Increase exercise - cause it can burn off nervous energy

Cognitive behavioral therapy - introduce to fear so you diminish response

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11
Q

Obsessive Compulsive Disorder prevalence ?

A

~1.7-4% in the U.S.

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12
Q

Obsessive Compulsive Disorder etiology and risk factors ?

A

Exact cause unknown

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13
Q

Obsessive Compulsive Disorder genetics ?

A

Strong heritability with a genetic influence of 45-65%

Monozygotic twins may be strikingly concordant for OCD (80-87%)

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14
Q

Obsessive Compulsive Disorder DDx ?

A

Major depressive disorder / GAD / Panic disorder

Body dysmorphic disorder / Trichotillomania

Social phobia and simple phobia

ADHD

Tourette syndrome (5-7%) / 
Other tic disorders (20-30%)

Substance abuse / Eating disorders

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15
Q

Obsessive Compulsive Disorder prognosis ?

A

~70% of patients entering treatment experience a significant improvement in their symptoms. However, OCD remains a chronic illness

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16
Q

Obsessive Compulsive Disorder medications ?

A

SSRIs are mainstay of treatment – may take 6-10 weeks

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17
Q

Obsessive Compulsive Disorder procedures / therapy / surgery ?

A

Behavioral Therapy

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18
Q

Sertraline (Zoloft) ?

A

Sertraline (Zoloft): selectively inhibits presynaptic serotonin reuptake at the neuronal membrane.

It is FDA approved for the treatment of OCD, posttraumatic stress disorder, panic disorder, and social anxiety disorder.

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19
Q

Fluvoxamine (Luvox) ?

A

enhances serotonin activity by selective reuptake inhibition at the neuronal membrane. It does not significantly bind to alpha-adrenergic, histamine, or cholinergic receptors and thus has fewer adverse effects than TCAs.

It is FDA-approved for OCD in children (8-17 y) and adults.

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20
Q

Trichotillomania prevalence ?

A

1%-2% in the U.S. F > M

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21
Q

Trichotillomania etiology and risk factors ?

A

Family history

Young age usually 11 to 13 years old

Negative emotions (stress, depression, anxiety)

Positive reinforcement (anxiety relief when pulling hair)

Other mental illness such as OCD

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22
Q

Trichotillomania DDx ?

A

Alopecia Ariata

Anxiety Disorder: Obsessive-Compulsive Disorder

Monilethrix (genetic “beaded hair”)

Tinea Capitis

Traction Alopecia

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23
Q

Trichotillomania prognosis ?

A

Variable with reasonable prognosis however may revert under stress

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24
Q

Trichotillomania medications ?

A

Little evidence of effectiveness of
Medications

Maybe SSRIs to treat underlying mental illness

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25
Q

Trichotillomania procedures / therapy / surgery ?

A

CBT

Habit reversal training

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26
Q

Post Traumatic Stress Disorder prevalence ?

A

PTSD has a lifetime prevalence of 8-10% and accounts for considerable disability and morbidity.

Approximately 30% of men and women who have spent time in a war zone experience PTSD

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27
Q

Post Traumatic Stress Disorder etiology and risk factors ?

A

Highly variable on factors such as:

Characteristics of the trauma and the individual

Post trauma factors

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28
Q

Post Traumatic Stress Disorder genetics ?

A

Possible predisposition but poorly understood

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29
Q

Post Traumatic Stress Disorder DDx?

A

Anxiety Disorders / Obsessive-Compulsive Disorders

Schizophrenia

30
Q

Post Traumatic Stress Disorder prognosis ?

A

Highly variable and often chronic condition

High correlation to substance abuse

31
Q

Post Traumatic Stress Disorder medications ?

A

SSRIs, Benzodiazepines

Prazosin may help with nightmares

** read this E medicine article!

more in depth oil the tx.**

32
Q

Post Traumatic Stress Disorder procedure / therapy / surgery ?

A

Cognitive Behavioral Therapy

EMDR

33
Q

Prazosin (Minipress, Vasoflex, Lentopres and Hypovase) ?

A

is a sympatholytic drug used to treat HTN and BPH. Off label used to treat PTSD and possibly helps with nightmares). Test questions usually present as someone with HTN and BPH and you need to select a drug. Other similar medications: Terazosin, and Doxazosin for HTN and BPH.

34
Q

EMDR ?

A

The goal of EMDR is to reduce the long-lasting effects of distressing memories by developing more adaptive coping mechanisms. The therapy uses an eight-phase approach that includes having the patient recall distressing images while receiving one of several types of bilateral sensory input, such as side to side eye movements. EMDR was originally developed to treat adults with PTSD; however, it is also used to treat other conditions and children.

35
Q

Generalized Anxiety Disorder prevalence ?

A

Slightly more women than men

36
Q

Generalized Anxiety Disorder etiology and risk factors ?

A

Generally starts early in life

High rate of comorbidity with depression

Related to neuroticism

37
Q

Generalized Anxiety Disorder genetics ?

A

Mild to moderate familial component

38
Q

Generalized Anxiety Disorder DDx ?

A

Major Depression and OCD a strong link

39
Q

Generalized Anxiety Disorder prognosis ?

A

Variable with waxing and waning pattern

Comorbid conditions contribute to chronicity

Pharmacologic agents help, but GAD usually returns when d/c

40
Q

Generalized Anxiety Disorder medications ?

A

Sertraline (Zoloft)

Paroxetine (Paxil)

Hydroxyzine (Vistaril)

Buspirone (Buspar)

Benzodiazepines (i.e. Xanax)

41
Q

Generalized Anxiety Disorder procedures / therapy / surgery ?

A

Behavioral Therapy and Cognitive Behavioral Therapy

42
Q

Paroxetine (Paxil) ?

A

is a potent selective inhibitor of neuronal serotonin reuptake. It also has a weak effect on norepinephrine and dopamine neuronal reuptake.

43
Q

Buspirone (Buspar) ?

A

is an antianxiety agent not chemically or pharmacologically related to the benzodiazepines, barbiturates, or other sedative or anxiolytic drugs. It is a 5-HT1 agonist with serotonergic neurotransmission and some dopaminergic effects in the CNS. Note no black box warning.

44
Q

Specific Phobia prevalence ?

A

7-9% over 12 months,

5% in children,

16% in 13-17 year olds

45
Q

Specific Phobia etiology and risk factors ?

A

Female

Family Hx

Environment- parental overprotection, loss of parent, abuse, preceding negative event

Temperament (i.e. neuroticism, anxiety disorders

Physiological-Vasovagal fainting-needle injections

Genetics- 1st degree relative increased risk

Increased Risk of Suicide-60% more likely

46
Q

Specific Phobia DDx?

A

Agoraphobia

Social Anxiety/Separation anxiety

Panic Disorder

OCD

Eating disorder/ trauma stress

Disorders

47
Q

Specific Phobia prognosis ?

A

Often persist through life. Fear response decreases with age.

Often respond to treatment with GOOD prognosis

48
Q

Specific Phobia medications ?

A

6-12 months of medications

SSRIs (Paroxetine, Sertraline)

SNRIs (venlafexine)

Benzodiazepines

49
Q

Specific Phobia procedure / therapy / surgery ?

A

CBT including exposure therapy

50
Q

Social anxiety disorder prevalence ?

A

6-8% average of onset 13 yo

51
Q

Social anxiety disorder etiology and risk factors ?

A

Female

Family Hx

Environment / Learned
Behavior

Temperament (i.e. Timid children)

Health conditions (i.e. disfigurements)

52
Q

Social anxiety disorder genetics ?

A

1st degree relative 2-3x risk

53
Q

Social anxiety disorder DDx ?

A

Generalized anxiety disorder (GAD)

Panic Disorder

Autistic Spectrum Disorder

Avoidant Personality Disorder

54
Q

Social anxiety disorder prognosis ?

A

Good to very good

55
Q

Social anxiety disorder medications ?

A

SSRIs (i.e. Paroxetine, Sertraline)

Benzodiazepines

56
Q

Social anxiety disorder procedures / therapy/ surgery ?

A

CBT including exposure therapy

57
Q

Agoraphobia prevalence ?

A

1.2-8.4% - Avg. age of onset 20 yo

58
Q

Agoraphobia etiology and risk factors ?

A

Having panic disorder

Stressful life events such as sexual / physical abuse

59
Q

Agoraphobia genetics ?

A

30-40% concordance MZ twins

60
Q

Agoraphobia DDx ?

A

Generalized anxiety disorder

Social anxiety disorder

PTSD

61
Q

Agoraphobia prognosis ?

A

Good to very good

62
Q

Agoraphobia medications?

A

SSRI (i.e. Paxil, Celexa) possibly benzodiazepines (i.e. Xanax- short term)

63
Q

Agoraphobia procedures / therapy / surgery ?

A

CBT

Combined treatment for GAD and Panic Disorder can be very effective at treating agoraphobia

64
Q

Acute Stress Disorder prevalence ?

A

20-50% of cases follow interpersonal traumatic events (eg, assault, rape, and witnessing a mass shooting);

13-21% of motor vehicle accidents; 19% of assaults; 10% of severe burns

65
Q

Acute Stress Disorder etiology and risk factors ?

A

Depending on underlying exposure

66
Q

Acute Stress Disorder genetics ?

A

N/A

67
Q

Acute Stress Disorder DDx?

A

Anxiety / Depression / PTSD / Adjustment Disorder

Dissociative Disorders

Brief psychotic episode

Substance abuse

68
Q

Acute Stress Disorder prognosis ?

A

Generally good

69
Q

Acute Stress Disorder medications ?

A

SSRIs

Benzodiazepines

70
Q

Acute Stress Disorder procedure / therapy / surgery ?

A

Reduce stress by all possible means

Ensure that survivors have a safe environment

Promote contact with loved ones and other sources of support (eg, religious and/or social organizations)

71
Q

Acute Stress Disorder note ?

A

If greater than 1 month then consider PTSD.

Psychiatry / Addiction Medicine (11 decks)

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