anxiety: GAD, panic, phobias, PTSD

Question 1

anxiety definition

Answer 1

emotional and physical fear response to a perceived threat
pathologic anxiety occurs when sx are excessive, irrational, out of proportion to trigger or without an IDd trigger
criteria for most anxiety disorders cause impairment in social/occupation

MOST common form of psychopathology

Question 2

sx of anxiety

Answer 2

constitutional: fatigue, diaphoresis, shivering
CV/pulm: chest pain, palpitations, tachycardia, Hyperventilation, HTN, SOB
neuro/MSK: vertigo, light headed, parasthesias, tremors, insomnia, muscle tension
GI: abd pain, n/v/d/c, anorexia

Question 3

drug induced anxiety

Answer 3

intoxication: EtOH, MJ, PCP/LSD, cocaine, stimulants, caffeine, tobacco
withdrawal: BZDs, stimulants, tobacco, opioids

Question 4

medical causes of anxiety

Answer 4

epilepsy, migraine, brain tumor, MS, HD, hyperTH, hypoglycemia, pheo, carcinoid, b12 def, lytes, asthma, COPD, PNA, PE, PTX, CHF, arrythmia, MI

Question 5

anxiety tx

Answer 5

SSRI/SNRI 1st line
BZD = short term
anxiolytics: benedryl or hydroxyzine
buspar (5HT agonist)
BB: autonomic sx of palp, tachy, sweats, panic
TCAs/MAOIs last line 
CBT or psychotherapy

Question 6

Panic attack

Answer 6

abrupt surge of intense anxiety –> triggered or occur spontaneously
peak within minutes, resolve quickly
residual sx of anxiety after

Question 7

sx of panic attack

Answer 7

Da PANICS
D: Dizzy, disconnected, dereal, depresonalized
P: Palps and parasthesias
A: Abd distress
N: numbness, nausea
I: Intense fear of dying, losing control or going crazy
C: Chills and CP
S: sweating, shaking, SOB

Question 8

Panic attack DSM 5

Answer 8

recurrent, unexpecte panic attacks w/o trigger
panic attack followed by 1 mo of continuous worry about experiencing subsequent attacks or their consequences and/or maladaptation (avoidance)
no other causes

Question 9

agoraphobia DSM

Answer 9

intense fear/anxiety about 2+ situations due to concern of difficulty escaping or obtaining help in case of panic
–outside home alone, open spaces, closed spaces, transpo, crowds
triggering situations cause far/anxiety out of proportion, leading to intense anxiety, avoidance or requires companion
sx > 6 mos

Question 10

phobia

Answer 10

irrational fear that leads to endurance of anxiety and/or avoidance of feared object or situation

Question 11

social anxiety

Answer 11

fear of scrutiny by others or fear of acting in a humiliating or embarrassing way

social situations causing significant anxiety may be avoided –> impairment

Question 12

specific phobia DSM

Answer 12

persistent excessive fear elicited by specific situation or object which is out of proportion
exposure to situation triggers immediate fear
avoided when possible or tolerated with intense anxiety
sx cause impairment >6 mos of sx

Question 13

GAD

Answer 13

generalized anxiety disorder: persistent excess anxiety about man aspect of lives
somatic sx including fatigue and tension

Question 14

GAD DSM

Answer 14

excessive anxiety/worry about various daily events/activities >6 mos
difficulty controlling the worry
associated with >3 sx: restless, fatigue, impaired concentration, irritable, tension, insomnia
cause impairment

Question 15

PTSD

Answer 15

characterized by development of multiple sx after exposure to traumatic events:
intrusive sx (nightmares, flashbacks), avoidance, neg alterations in thoughts/mood, increased arousal
sx > 1 month

Question 16

acute stress disorder

Answer 16

major traumatic event and sim sx to PTSD (night mare, mood, flashback), but < 1 month

Question 17

PTSD DSM

Answer 17

exposure to actual threatened death, serious injury, sex violence by directly experiencing or witnessing trauma
recurrent intrusions of re-experiencing the event via memories, night mares or dissociate rx (flashback), distress at exposure to cues relating to trauma or physiological reactions to cues
active avoidance of triggering stimuli (memories, feelings, people, places) associated with trauma
2+ negative cognition/mood: dissociate amnesia, neg feeling of sel/others/world, self-blame, neg emotions (fear, horror, guilt, anger), anhedonia, feelings of detachment, cant experience positive emotions
2+ increased arousal: hypervigilance, exaggerated startle response, anxiety, anger, insomnia

Question 18

PTSD mnemonic

Answer 18

TRAUMA:
T: Traumatic event
Re-experience
Avoidance
Unable to fx
Month or more of sx
Arousal increased