anxiety disorders

Question 1

is the emotional (and physiological) response to an imminent threat.

Answer 1

fear

Question 2

is the anticipation, or worry/preoccupation with a future threat.

Answer 2

anxiety

Question 3

Recurrent distress when anticipating or experiencing separation

Persistent and excessive worry about separation and/or harm/illness that will result to them as a result

Affects daily functioning, going to school, work, leaving the house, fear of being alone

Answer 3

Separation Anxiety Disorder

Question 4

what symptoms present with separation anxiety

Answer 4

Recurrent physical symptoms when separation is imminent, recurrent nightmares

Question 5

how long must symptoms be present for in separation anxiety

Answer 5

In children and adolescents, 4 weeks of symptoms, in adults 6 months or more

Question 6

what is the cause of separation anxiety in kids

adults?

Answer 6

Usually parent is the focus for children,

in adults usually spouse or a friend

Question 7

what is normal separation anxiety

Answer 7

experienced by babies. This is normal stage of development that begins around 9 months of age.

Question 8

how may separation anxiety present in school aged kids

Answer 8

In pre-school/grade school may manifest as “illnesses” keeping the child at home or sneaking away from school to return home

Question 9

Irrational, excessive fear of objects, places, situations

Must last at least 6 months (not transient)

Answer 9

Specific Phobia Disorder

Question 10

Fear of humiliation or embarrassment in social settings, being observed by other people

Answer 10

Social anxiety disorder (SAD)

Question 11

Specific Phobias & Social Anxiety Disorder tx

Answer 11

approved medications for  SAD include: 
fluoxetine, 
paroxetine, 
sertraline (SSRIs) 
and venlafaxine (SSNRI)

MAOIs and benzodiazepines are also effective but first-line med have better side effect profiles

Beta-blockers are effective for short-term treatment of performance anxiety but not effective for SAD

Behavior therapy including exposure and flooding therapy has been shown to be very effective for both specific phobias and SAD

Question 12

is medication effective for specific phobias

Answer 12

no

Question 13

t/f Both specific phobias and SAD run in families;

Answer 13

true, Blend of genetics and learning most likely.

Question 14

a collection of symptoms
They are not diagnosable as a discrete mental disorder

can occur in many different psychiatric conditions

usually begin suddenly and attacks usually peak in 10 minutes

Answer 14

Panic attacks

Question 15

how long do most panic attacks last

Answer 15

Most last somewhere from 5-20 minutes

Question 16

may cause generalized fear reactions to multiple things associated with social situations - starts as eating in a restaurant, then standing in line, then using public bathroom, then won’t go out at all

Answer 16

Social anxiety disorder (SAD)

Question 17

Recurrent, unexpected panic attacks with at least 1 month of worry about having more panic attacks

Must have 4 of the 13 symptoms for a panic attack

Many of these symptoms could also be indicative of a serious medical condition

Answer 17

Panic Disorder

Question 18

common comorbities that go with panic disorder

Answer 18

Major depression and alcohol use disorder are the most common psychiatric comorbidities

Question 19

common age for panic disorder

Answer 19

before age 30, mid-20s is when most patients present

Question 20

panic disorder tx

Answer 20

Medication in conjunction with psychotherapy

fluoxetine,
paroxetine,
sertraline
and venlafaxine

Cognitive behavioral therapy should also be employed, specifically Panic Control Therapy (PCT)

Question 21

what must you rule out for panic disorder

Answer 21

hyperthyroidism, pheochromocytoma, hypoglycemia, SVT, angina, etc.

Question 22

Worry excessively about life circumstances (job, health, finances, relationships)

Rates are higher in women and those under 30

The disorder is usually chronic with fluctuation in the severity of the symptoms

Answer 22

Generalized Anxiety Disorder

Question 23

GAD tx

Answer 23

Combined therapy is best

Cognitive behavioral therapy is the mainstay for therapeutic treatment

paroxetine,
escitalopram,
venlafaxine
and buspirone

Pure behavior therapies include: relaxation training, re-breathing exercises, meditation

Question 24

comorbities in GAD

Answer 24

substance use and major depression are common comorbidities

Question 25

Compulsions occur to distract or relieve anxiety the patient feels due to their obsessions

obsession/compulsions are very time consuming or cause significant distress

Answer 25

obsessive compulsive disorder

Question 26

are repetitive and intentional, and highly stereotyped/rigid

Answer 26

Compulsions

Question 27

intrusive thoughts

Answer 27

obsessions

Question 28

marker for OCD prognosis

Answer 28

Whether or not a patient has insight into their condition is a marker for prognosis

Question 29

t/f of oc disorder

Most patients will suffer a chronic course (85%), a smaller percentage will have a deteriorating course (10%)
Patient usually report worsening symptoms when they are stressed

Answer 29

true

Question 30

OC disorder age of onset

Answer 30

OC Disorder typically begins in late teens to early 20s

Question 31

t/f OC disorder Onset is gradual to sudden

equal in male and females but males tend to present slightly earlier

Answer 31

true

Question 32

t/f 70-80% of patient with OC disorder will not have recurrent major depression

Answer 32

false they do

Question 33

OCD occurs more frequently in people with what?

Answer 33

neurological disorders like epilepsy, Sydenham’s chorea, Huntington’s disease and thus a neurobiological basis is likely.

Question 34

Obsessive Compulsive Disorder tx

Answer 34

Medication and cognitive behavior therapy

SSRIs
fluoxetine,
paroxetine
and sertraline

Other classes of anti-depressants have not been effective

The effective dosage, however, is about 2x as that used for depression and it may take 3-4 months to have a clear effect

Question 35

is the mainstay of tx for OC disorder

Answer 35

CBT is the mainstay, specifically Exposure and Response Prevention (ERP) therapy

Question 36

t/f oc disorder and tourette’s are the same disorder

Answer 36

false they are not

but occur together often