Anxiety Disorders, OCD, and Trauma

Question 1

A 29-year-old man presents to the clinic and reports he has felt increasingly nervous and agitated. He explains that he was recently promoted at work and now gives frequent oral presentations in front of large groups of people. He becomes nervous and agitated at the podium but is calm after the presentation. He believes the symptoms are affecting his overall work performance and that he may lose his job. What two drug classes can be used to treat his performance-only anxiety disorder?

Answer 1

Beta Blocker’s (Propranalol) or benzodiazepines (Clonazapam)

Question 2

What receptors do benzodiazepines bind to?

Answer 2

Gamma-aminobutyric acid type A (GABAA) receptors

Question 3

What is the first-line treatment for OCD?

What is the most common compulsion in OCD?

Answer 3

SSRI’s

Typically patients require higher doses than the standard doses to treat anxiety or depression

Excessive washing, grooming, handwashing

Question 4

What are the forms of exposure therapy that may be used to treat panic attacks?

Answer 4

Flooding or gradual exposure therapy

Question 5

A 55-year-old man with PTSD presents to the clinic for a follow-up after 3 months of psychotherapy sessions. His PTSD is still uncontrolled, and you have decided to start him on paroxetine. What are the most common starting dose and titration schedule for paroxetine?

Answer 5

SSRI’s are started on the lowest dose and then titrated every 3-4 weeks (4 weeks most commonly)

Question 6

What sleep medication can reduce nightmares in patients with PTSD?

Answer 6

Prazosin

Question 7

What is the psychotherapy of choice for generalized anxiety disorder?

Answer 7

Cognitive Behavioral Therapy (CBT)

Question 8

What should be ruled out prior to making the diagnosis of generalized anxiety disorder?

Answer 8

• Alcohol withdrawal
• Thyroid dysfunction
• Substance abuse

Question 9

Are hallucinations considered a normal berieavment response?

Per the DSM-5, how long do symptoms of berieavement persist?

Answer 9

Yes

2 months

Question 10

How long after a stressor event does adjustment disorder develop?

Answer 10

Within 3 months of the stressor

Question 11

A 54-year-old woman presents to the office, stating she has not been feeling well after running out of her medication yesterday. She states she is having a difficult time sleeping, has been feeling more anxious, and is experiencing nausea. The physical exam reveals tachycardia on heart auscultation and mild hyperreflexia. Vital signs reveal an HR of 113 bpm, RR of 21/minute, BP of 140/92 mm Hg, SpO2 of 98% on room air, T of 98.7°F, and BMI of 21.5 kg/m2. Which of the following additional exam findings might you observe based on the most likely medication she is withdrawing from?

A. Increased appetite
B. Piloerection
C. Tremor
D. Yawning

Answer 11

Tremor

The patient is withdrawing from benzo’s. Other symptoms may include anxiety, nervousness, insomnia, tremor, headaches, nausea, dysphoria, perceptual disturbances, and cognitive impairments.

Seizures and death can also occur in more serious cases. Physical exam may show tachycardia, hypertension, and sweating.