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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
Trichotillomania procedures / therapy / surgery ?
CBT Habit reversal training
26
Post Traumatic Stress Disorder prevalence ?
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
27
Post Traumatic Stress Disorder etiology and risk factors ?
Highly variable on factors such as: Characteristics of the trauma and the individual Post trauma factors
28
Post Traumatic Stress Disorder genetics ?
Possible predisposition but poorly understood
29
Post Traumatic Stress Disorder DDx?
Anxiety Disorders / Obsessive-Compulsive Disorders Schizophrenia
30
Post Traumatic Stress Disorder prognosis ?
Highly variable and often chronic condition High correlation to substance abuse
31
Post Traumatic Stress Disorder medications ?
SSRIs, Benzodiazepines Prazosin may help with nightmares ** read this E medicine article! more in depth oil the tx.**
32
Post Traumatic Stress Disorder procedure / therapy / surgery ?
Cognitive Behavioral Therapy EMDR
33
Prazosin (Minipress, Vasoflex, Lentopres and Hypovase) ?
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
EMDR ?
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
Generalized Anxiety Disorder prevalence ?
Slightly more women than men
36
Generalized Anxiety Disorder etiology and risk factors ?
Generally starts early in life High rate of comorbidity with depression Related to neuroticism
37
Generalized Anxiety Disorder genetics ?
Mild to moderate familial component
38
Generalized Anxiety Disorder DDx ?
Major Depression and OCD a strong link
39
Generalized Anxiety Disorder prognosis ?
Variable with waxing and waning pattern Comorbid conditions contribute to chronicity Pharmacologic agents help, but GAD usually returns when d/c
40
Generalized Anxiety Disorder medications ?
Sertraline (Zoloft) Paroxetine (Paxil) Hydroxyzine (Vistaril) Buspirone (Buspar) Benzodiazepines (i.e. Xanax)
41
Generalized Anxiety Disorder procedures / therapy / surgery ?
Behavioral Therapy and Cognitive Behavioral Therapy
42
Paroxetine (Paxil) ?
is a potent selective inhibitor of neuronal serotonin reuptake. It also has a weak effect on norepinephrine and dopamine neuronal reuptake.
43
Buspirone (Buspar) ?
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
Specific Phobia prevalence ?
7-9% over 12 months, 5% in children, 16% in 13-17 year olds
45
Specific Phobia etiology and risk factors ?
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
Specific Phobia DDx?
Agoraphobia Social Anxiety/Separation anxiety Panic Disorder OCD Eating disorder/ trauma stress Disorders
47
Specific Phobia prognosis ?
Often persist through life. Fear response decreases with age. Often respond to treatment with GOOD prognosis
48
Specific Phobia medications ?
6-12 months of medications SSRIs (Paroxetine, Sertraline) SNRIs (venlafexine) Benzodiazepines
49
Specific Phobia procedure / therapy / surgery ?
CBT including exposure therapy
50
Social anxiety disorder prevalence ?
6-8% average of onset 13 yo
51
Social anxiety disorder etiology and risk factors ?
Female Family Hx Environment / Learned Behavior Temperament (i.e. Timid children) Health conditions (i.e. disfigurements)
52
Social anxiety disorder genetics ?
1st degree relative 2-3x risk
53
Social anxiety disorder DDx ?
Generalized anxiety disorder (GAD) Panic Disorder Autistic Spectrum Disorder Avoidant Personality Disorder
54
Social anxiety disorder prognosis ?
Good to very good
55
Social anxiety disorder medications ?
SSRIs (i.e. Paroxetine, Sertraline) Benzodiazepines
56
Social anxiety disorder procedures / therapy/ surgery ?
CBT including exposure therapy
57
Agoraphobia prevalence ?
1.2-8.4% - Avg. age of onset 20 yo
58
Agoraphobia etiology and risk factors ?
Having panic disorder Stressful life events such as sexual / physical abuse
59
Agoraphobia genetics ?
30-40% concordance MZ twins
60
Agoraphobia DDx ?
Generalized anxiety disorder Social anxiety disorder PTSD
61
Agoraphobia prognosis ?
Good to very good
62
Agoraphobia medications?
SSRI (i.e. Paxil, Celexa) possibly benzodiazepines (i.e. Xanax- short term)
63
Agoraphobia procedures / therapy / surgery ?
CBT Combined treatment for GAD and Panic Disorder can be very effective at treating agoraphobia
64
Acute Stress Disorder prevalence ?
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
Acute Stress Disorder etiology and risk factors ?
Depending on underlying exposure
66
Acute Stress Disorder genetics ?
N/A
67
Acute Stress Disorder DDx?
Anxiety / Depression / PTSD / Adjustment Disorder Dissociative Disorders Brief psychotic episode Substance abuse
68
Acute Stress Disorder prognosis ?
Generally good
69
Acute Stress Disorder medications ?
SSRIs Benzodiazepines
70
Acute Stress Disorder procedure / therapy / surgery ?
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
Acute Stress Disorder note ?
If greater than 1 month then consider PTSD.

Psychiatry / Addiction Medicine (11 decks)

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