Anxiety Disorders, OCD, and Trauma Flashcards
Are panic attacks a DSM-5 diagnosis in and of itself?
No
Who are more likely to experience panic attacks?
Younger females
What are short term treatments for a panic attack?
Limited options, reassurance and positive self-talk
What are some long-term treatments for panic attack?
CBT and relaxation techniques
In an individual with panic disorder what can precipitate a panic attack?
Inhaling CO2 or infusion with sodium bicarb - at high risk or sensitivity to acidotic states
How does the DSM characterize panic disorder?
Recurrent unexpected, unprovoked panic attacks (4 or more)
What are the treatments for panic disorder?
SSRI’s or SNRI’s
Benzodiazapines short term
CBT
How long should you continue a patient with panic disorder on antidepressant therapy after the resolution of symptoms?
1-2 years due to the high risk of relapse
Why should you use caution in prescribing an SSRI in adolescent/children?
Increased risk of suicide ideation
What is the most common anxiety disorder?
Phobias
When is the typical onset of phobias?
Early adolescents, usually before age 12
What is Agoraphobia?
Fear of public places/places outside the home
Fear around perceived inability to exit
What is tyrpanophobia?
Fear of needles
Is it common for a patient with social anxiety disorder to self-medicate with ETOH when in public?
Yes
What situations are included under the DSM-5 situations for diagnosing agoraphobia?
Using public transportation
Bein in open spaces
Being in enclosed spaces
Standing in line or crowd
Being outside the home alone
What are the treatments for phobias?
Desensitization (gradually introducing fear)
Flooding (rapid, intense exposure)
CBT
Medications- SSRI’s are preferred
What SSRI is considered first line in the treatment for agoraphobia or social anxiety?
Paroxetine (Paxil)
What medication treatment can be used for performance anxiety?
Propranolol
What other disorders is Generalized Anxiety Disorder frequently associated with?
Major Depression and SUD
What neurotransmitters are impaired in GAD?
Norepinephrine
GABA
5-HT
What symptoms are associated with GAD?
Restlessness, edgy
Easy fatigability
Difficulty with concentration
Irritability
Muscle tension
Disrupted sleep
What is the goal of treatment in GAD?
Control of symptoms, complete abatement is rare
What is the treatment options for GAD?
CBT (most effective)
Medications - SSRI’s (Paroxitine) and anxiolytics (Buspiron)
What brain anatomy structures have been found to be impaired on brain autopsy in patients with OCD?
Basal Ganglia and Prefrontal Cortex
What environmental association has been linked to OCD?
PANDAS due to streptococcal infections in pediatric patients
What are some common compulsions in OCD?
Handwashing, cleaning
Double, triple checking
Counting
Seeking/demanding reassurance
Organizing
Following a strict routine
What is the cornerstone of treatment in OCD?
Exposure to stimuli and prevention of response (ERP)
What SSRI is especially approved in the treatment of OCD?
Flovoxamine
What other psychiatric conditions is Body Dysmorphic Disorder associated with?
Social phobia
Major depression
Suicide
What is Trichotillomania?
“Hair Pulling Disease” and may involve any site with hair
When will adjustment disorder commonly resolve?
Usually within 6 months of termination of the stressor with or without treatment
Is PTSD more common in men or women?
Women
What are risk factors for PTSD?
Younger age
History of Psychiatric illness
Decreased social support
Victim of stressful event
Severity and duration of stressor
Low SES
Family history of depression
What neurotransmitters are disrupted in PTSD?
Norepinephrine
Dopamine
5-HT
What other physiologic disruptions are associated with PTSD?
Noradrenergic dysfunction
Endogenous opioids
Benzodiazapine receptors
Endocrine dysfunction
What is the first line medication treatment for PTSD?
SSRI’s (Paroxetine and Sertraline)
What medication can be used to treat nightmares in PTSD?
Prazosin (alpha-adrenergic blocker)
Is dissociation a unconscious or conscious defense mechanism?
Unconscious
