Anxiety Disorders, Trauma & Stress-Related Disorders

Question 1

What is the diagnostic critera for GAD?

Answer 1

excessive worry or anxiety for ≥ 6 months PLUS ≥ 3 sxs

Question 2

How is GAD treated?

Answer 2

CBT + SSRIs (1st line, Paroxetine) or SNRI (Venlafaxine, Duloxetine)
* Buspirone: can be used as an adjunct, non-sedating & non-addictive
* BZDs: can be used short-term only until SSRIs/SNRIs take effect

Question 3

What is a panic attack?

Answer 3

NOT a stand-alone mental disorder
* Sudden, discrete episode of intense fear, anxiety, or discomfort that peaks within 10 min & resolves within 1 hour

Question 4

What are symptoms of a panic attack?

Answer 4

≥ 4 of the following
* Dizziness, trembling, choking feeling, paresthesia, sweating, SOB, CP, chills/hot flashes, fear of losing control or dying, palpitations or tachycardia, nausea, depersonalization or derealization
* Hallmark: sense of impending doom or dread

Question 5

What can be used for acute relief of a panic attack?

Answer 5

BZD – Alprazolam

Question 6

What is the diagnostic criteria for panic disorder?

Answer 6

≥ 2 panic attacks PLUS ≥ 1 month of
* persistent concern about future attacks or implications
* significant maladaptive behavior to try & avoid potential trigger

Question 7

How is panic disorder treated?

Answer 7

CBT + SSRI (Paroxetine, Sertraline)
* May initiate w/ SSRI + BZD, then taper and discontinue BZD

Question 8

What is agoraphobia?

Answer 8

Fear of being in places where escape is difficult (open/public/crowds) & may lead the pt to confinement at home

Question 9

How is agoraphobia diagnosed?

Answer 9

sxs ≥ 6 months & cause significant functional impairment

Question 10

How is agoraphobia treated?

Answer 10

CBT + SSRI
* Sertraline, Citalopram, Fluoxetine

Question 11

What is the most common type of phobia?

Answer 11

Public speaking AKA social anxiety disorder

Question 12

What is the diagnostic criteria for social anxiety disorder?

Answer 12

Fear of social scrutiny of others d/t fear of embarrassment for ≥ 6 months
* Fears they will act in a way or show anxious sx that will be humiliating, embarrassing, or lead to rejection
* Almost always provoke fear or anxiety and are avoided or endured with intense fear/anxiety

Question 13

How is social anxiety disorder treated?

Answer 13

CBT + SSRIs (Paroxetine)/SNRIs
* Performance only: beta-blockers (propranolol, atenolol) or BZDs (clonazepam or lorazepam)

Question 14

What are specific phobias?

Answer 14

Fear of a specific object or situation that leads to the endurance of the anxiety &/or avoidance of the feared object/situation
* Animal/insects
* Natural phenomena
* Blood-injection injury
* Situational: bridges, flying, confined spaces
* Other: vomiting, choking, becoming sick, death

Question 15

What is the diagnostic criteria for specific phobias?

Answer 15

Intense fear or anxiety of a specific situation, object or place for ≥ 6 months
* Exposure triggers an immediate response out of proportion to any real danger/threat
* Avoided when possible or tolerated w/ intense anxiety

Question 16

How are specific phobias treated?

Answer 16

exposure & desensitization
* Short-term BZDs or beta-blockers can be used

Question 17

What is adjustment disorder?

Answer 17

Occur when behavioral or emotional sxs develop after a non-life-threatening, stressful life event (divorce, death of loved one, fired)

Question 18

What is the diagnostic criteria for adjustment disorder?

Answer 18

≥1 sxs that occur w/in 3 months of sxs onset
* Marked distress that is out of proportion to the severity or intensity of the stressor
* Significant impairment in social, occupational, or other important areas of functioning
* Once the stressor is relieved, sxs resolve within 6 months

Question 19

How is adjustment disorder treated?

Answer 19

psychotherapy

Question 20

What screening test can be used for PTSD?

Answer 20

Primary Care PTSD (PC-PTSD-5) – score ≥ 3 = high likelihood

Question 21

What is the diagnostic criteria for PTSD?

Answer 21

stressor, duration, recurrent intrusions, avoidance, negative alterations in moos, alterations in arousal/reactivity
* Stressor: exposure to actual or threatened death, serious injury, or sexual violence
* Duration: Sx last > 1 month, traumatic event occurred anytime in the past
* Recurrent intrusions (1): distressing dreams, nightmares, memories, flashbacks
* Active avoidance of triggers
* Negative alterations in mood (2): dissociative amnesia, negative emotions, anhedonia, inability to feel positive feelings
* Alterations in arousal & reactivity (2): angry outbursts, irritable, reckless, self-destructive, hypervigilance

Question 22

How is PTSD treated?

Answer 22

trauma-focused therapy + SSRIs (Sertraline, Paroxetine) or SNRIs
* Trazodone: insomnia
* Prazosin: nightmares, sleep disturbance, hypervigilance

Question 22

What is the difference between acute stress disorder and PTSD?

Answer 22

• ASD: trauma occurs < 1 month AND sx last < 1 month in duration, tx w/ CBT
• PTSD: trauma occurred at any time in the past > 1 month OR sxs > 1 month

Question 23

What is malingering?

Answer 23

NOT a mental illness
* internal falsification or exaggeration of sxs of a medical ot psychatric illness for external gain
* financial (insurance/lawsuits), food, shelter, avoid school/work/prison