ANXIETY DISORDERS

Question 1

embraces the totality of a person’s mental attributes,
observable behavior, and reportable subjective
experience–the sum of which distinguishes one individual
from all others

Answer 1

personality

Question 2

approximately _______percent of the general population,
certain personality traits are so pronounced as to
be distressing to the individual and disturbing to others,
even though the patient is not manifestly sociopathic

Answer 2

15

Question 3

Although considered to be the most frequent of mental
disturbances, the ________ are among the least
understood

Answer 3

anxiety disorders

Question 4

all of the neuroses have been
again subsumed in three broad categories:

(1)______ (which include panic states, with and without
agoraphobia, and the phobic and obsessive-compulsive
neuroses);

(2) ________ (comprising hysterical
neurosis, orconversiondisorder, andhypochondriasis);
and
(3)__________

Answer 4

anxiety disorders

somatoform disorders

dissociative disorder

Question 5

A syndrome of general irritability,
anxious expectation, anxiety attacks, somatic accompaniments
or equivalents of anxiety (breathlessness, chest
pain, asthenia), and nightmares

Answer 5

anxiety neurosis

Question 6

the

sensory experience was all there was to emotion. What theory?

Answer 6

James-Lang theory of emotion

Question 7

Many patients experience a constant uneasiness that
the spells may reoccur, especially in public; hence the
patient may be fearful of leaving home lest help not be
available should an attack occur. What phenomenon?

Answer 7

Agoraphobia

Question 8

anxiety are also a prominent feature of

the ________ and ______

Answer 8

postconcussive and posttraumatic stress syndromes

Question 9

Anxiety disorder has been attributed to a:

Answer 9

1. genetic abnormality,
2. to a “constitutional weakness” of the nervous
   system,
3. to social and psychologic factors, and to
4. physiologic and biochemical derangements

Question 10

Ave age of acute and chronic anxiety

Answer 10

25

Question 11

T or F

The symptoms o f an anxiety attack resemble those of
fear in many ways, although nearly always the former are
longer in duration and less distinct.

Answer 11

T

Question 12

it has been observed that anger provokes an excessive secretion
of ________, whereas fear is accompanied by
increased secretion of ________

Answer 12

norepinephrine

epinephrine.

Question 13

lobes. In states

of fear, the tips of the _______ and ______i are known to become activated.

Answer 13

temporal lobes and the amygdaloid

nuclei

Question 14

In the relaxed
period between panic attacks, the_________ and ________are abnormally active in
some studies.

Answer 14

right limbic system

and the parahippocampal gyrus

Question 15

Indeed, some
psychiatrists believe that anxiety neurosis is accounted
for mainly by a variant of ______

Answer 15

depression

Question 16

The presence of symptoms such as
overwhelming fatigue, self-deprecation, and feelings of
hopelessness and, of course, ideas of self-destruction
makes depression the fundamental diagnosis, with anxiety
an associated feature

Answer 16

anxious depression

Question 17

Certain medications, particularly _____ and ______
are effective in suppressing panic attacks and
creating a sense of well-being

Answer 17

anxiolytics

antidepressants,

Question 18

Anxiety disorder tx

the benzodiazepine
__________ is favored by some psychiatrists, but lorazepam and clonazepam are almost as effective and are considered slightly less likely to cause dependence.

Answer 18

alprazolam (2 to 6 mg/ d)

Question 19

________ and________ are also effective
in the prevention of panic attacks and agoraphobia, but
their onset of action is delayed for weeks

Answer 19

Tricyclic antidepressants and drugs that raise serotonin
concentrations in the nervous system (selective
serotonin reuptake inhibitors [SSRis]

Question 20

_______, a specific serotonin 5-HT
agonist, has been promoted as effective in the treatmen􀃡
of anxiety and as a surrogate for benzodiazepines, but
to us its benefit has seemed to be slight

Answer 20

Buspirone

Question 21

T or F

during the initial weeks of admin istration of
antzdepressants, the underlying anxiety Symptoms may worsen and an anxiolytic is usually required until the antidepressant becomes effective

Answer 21

T

Question 22

___________, reduces many of
the autonomic accompaniments of anxiety and is useful
to many patients.

Answer 22

Propranolol, 10 to 20 mg tid

Question 23

With regard to psychotherapy, behavioral
therapy __________ is said to be beneficial, particularly
if agoraphobia is a major symptom

Answer 23

(progressive exposure of the patient to panicprovoking

situations)

Question 24

The patient is
chronically fearful of a particular animal or situation
and becomes extremely anxious or panic stricken and
incapacitated when placed in a situation that evokes the
phobia.

Answer 24

Phobic d/o

Question 25

􀃤ike the pure phobic states, a state dominated by _______ is relatively rare, occurring in less than 5 percent of patients seeking help in a psychiatric outpatient clinic, but it can be extremely disabling

Answer 25

obsessions | and compulsions

Question 26

defined as imperative and distressing thoughts and impulses that persist in the patient's mind despite a desire to resist and to get rid of them

Answer 26

Obsessions

Question 27

in which phrases, rhymes, ideas, or vivid images (these are often absurd, blasphemous, obscene, and sometimes frightening) constantly intrude into consciousness

Answer 27

intellectual obsessions

Question 28

in which the mind is dominated by an impulse to kill oneself, to stab one's children, or to perform some other objectionable act

Answer 28

impulsive obsessions,

Question 29

in which every act must be ruminated upon and analyzed before it is carried out-a state that is cleverly called doubting mania

Answer 29

inhibiting obsessions

Question 30

________are acts that result from obsessions. These are single acts or a series of acts (rituals) that the patient must carry out in order to put his mind at ease

Answer 30

Compulsion

Question 31

The most common of these obsessions and | compulsions center around _____

Answer 31

contamination concerns that | lead to repeated hand washing or bathing

Question 32

Certain motor disturbances-namely, habit spasms or tics-are, in a sense, _________. They consist of repetitious movements of the shoulders, arms, hands, and certain of the facial muscles

Answer 32

motor compulsions

Question 33

Additional insight into obsessive-compulsive disorder may be obtained from the many cases in which acquired striatal damage may be linked to obsessional behavior. One such entity is a_______

Answer 33

poststreptococcal tic disorder termed PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections),

Question 34

of multiple tics, including vocal ones, beginning in childhood or adolescence and lasting more than a year, has a strong component of obsessive-compulsive disorder

Answer 34

Gilles de Ia Tou rette syndrome

Question 35

Because_________ are beneficial in the management of the Tourette syndrome, a number of etiologic hypotheses revolve around serotonergic and dopaminergic neurotransmitter systems

Answer 35

dopamine | antagonists

Question 36

In the case of phobic neurosis, the aim is to reduce the patient's fear to the extent that exposure to the phobic situation can be tolerated. A popular form of therapy is _______

Answer 36

systematic desensitization,

Question 37

What is systemic desensitization

Answer 37

which consists of increasing and graded exposure of the | patient to the object or situation that arouses the fea

Question 38

Certain medications, particularly the SSRI types such as _______, are considered to be effective in reducing obsessions and compulsions in more than half of patients

Answer 38

fluoxetine

Question 39

In the past, ______produced symptomatic improvement in both phobic and obsessional neuroses and was considered a reasonable procedure.

Answer 39

cingulotomy

Question 40

________ is probably best reserved for a disease that is largely confined to women and is characterized by a distinctive age of onset, natural history, and certain somatic symptoms and signs, which typically include conversion symptoms, dissociative reactions, or states of "multiple personality."

Answer 40

hysteria

Question 41

polysymptomatic disorder, involving almost every organ system. Sx include headache, blurred vision, lump in the throat, loss of voice, dyspnea, palpitation, anxiety attacks, anorexia, nausea and vomiting, abdominal pain, unusual food allergies, severe menstrual pain, urinary retention, painful intercourse, paresthesias, dizzy spells, nervousness, and easy crying

Answer 41

Classic Hysteria ( Briq u et d i sease)

Question 42

This calm attitude toward a turbulent illness and seemingly disabling physical signs is so common that it has been singled out as an important characteristic of hysteria called ______

Answer 42

Ia belle indifference

Question 43

Characteristics of hysterical pain 1) 2) 3) (4) its persistence, either continuous or intermittent, for long periods of time; (5) the assumption of bizarre postures; and, most important, (6) the coexistence of other clinical features or previous attacks of hysterical nature

Answer 43

(1) the patient's inability to give a clear, concise description of the type of pain; (2) the location of the pain does not conform to the pattern of pain in the familiar medical syndromes; (3) the dramatic elaborations of its intensity

Question 44

Characteristics of hysterical vomiting

Answer 44

The vomiting often occurs after a meal, leaving the patient hungry and ready to eat again; it may be induced by unpleasant circumstances

Question 45

___________ in which the patient wanders about for hours or days and carries out complex acts may simulate temporal lobe epilepsy or any of the conditions that lead to confusional psychosis

Answer 45

Hysterical trances or fugues,

Question 46

In Hysterical paralysis, Movements are slow, tentative, and poorly sustained; often it can be demonstrated that the strength of voluntary movement is proportional to the resistance offered by the examiner, thus imparting a__________ character

Answer 46

"give-way"

Question 47

In a most remarkable and recalcitrant form of psychogenic movement disorder, maintenance of the limbs in a rigid or dystonic posture for a long time may result in a bed-bound, crippled state with severe flexion ________ of the limbs

Answer 47

pseudocontractures

Question 48

Characteritics of tremor of psychogenic | movement disorder

Answer 48

the cessation of tremor with distracting taskse. g., complex finger movement patterns on the side opposite the tremor (such as touching the fourth, second, and fifth fingers in sequence rapidly), or refixation of the eyes on a target, or walking on the outside of the heels

Question 49

In psychogenic movement disorder A fairly dependable sign is worsening of a tremor with loading that is accomplished by__________ (most basal ganglionic and cerebellar tremors are muted by this maneuver)

Answer 49

placing a heavy object in the patient's hand

Question 50

Characteristics of hysterical blindness

Answer 50

Some such individuals can | reduce reflexive blinking in response to a visual threat

Question 51

_______ occurring as an isolated phenomenon, | is practically always of hysterical nature

Answer 51

Convergence spasm,

Question 52

In the ________ (amnesia, disturbance of consciousness, and hallucinations) patients pretend to have lost their memory or to have become insane

Answer 52

Ganser syndrome

Question 53

_______ as in the classic form of hysteria, multiple symptoms are reported; many of the symptoms are the same as those listed under female hysteria

Answer 53

compensation neurosis,

Question 54

_________, which held that both conversion and dissociative symptoms are based on particular psychodynamic mechanisms, is impossible to affirm or refute

Answer 54

Psychoanalytic theory

Question 55

The presence of extreme suggestibility and the tendency to dramatize symptoms as measured by one part of the ______________ and other psychometric tests is helpful in diagnosis but not pathognomonic

Answer 55

Minnesota | Multiphasic Personality Inventory

Question 56

Goals of Tx for Hysteria

Answer 56

the amelioration of the long-standing basic personality defect and relieving the recently acquired physical symptoms

Question 57

How to address hysterical d/o

Answer 57

Some of our better results have been obtained by indicating that the neurologic symptoms are a "pattern of brain circuits" or "constitutional" weakness that can be overcome by physical and other therapies

Question 58

This is the preoccupation with bodily functions or physical signs and sensations, leading to the fear or belief of having serious disease

Answer 58

Hypoch ondriasis

Question 59

It is estimated that 85 percent of hypochondriasis is secondary to other mental disorders, chiefly________ but also schizophrenia and anxiety neuroses.

Answer 59

depression,

Question 60

Of all the abnormal personality types, the ________ is the best defined and the one most likely to cause trouble in the family and community

Answer 60

antisocial

Question 61

What personality disorder? always in trouble, profiting not from experience or punishment, unable to empathize with family or friends or to maintain lm;alties to any person, group, or code. He is likely to be shallow, callous, and hedonistic, showing marked emotional immaturity with lack of sense of responsibility;, lack of judgment, and an ability to rationalize his behavior so that it appears warranted, reasonable and justified.

Answer 61

antisocial

Question 62

It consists essentially of deviant behavior in which individuals seem driven to cause difficulty in everything they do or behave in a way that most societies identify as grossly criminal

Answer 62

Sociopathic behavior

Question 63

it is advised that the diagnosis of antisocial personality disorder be reserved for adults; the same behavior pattern in children is designated as __________

Answer 63

conduct disorder.

Question 64

EEG abnormalities, taking the form of ____________ are more frequent in criminals and sociopaths than they are in the normal population in some series, but the validity of this finding is uncertain

Answer 64

mild to moderate bilateral slowing,

Question 65

refers to the conscious and deliberate feigning of illness or disability in order to attain a desired goal

Answer 65

M a l i n geri n g

Question 66

Difference between Malingering and Hysteria (1) the conscious or unconscious quality of the motivation, which seems more unconscious in the _____patient and more conscious in the ______; (2) the influence of persuasion, which is usually effective in _____ and not in the______; and (3) the attitude of the patient

Answer 66

hysteria malingerer hysteria malingerer

Question 67

A particular form of sociopathy or malingering, which consists essentially of systematically and specifically deceiving the medical profession, has been described as ________

Answer 67

Munchausen's syndrome

Question 68

Some persons with intermittent explosive disorder have, from early childhood, reacted to frustration with a loss of self-control, striking out in blind rage at anyone who crossed them ______

Answer 68

(episodic | dyscontrol syndrome);

Question 69

In intermittent explosive behavior, Polymorphisms of the ___________ receptor have been implicated in several preliminary studies

Answer 69

androgen

Question 70

__________ i s a behavioral disorder o f previously healthy girls and young women living in affluent societies, mainly from upper and middle social classes, who become emaciated as a result of voluntary starvation

Answer 70

Anorexia nervosa

Question 71

As a rule, anorexia nervosa begins shortly after ________sometimes later, but seldom after 30 years of age

Answer 71

puberty-

Question 72

The patient shows no concern about her obvious emaciation and remains active. If left alone, these patients waste away, and approximately ____ percent have succumbed to some intercurrent infection or other medical complication, placing it among the most lethal of psychiatric conditions.

Answer 72

5

Question 73

______ and _____ are indicators | for hospitalization in Anorexia

Answer 73

Bradycardia and hypotension

Question 74

Pubic hair and breast tissue (except for loss of fat) are normal, and, in this respect, anorexia nervosa is unlike___________

Answer 74

hypopituitary cachexia (Simmonds disease).

Question 75

In Anorexia Nervosa, ______ is practically always present and may precede the extreme weight loss

Answer 75

Amenorrhea

Question 76

___________ fails to stimulate a rise in LH, as it does normally. Administration of gonadotropicreleasing factor raises the LH and follicle-stimulating hormone (FSH) levels, suggesting a hypothalamic disorder.

Answer 76

Clomiphene citrate

Question 77

T or F, ``` In anorexia, The basal metabolic rate is low; triiodothyronine (T 3) and thyroxine (T4) are low, while levels of physiologically inactive 3,3,5-triiodothyronine (reverse T3) are decreased ```

Answer 77

F T 3 is Normal or increased

Question 78

The pathologic fear of becoming fat and the obsession with weight might be interpreted as a phobic or ________

Answer 78

obsessional neurosis.

Question 79

Probably important is that anorexia nervosa has its onset in relation to _________, at a time when the female exhibits rather large fluctuations in appetite and weigh

Answer 79

menarche

Question 80

A disorder of infants described under the title of _________ causes progressive and ultimately fatal emaciation ("failure to thrive") despite normal food intake in an otherwise alert and cheerful infant.

Answer 80

"diencephalic syndrome"

Question 81

In "diencephalic syndrome" The causative lesion has usually proved to be a low-grade astrocytoma of the ______ or ______

Answer 81

anterior hypothalamus or | optic nerve region

Question 82

In Anorexia, The menses do not return until considerable weight has been gained (approximately ______percent above the weight

Answer 82

10

Question 83

Drugs that may be effective in Anorexia

Answer 83

imipramine or | fluoxetine