Anxiety Disorders - Todder

Question 1

What are the 5 Classifications of Anxiety Disorders?

Answer 1

• Generalized Anxiety disorder (GAD)
• Panic disorder (PD)
• Obsessive-Compulsive disorder (OCD)
• Phobias
• Post-traumatic Stress disorder (PTSD)

Question 2

What is the therapy for General Anxiety Disorder?

Answer 2

1.Benzodiazepines
Used in first few weeks and then discontinue if accepted by patient
Patients say it is better for physical symptoms

2.Antidepressants: SSRIs, SNRI, and TCA
First line
Works slowly
Use Benzo first
Patients say better for cognitive symptoms

3.Azapirones(buspirone): partial agonists of
the serotonin 1areceptor
Anxiolytic
Not habit forming but not as effective

4.CBT + Relaxation or Biofeedback.
How to manage
Biological basis not addressed

5.Supportive ?, Insight oriented ?

Question 3

What characterizes Panic Disorder?

Answer 3

• recurrent, unexpected panic attacks,
characterized by rapid onset of :
accelerated heart rate sweating
trembling sensations of smothering
feeling of choking or chest pain nausea
feeling dizzy derealization
fear of losing control or dying chills or hot flashes
numbness or tingling sensations
persistent concern about having an attack
behavior change

Panic attacks without panic disorder.

Question 4

What is the difference between Generalized Anxiety Disorder and Panic Disorder?

Answer 4

GAD is anxiety out of proportion (inappropriate)

PD is out of context with no cause (panic attack on the best day of patient’s life)
Must have a few

Question 5

What is agoraphobia?

Answer 5

Fear of having an attack in a location and not being able to be accessed to help

Not fear of attack will be

Subjective to anxiety can be home or open market

Can be with or without panic disorder, without would be disconnected from ever having had a panic attack

Ex: Panic attack when asked to give a speech

Question 6

What is the treatment for panic disorder?

Answer 6

Start low and slow because response is very sensitive

• BNZ
for first 2 weeks until antidepressants take control then won’t need them (but will carry the same pack for 2 years)

• SSRI, SNRI, NRI, TCA, MAO …

• CBT
very important, teach what a panic attack is and why it isn’t dangerous

• Relaxation
• Respiratory training

Question 7

What is the treatment for OCD?

Answer 7

• Law of “4” (need to give 4x the dose, in 4x the time (8 weeks) and only see 1/4 response-25%, 50% don’t respond at all)
• SSRI
• SNRI
• TCA (serotonergic, noradrenergics won’t work).
• Dopamine antagonist.
• CBT- best treatment, if it’s good you don’t need drugs

Antipsychotic drugs
• Response prevention.
• Insight oriented.

Question 8

What are the two types of phobia?

What is the treatment for each?

Answer 8

1. Social

a. specific social
only one situatino connected to issues, most commonly public phobia

b. general (many feared activities)

Treatment: antidepressants and CBT

2. Specific phobias
   anything (buttons)

CBT and beta-blockers