Anxiety Disorders

Question 1

PTSD
Pt:
Dx:
Tx:

Answer 1

Pt: Reminders of traumatic events
Men-> combat, urban violence
Women-> rape, assault

Dx:

1. Exposure to actual or threatened death, serious injury or sexual violence via
   - Direct exposure
   - Witnessing the event in person
   - Learning the event happened to someone close (family member, friend)
   - Experiencing extreme or repeated exposure to aversive details of the traumatic event (first responders collecting human remains during 9/11)
2. Presence of 1+ follow intrusions sx
   - Re-experiencing: >1month as repetitive recollections (dreams) and dissociative reactions (flashbacks)
   - Avoidance of stimuli associated with dramatic event
   - Negative alterations in cognition and mood
   - Arousal and reactivity

Tx:
Antidepressants: SSRIs (MAOi, tazodone)
Trauma-focused CBT
Nightmares/ sleep disturbances: prazosin

Question 2

Generalized anxiety d/o
Dx:
Tx:

Answer 2

Dx: excessive anxiety/worry a majority of days >/=6m about various aspects of life
3+ sx: fatigue, restlessness, difficulty, concentrating, muscle tension, sleep disturbance, irritability, shakiness, HA

Tx: 
SSRI (lexapro, paxil); SNRIs (venlafaxine) 
Buspirone
Benzos, BB, TCAs
CBT

Question 3

Phobic Disorders
Dx:
Tx:

Answer 3

Dx:
Excessive/unreasonable fear interfering with normal function for >6m
Fear leads to avoidance behavior

Tx:
CBT
Benzos-> short course (lorazepam) for infrequent situations that bring on specific phobia
Desensitization therapy

Question 4

Adjustment disorder
Dx
Tx

Answer 4

Sx at time of stressor; reaction disproportional to identified stressor
Stressor can be positive (promotion of job), neutral, or negative
Want to specify type of stressor-> Depressed mood, anxiety, mixed anxiety and depressed mood, disturbance of conduct, mixed disturbance of emotions and conduct, other symptoms
Tx: Psychotherapy

Question 5

Acute Stress Disorder
Dx
Tx

Answer 5

Similar to PTSD but sx last <1m
stressor can be neutral or negative
Tx: counseling, psychotherapy

Question 6

Panic d/o
Pt:
Dx:
Tx:

Answer 6

Pt: Sudden onset
Intense apprehension, fearfulness, terror
Sx peak in 10 mins
Intense and debilitating fear of future attacks

Dx:
Recurrent unexplained panic attacks + at least one of the attacks has been follow by a month of:
-Persistent concern or worry about additional panic attacks or their consequences
-A significant maladaptive change in behavior related to the attacks

Disturbance is not attributable to physiology effects of a substance or another medical condition

Tx:
SSRIs (lexapro, paxil), SNRI (venlafaxine)
Buspirone
Benzos (short term), BB, TCAs
CBT
Approach includes education, self-assessment, breathing techniques, muscle relaxation, cognitive restructuring, and controlled exposure to panic-provoking stimuli

Question 7

Specific phobias
Pt:
Dx:
Tx:

Answer 7

Pt: Circumscribed phobic objects or situations

Dx: 
Fear of a specific object or situation 
Can be divided into
-Animal
-Natural environment 
-Blood-injection-injury
-Situational 
-Other categories 

(A panic attack occurs when exposed to the specific trigger)

Tx:
Short-term benzos
BB
Systematic desensitization therapy