Anxiety Disorders/bipolar/CNS-DA and pharm Flashcards
What is the only FDA approved use for buspirone?
Mech of action?
generalized anxiety disorder GAD
It is a 5HT receptor agonist
It is a first line treatment for GAD because it generally has less sexual and weight gain side effects than SSRI/SNRI
What is the medication used to treat social anxiety disorder, performance type (performance anxiety)
1st line tx is beta blockers (propanolol)
Diagnostic criteria for generalized anxiety disorder (GAD):
A. Excessive anxiety/worry, occurring more days than not for >/= to ____ months and about >/= ___ events or activities.
B. Difficult to control worry
C. Associated with ____ of the following symptoms:
Restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbances
A. Excessive anxiety/worry, occurring more days than not for >/= to 6 months and about >/= 1 events or activities
C. Associated with >/= 3 of the following symptoms
This MUST cause significant impairment for dx and NO other explanation for symptoms (physical, mental, or chemical)
What is the tx for GAD?
- CBT
- buspirone
- SSRI
- SNRI
- Benzos
DSMV criteria for Panic Attack:
An abrupt surge of intense fear or discomfort, peaks within minutes, that is unexpected and includes _____ of the following:
-palpitations, sweating, shaking/trembling, choking feeling, chest pain, nausea, dizziness, chills, derealization
> /= 4 of those symptoms.
Notice that most anxiety disorders have both physical AND psychological components
DSMV criteria for Panic Disorder:
A. Recurrent unexpected panic attacks
B. ____ attack followed by ____ month(s) of ____ of the following:
-Concern about additional panic attacks or consequences
-Significant maladaptive change in behavior related to attacks (avoidance)
C. No other explanation of symptoms
B. >/= 1 attack followed by >/= 1 month(s) of >/= 1 of the following:
DSMV criteria for Agoraphobia:
A. Fear/anxiety about >/= ____ of the following situation:
1. Using public transportation
2. Being in open spaces
3. Being in closed spaces
4. Standing in line or in a crowd
5. Being outside the home alone
B. Fear of not being able to ____ a situation
C. Situation almost always produces fear/anxiety
D. Avoids situations
E. Fear/anxiety ________ to actual danger
F. >/= ___ months
G. Causes significant impairment
H. No other explanation of symptoms
A. Fear/Anxiety about >/= 2 of the following
E. out of proportion
F. >/= 6 months
Agoraphobia often accompanies panic disorder
What is the tx for panic disorder?
You can do CBT
Meds: SSRI/SNRIs are first line if you can do longer term treatment, but if you need very fast treatment then you can use benzos (xanex)
DSMV diagnostic criteria for specific phobia:
A. ____ months
B. Causes significant impairment
C. Marked fear/anxiety about a specific object/situation
D. Object/situation almost always provokes fear/anxiety
E. Actively______ object/situation
F. Fear/anxiety out of proportion to actual danger
G. No other explanation of symptoms
A. >/= 6 months
E. avoids
Not a true phobia diagnostically if it does not cause significant impairment
DSMV diagnostic criteria for Social Anxiety Disorder (social phobia):
A. ____ months
B. Causes significant impairment
C. Marked fear/anxiety when exposed to social situation with possible scrutiny by others
D. Fear of acting in ways that may be negatively scrutinized
E. ______ provokes fear
F. ______ social situations
G. Fear/anxiety out of proportion to actual danger
H. No other explanation of symptoms
A. >/= 6 months
E. Social situation provokes fear
F. Avoids social situations
Treat performance anxiety with propanolol (beta blocker)
Treatment for specific phobia?
Treatment for social anxiety disorder?
Specific phobia:
- Therapy: CBT, assertiveness training
- Meds: SSRI/SNRI are first line, followed by MAOI.
Beta blockers are first line for performance anxiety variant
DSMV criteria for obsessive compulsive disorder:
A. the presence of ____ and/or _________.
B. These obsessions and compulsions must be either:
1. _________
2. Cause clinically significant _____
{either 1 or 2 from criteria B}
3. Are not ______
4. Not better explained as the symptoms of another mental or medical disorder
A. The presence of obsessions and/or compulsions
B. These obsessions and compulsions must be either:
1. Time consuming (>1h each day), or
2. Cause clinically significant distress
3. Are not substance-induced
With regard to OCD:
1/3 have co-morbid ______
Up to 2/3 of patients with ________ are diagnosed with OCD
1/3 have co-morbid Major Depressive Disorder
Up to 2/3 of patients with Tourette’s Syndrome are diagnosed with OCD
A 23-year-old medical student comes to the emergency room with elevated heart rate, sweating, and shortness of breath. The student is convinced that she is having an asthma attack and that she will suffocate. The symptoms started suddenly during a car ride to school. The student has had episodes such as this on at least three previous occasions over the past 2 weeks and now is afraid to leave the house even to go to school. She has no history of asthma and, other than an increased pulse rate, physical findings are unremarkable.
The most effective immediate treatment for this patient is:
(A) an antidepressant
(B) a support group
(C) a benzodiazepine
(D) buspirone
(E) a β-blocker
This patient is showing evidence of panic disorder with agoraphobia. Panic disorder is characterized by panic attacks, which include increased heart rate, dizziness, sweating, shortness of breath, and fainting, and the conviction that one is about to die. Attacks commonly occur twice weekly, last about 30 minutes, and are most common in young women, such as this patient. This young woman has also developed a fear of leaving the house (agoraphobia) which occurs in some patients with panic disorder. While the most effective immediate treatment for this patient is a benzodiazepine because it works quickly, the most effective long-term (maintenance) management is an antidepressant, particularly a selective serotonin reuptake inhibitor (SSRI) such as paroxetine
A 23-year-old medical student comes to the emergency room with elevated heart rate, sweating, and shortness of breath. The student is convinced that she is having an asthma attack and that she will suffocate. The symptoms started suddenly during a car ride to school. The student has had episodes such as this on at least three previous occasions over the past 2 weeks and now is afraid to leave the house even to go to school. She has no history of asthma and, other than an increased pulse rate, physical findings are unremarkable.
The most effective longterm management for this patient is:
(A) an antidepressant
(B) a support group
(C) a benzodiazepine
(D) buspirone
(E) a β-blocker
This patient is showing evidence of panic disorder with agoraphobia. Panic disorder is characterized by panic attacks, which include increased heart rate, dizziness, sweating, shortness of breath, and fainting, and the conviction that one is about to die. Attacks commonly occur twice weekly, last about 30 minutes, and are most common in young women, such as this patient. This young woman has also developed a fear of leaving the house (agoraphobia) which occurs in some patients with panic disorder. While the most effective immediate treatment for this patient is a benzodiazepine because it works quickly, the most effective long-term (maintenance) management is an antidepressant, particularly a selective serotonin reuptake inhibitor (SSRI) such as paroxetine
A 40-year-old man tells his physician that he is often late for work because he has difficulty waking up on time. He attributes this problem to the fact that he gets out of
bed repeatedly during the night to recheck the locks on the doors and to be sure the gas jets on the stove are turned off. His lateness is exacerbated by his need to count all of the traffic lights along the route. If he suspects that he missed a light, he becomes quite anxious and must then go back and recount them all. Physical examination and laboratory studies are unremarkable. Of the following, the most effective long term management for this patient is most likely to be
(A) an antidepressant
(B) an antipsychotic
(C) a benzodiazepine
(D) buspirone
(E) a β-blocker
The answer is A. This man’s repeated checking and counting behavior indicates that he has OCD. The most effective long-term management for OCD is an antidepressant, particularly an SSRI such as fluvoxamine
or a heterocyclic agent such as clomipramine. Antianxiety agents such as benzodiazepines (e.g., diazepam) and buspirone, and β-blockers such as propranolol are more commonly used for the management of acute or chronic anxiety. Antipsychotic agents such as haloperidol may be useful as adjuncts but do not substitute for SSRIs or clomipramine in OCD.
The mother of a 4-year-old child with diabetes takes the child to the pediatrician to “be checked” at least 3 times per week. She watches the child at all times and does
not let him play outside. She also measures and remeasures his food portions three times at every meal. The mother understands that this behavior is excessive but states that she is unable to stop doing it. The most appropriate pharmacological treatment for this mother is
(A) diazepam
(B) buspirone
(C) clomipramine
(D) haloperidol
(E) propranolol
The answer is C. The need to check and recheck the child’s portions and repeatedly take him to the doctor indicates that this patient is showing symptoms of OCD. The fact that she knows that her behavior is excessive (“insight”) is typical of patients with OCD. The most effective long-term management for OCD is an nantidepressant such as clomipramine.
A patient with bipolar disorder is prescribed antidepressants. What is a concerning side effect of antidepressants in this patient?
In a misdiagnosed individual with bipolar disorder, antidepressants may trigger a manic episode.
To dx mania, a patient needs to have:
ELEVATED MOOD (mania) with ___ of DIGFAST symptoms
OR
IRRITABLE MOOD with ____ of DIGFAST Symptoms
What are the DIGFAST symptoms?
ELEVATED MOOD (mania) with 3 of DIGFAST symptoms OR IRRITABLE MOOD with 4 of DIGFAST Symptoms Distractibility Impulsivity Grandiosity Flight of ideas Activity increased Sleep impaired Talkativity
What are the DIGFAST Symptoms and for what mental disorder are they associated with?
Bipolar disorder Distractibility Impulsivity Grandiosity Flight of ideas Activity increased Sleep impaired Talkativity
Hypomania is different from mania in which way?
Samy symptoms as mania, but hypomania has a shorter duration of at least 4 days but less than 7.
No marked loss in function (unlike mania)
Mania with major depression is associated with which type of bipolar disorder (I or II?)
Bipolar I has episodes of mania continuing for at least 7 days, and depression
