Anxiety Disorders

Question 1

Anxiety disorders are associated with what neurotransmitter changes?

Answer 1

a decrease in GABA and serotonin and an increase in norepinephrine

Question 2

What are the diagnostic criteria for a panic attack?

Answer 2

four of the following symptoms either provoked or spontaneous

• palpitations
• abdominal distress
• numbness, nausea
• intense fear of death
• choking, chills, chest pain
• sweating, shaking, SOA
• depersonalization or derealization
• fear of losing control or dying

Question 3

What are the diagnostic criteria for panic disorder?

Answer 3

> spontaneous recurrent panic attacks with no obvious precipitant
at least one of which is followed by at least one month of persistent concern about having more, worry about the implications of the attack, or significant change in behavior related to the attack such as avoidance
must always specify as either with or without agoraphobia

Question 4

What is the treatment for panic disorder?

Answer 4

• the best long-term treatment is an SSRI

- short-acting benzodiazepines can be helpful but are not a long-term solution

Question 5

What is agoraphobia?

Answer 5

the feat of being alone in public places due to anxiety around places or situations from which escape or help might be difficult to achieve

Question 6

What is social anxiety disorder?

Answer 6

a specific phobia disorder in which the feared situation is related to social settings in which the patient may be embarrassed

Question 7

What are the diagnostic criteria for specific phobias?

Answer 7

• persistent excessive fear brought on by a specific situation or object
• exposure to the situation brings about an immediate anxiety response
• patient recognizes that the fear is excessive
• the situation is avoided when possible or tolerated with intense anxiety
• and the phobia persists beyond 6 months if the person is under age 18

Question 8

What is the treatment for specific phobia and social phobia?

Answer 8

• for specific phobia disorder, behavior therapy, and systemic desensitization in particular, are the best treatment
• for social phobia, paroxetine is effective
• beta-blockers can be useful for controlling the symptoms of performance anxiety

Question 9

OCD is often comorbid with what other conditions?

Answer 9

Tourette’s syndrome and ADHD

Question 10

What is the treatment for OCD?

Answer 10

• SSRIs are first line agents and TCAs are second-line
• behavioral therapy in the form of exposure and response prevention are used alongside pharmacotherapy
• ECT can be used for severe treatment-resistant cases

Question 11

What are the diagnostic criteria for PTSD?

Answer 11

• persistent re-experiencing of the event
• avoidance of stimuli associated with the trauma
• numbing of responsiveness (limited affect and estrangement from others)
• persistent symptoms of arousal
• all lasting at least one month

Question 12

What is the preferred treatment for PTSD?

Answer 12

antidepressants with anticonvulsants to treat flashbacks or nightmares

Question 13

What is the difference between PTSD and acute stress disorder?

Answer 13

PTSD is diagnosed when symptoms last longer than 1 month while a diagnosis of acute stress disorder requires symptom onset within 1 month of the offending event and symptoms lasting less than 1 month

Question 14

What are the diagnostic criteria for GAD?

Answer 14

• excessive anxiety and worry about daily events and activities for at least six months
• associated with at least three of the following: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbance