Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Behavioral Dynamics > Anxiety- Exam 2 > Flashcards

Anxiety- Exam 2 Flashcards

1
Q

Define akathisia

A

the feeling of not being able to sit still, constantly feeling the urge to move

aka the inability to remain still

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some defining characteristics of fear?

A

emotional reaction to a real, external threat perceived as painful, dangerous, or harmful

very specific stimulus and short duration
always gear towards the present
goal is to get away from the threat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are some defining characteristics of anxiety?

A

apprehension, nervousness, or dread associated with an anticipated event or an unknown, vague stimulus

nonspecific stimulus
long duration
geared towards the future
the idea of something

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When does anxiety become pathologic?

A

Present without an obvious or reasonable cause

Excessive and out-of-proportion to actual threat

Causes distress, functional impairment, and/or reduced quality of life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

name 4 maladaptive congnitions that a person with anxiety might exhibit

A

Judgement biases
Attentive biases
Avoidant behaviors
Low self-confidence in problem solving skills

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

_____ are oriented toward identifying how thoughts influence behaviors and perception of outcomes

A

Cognitive-based therapies (CBT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

_____ exposing patients to anxiety-inducing stimuli in small doses that gradually become more intense

A

Desensitization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

_____ patient observes other individuals who are around anxiety-inducing stimuli

A

modeling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

______ patient is exposed to stimulus that causes anxiety at its worst and made to use relaxation techniques to get through the experience

A

flooding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which exposure therapy technique is quicker in the short term but is prone to spontaneous relapses?

A

flooding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the short term/prn therapy for anxiety?

A

Benzodiazepines (BZDs)
Hydroxyzine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the first line treatment for anxiety? second line?

A

SSRIs, SNRIs

Second-Line - Buspirone, TCAs, BZDs, antipsychotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

_____ MOA enhances the effect of GABA at the GABA receptor

A

Benzodiazepines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Name some uses of Benzodiazepines

A

anxiety, panic, insomnia, ETOH withdrawal, agitation, seizures, procedural sedation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Benzos in high doses can cause ____ and _____

A

amnesia and dissociation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the SE of benzos? What are the 2 major ones? A patient is at risk for ____ and _____

A

*drowsiness, *dizziness, decreased motor coordination, decreased libido, disinhibition, rebound anxiety, amnesia, suicidal ideation

dependence and withdrawal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the DDI of benzos? What are the 2 major ones?

A

*ETOH, *opioids, and other CNS depressants, anticonvulsants, antidepressants, antifungals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the CI of benzos?

A

*pregnancy, BZD allergy, myasthenia gravis, narrow-angle glaucoma
Risk for respiratory depression - COPD, sleep apnea, myasthenia gravis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

_____ and _____ are short acting benzos. Which one is IV only? What is the onset?

A

Midazolam: IV only: 3-5 minutes

Triazolam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the indication for Triazolam? What is the onset?

A

insomnia

15-30 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the intermediate acting benzos?

A

alprazolam
temazepam
oxazepam
lorazepam
clonazepam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

_____ has a high abuse potential and possible rebound anxiety. What is the onset? 1/2 life?

A

alprazolam

15-30 minutes

11-16 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is alprazolam indicated for?

A

panic, anxiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is temazepam indicated for? What is the onset? 1/2 life? Will it show up on a UDS?

A

insomnia

30-60 minutes

8-15 hours

minimally active metabolite

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

______ and _____ have no active metabolite

A

oxazepam and lorazepam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is oxazepam indicated for? onset? 1/2 life?

A

insomnia and alcohol withdrawal

60-120 minutes

5-15 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is lorazepam indicated for? onset? 1/2 life?

A

Anxiety, Seizures, Agitation, ETOH withdrawal, Insomnia, Procedural sedation

30-60 minutes

10-14 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is clonazepam indicated for? onset? 1/2 life?

A

Panic, Anxiety, Seizures, Tremor
RLS, Insomnia

30-60 minutes

18-39 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Of the intermediate acting benzos, _____ has the longest 1/2 life.

A

Clonazepam (Klonopin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the long acting benzos?

A

diazepam
chlordiazepoxide
flurazepam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the indication of diazepam? onset? 1/2 life?

A

anxiety, seizures, agitation, alcohol withdrawal, muscle spasms, procedural sedation

30 minutes

**50-100 hours- longer acting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the indication of chlordiazepoxide? onset? 1/2 life?

A

**alcohol withdrawal in the inpt setting

60 minutes

30-100 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the indication for flurazepam? onset? 1/2 life?

A

insominia

120 minutes

40-114 hours (up to 160 hours in the elderly)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are the prescribing cautions with benzos?

A

PRN only

limited time (1-4 weeks)

have a potential for dependence, tolerance and addiction

avoid use in patients with hx of substance abuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the recommended tapering schedule?

A

10-25% dose reduction per 1-2 weeks

Slower taper if s/s of withdrawal
Anxiety, dysphoria, tremor, seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

______ Histamine (H1) receptor antagonist
Anxiolytic, muscle relaxant, antihistamine, antiemetic, sedating
May be helpful in patients with insomnia due to anxiety

A

hydroxyzine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are the SE of hydroxyzine?

A

drowsiness, dizziness, dry mouth, rash, fatigue, respiratory depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are the DDI of hydroxyzine?

A

oral potassium, MAOIs, CNS depressants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Can you give hydroxyzine through an IV? Is it safe in pregnancy?

A

NO, only approved via PO

DO NOT GIVE in the the first trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

______ 5HT1a receptor agonist; also acts on dopamine receptors
More effective for cognitive anxiety s/s than somatic s/s
Less anxiolytic effects than BZDs

A

Buspirone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

_____ is often used increase SSRIs/SNRIs or in pregnant patients

A

Buspirone

42
Q

What are the SE of buspirone?

A

dizziness, drowsiness, nausea, headache

**Concern over potential for Serotonin Syndrome

43
Q

What is the DSM criteria for Generalized Anxiety Disorder?

A

Excessive anxiety and worry (apprehensive expectation) more days than not

Anxiety/worry is about multiple things

Anxiety/worry is present for at least 6 months

Patient finds it difficult to control anxiety/worry

______Plus at least 3 of the following things_____

Irritability
Muscle tension
Sleep disturbances
Restlessness or feeling keyed up/on edge
Being easily fatigued
Difficulty concentrating

+must cause distress or functional impairment

+not due to substance abuse or medical condition

44
Q

_____ is a syndrome of persistent worry coupled with symptoms of hyperarousal, worry over minor matters, often coupled to somatic s/s

A

Generalized anxiety disorder

45
Q

______ Initial screening for GAD, used to monitor severity of s/s and response to tx

A

GAD-7

46
Q

______ 21-question self-reported inventory of s/s
Can be used for GAD or other anxiety disorders
No overlap with depressive s/s

A

Beck Anxiety inventory

47
Q

What is first line treatment for GAD? 2nd line?

How long do you need to continue therapy?

A

1st- SSRI/SNRI, CBT, or both

2nd- TCAs, buspirone, other meds

6-12 months

48
Q

_____ intense fear or discomfort with multiple accompanying symptoms

A

panic attacks

49
Q

______ recurrent episodes of panic attacks

A

panic disorder

50
Q

______ anxiety about and/or avoidance of situations where help may not be available or leaving would be difficult if the patient were to develop incapacitating or embarrassing symptoms (e.g. panic attacks, incontinence)

A

agoraphobia

51
Q

_____ is a separate dx from GAD or panic disorder. Have have similar s/s

A

Agoraphobia

52
Q

**What is the DSM dx for panic attack?

A

Abrupt surge of intense fear/discomfort that peaks within minutes

plus 4+ of the following:
Palpitations, pounding heart, or accelerated heart rate
Sweating
Trembling or shaking
Sensations of shortness of breath, choking, or smothering
Chest pain or discomfort
Nausea or abdominal distress
Feeling dizzy, unsteady, lightheaded, or faint
Chills or heat sensations
Paresthesias
Derealization¹ or depersonalization²
Fear of losing control, dying, or “going crazy”

53
Q

** What is the DSM for panic disorder?

A

Recurrent unexpected panic attacks

1+ attacks have been followed by 1+ months of one or both of the following:

——-Persistent concern or worry about additional panic attacks
or their consequences

———Significant maladaptive change in behavior due to the attacks

+must cause distress or functional impairment

+not due to substance abuse or medical condition

54
Q

T/F: Panic attacks only occur in response to a specific trigger

A

FALSE! Panic attacks DO NOT occur only in response to specific triggers

55
Q

What is the 1st line treatment for panic disorders? 2nd?

A

1st: CBT, SSRI, or combination

2nd: SNRIs or TCAs

56
Q

What is a good first SSRI to try for panic disorders? Why?

A

paroxetine due to its sedating effects

57
Q

What should you consider as an adjunct medication for panic disorders?

A

BZDs (short-term/PRN use)

58
Q

What are the pros/cons of using alprazolam and clonazepam?

A

alprazolam: commonly used due to short time to onset, Risk of dependency, rebound anxiety

clonazepam: Less risk of rebound anxiety, fewer doses/day

59
Q

What is the DSM criteria for agoraphobia?

A

Persistent (6+ months) of marked fear/anxiety about 2+ of the following:

Using public transportation
Being in open spaces (e.g., parking lots, marketplaces, bridges)
Being in enclosed places (e.g., shops, theaters, cinemas)
Standing in line or being in a crowd
Being outside of the home alone

Pt fears/avoids these situations due to fear that escape might be difficult or help might not be available in the event of developing incapacitating or embarrassing s/s:

Agoraphobic situations almost always provoke fear or anxiety
Agoraphobic situations are avoided, require presence of a companion, or are endured
with intense fear/anxiety
Fear/anxiety is out of proportion to the actual danger posed by situations and conditions

+must cause distress or functional impairment

+not due to substance abuse or medical condition

60
Q

What is the treatment for agoraphobia?

A

same as panic disorder:

1st: CBT, SSRI, or combination

2nd: SNRIs or TCAs

61
Q

What is the DSM criteria of social anxiety disorder?

A

Persistent (6+ months) of marked fear/anxiety about 1+ social situations in which the pt is exposed to possible scrutiny by others

Pt fears acting in a way or showing anxiety s/s that will be negatively evaluated

The social situations almost always provoke fear or anxiety

The social situations are avoided or endured with intense fear or anxiety

Fear/anxiety is out of proportion to the actual threat posed

+must cause distress or functional impairment

+not due to substance abuse or medical condition

62
Q

Children with social anxiety disorder the anxiety must occur _____ and with adults

A

in front of their peers

63
Q

How does social anxiety disorder manifest in children?

A

crying, tantrums, freezing, clinging, shrinking, failing to speak

64
Q

_____ is a subtype of social anxiety disorder, that only happens in specific instances usually related to public speaking

A

performance only social anxiety disorder

65
Q

What is the first line treatment for social anxiety disorder? How long do you need to continue treatment?

A

CBT, SSRI or SNRI, or both
May choose to augment with PRN BZD

6-12 months

66
Q

What is the treatment for performance only social anxiety disorder?

A

Propranolol 20-60 mg, 30-60 min before performance

PRN BZD dosing 30-60 min before performance

67
Q

Cannot use propanolol and pts who have _____ together

A

asthma

68
Q

How do acute stress disorder and posttraumatic stress disorder differ?

A

acute stress occurs within the initial month after a trauma

PTSD lasts more than 1 month

69
Q

What are some risk factors for acute stress and PTSD?

A

history of other psych disorder, female gender, severe trauma, avoidant coping mechanisms

70
Q

What is the DSM criteria for acute stress disorder?

A

Exposure to actual or threatened death, serious injury, or sexual violation in 1+ of the following ways:

Directly experiencing traumatic event(s)

Witnessing, in person, event(s) as it occurred to others

Learning that event(s) occurred to close family/friend
—For actual or threatened death of a family member or friend, event(s) must have been violent or accidental

Experiencing repeated or extreme exposure to aversive details of traumatic event(s) (think EMS, psych providers, social workers)

9+ of the following symptoms from any category, beginning or worsening after event(s) occurred, lasting at least 3 days - 1 month after trauma:

  1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).

-2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the event(s).

-3. Dissociative reactions (eg, flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.)

-4. Intense or prolonged psychological distress or marked physiological reactions in response to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).

  1. Persistent inability to experience positive emotions (eg, inability to experience happiness, satisfaction, or loving feelings).
  2. An altered sense of the reality of one’s surroundings or oneself (eg, seeing oneself from another’s perspective, being in a daze, time slowing).

-7. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs)

  1. Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).

-9. Efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)

  1. Sleep disturbance (eg, difficulty falling or staying asleep, restless sleep)

-11. Irritable behavior and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects

-12. Hypervigilance

-13. Problems with concentration

-14. Exaggerated startle response

+must cause distress or functional impairment

+not due to substance abuse or medical condition

71
Q

What is the treatment for acute stress disorder? What is adjunct therapy?

A

Trauma-oriented CBT with incorporated exposure therapy

2 weeks of benzos in pts with severe s/s such as agitation/insomnia

72
Q

Why are antidepressants NOT first line therapy for acute stress disorder?

A

because they take 4-6 to start working

73
Q

_____ is the MC trauma in women with PTSD

A

sexual assault

74
Q

_____ increases the risk of PTSD correlated with severity of injury and presence of traumatic brain injury (TBI)

A

military combat

75
Q

______ and _____ are 2-4x more common than in the general population

A

substance abuse and PTSD

76
Q

up to ____ of TBI pts also have PTSD

A

60%

77
Q

What is the first part of the DSM criteria for PTSD

A
78
Q

What is the additional part of DSM to dx PTSD?

A
79
Q

What is the treatment for PTSD?

A

Trauma-oriented CBT with exposure therapies

SSRIs or SNRIs if medication is needed

80
Q

_______ can be used for add-on therapy for refractory cases of PTSD

A

Atypical antipsychotics

81
Q

_____ is an 1-adrenergic blocker for insomnia associated with PTSD

A

Prazosin (Minipress)

82
Q

_____ mental event - recurrent intrusive thoughts, images, or urges that typically cause anxiety or distress

A

obsessions

83
Q

_____ behavioral event - repetitive acts that pt feels driven to perform, either due to an obsession or according to rules that he/she believes must be applied rigidly. Action is usually not ration or act is clearly excessive

A

compulsions

84
Q

T/F: Many OCD patients recognize their thoughts and behaviors are abnormal and take avoidant actions to hide them

A

True

85
Q

What populations are most common to have OCD? in children?

A

adult females

male children

86
Q

What is the DSM criteria to dx OCD?

A

Obessions: Recurrent and persistent thoughts, urges, or images that are intrusive and unwanted, and that in most pts cause marked anxiety or distress

Pt attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion)

Compulsions: Repetitive behaviors or mental acts that the individual feels driven to perform in response to an obsession, or according to rules that must be applied rigidly

Compulsions are aimed at preventing or reducing anxiety or distress or preventing some dreaded event or situation. Not usually realistically connected and are clearly excessive.

**Must be time-consuming or cause distress/functional impairment

87
Q

______ are aimed at preventing or reducing anxiety or distress or preventing some dreaded event or situation. Not usually realistically connected and are clearly excessive.

A

Compulsions

88
Q

Degree of OCD insight: _____ Pt recognizes OCD beliefs are definitely or probably not true, or that they may or may not be true

A

Good or fair insight

89
Q

Degree of OCD insight: ____ Pt thinks OCD beliefs are probably true

A

poor insight

90
Q

Degree of OCD insight: ______ Pt is completely convinced that OCD beliefs are true

A

Absent insight/delusional beliefs

91
Q

_____ behaviors and thoughts are focused on a specific fear-inducing stimulus

A

Phobic Disorder

92
Q

______ individuals are focused mainly on their body’s perceived flaws; no sense of dread if they do not take actions to hide flaws

A

Body Dysmorphic Disorder

93
Q

_______ similar obsessions and compulsions, but also have desire that other individuals should follow their OCD beliefs, and less distress caused by OCD beliefs

A

Obsessive-Compulsive Personality Disorder

94
Q

_______ compulsive hair-pulling is done because it brings a sense of satisfaction, instead of done to avoid negative outcomes; no obsessive thoughts

A

Trichotillomania

95
Q

What is first line therapy for OCD?

A

CBT with exposure therapy, SSRI, or combination

Psychotherapy preferred for OCD alone

Due to high rate of comorbid psych disorders - using SSRI is often beneficial

96
Q

OCD pts often need ______ of SSRI therapy

A

higher maintenance doses

97
Q

If an OCD patient has no response to SSRI, what should you do?

A

try another SSRI or SNRI

98
Q

_____ intense, irrational fear of a particular object or situation

A

phobia

99
Q

What is the DSM criteria for phobic disorder?

A

Persistent (6+ months) of marked fear/anxiety about a specific
object or situation

Phobic object/situation almost always causes immediate fear/anxiety

Phobic object/situation is actively avoided or endured with intense fear or anxiety

Fear/anxiety is out of proportion to the actual danger posed by object/situation

Fear/anxiety or avoidance causes distress or functional impairment

Syndrome is not better explained by another mental disorder

100
Q

Give some distinguishing factors of phobias vs fear

A

Is excessive and out of proportion

Cannot be alleviated with rational explanation

Is out of voluntary control

Leads to situational avoidance

Is maladaptive and persistent over time

Is not age or stage-specific

101
Q

What is the treatment for phobias?

A

CBT with exposure therapy

PRN benzos when the stimulus is infrequently encountered

2nd line SSRI, SNRI when the stimulus is frequently encountered

102
Q
A

Behavioral Dynamics (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions