Anxiety guidelines

Question 1

CBT interventions

Answer 1

Exposure, safety response inhibition, cognitive strategies, arousal management, surrender of safety signals

Question 2

Anxiety risk factors

Answer 2

family hx of anxiety
personal hx of anxiety or mood d/o
childhood stressful life events or trauma
female
chronic medical illness
behavioural inhibition

Question 3

Panic d/o and agoraphobia tx

Answer 3

CBT with exposure, combined or pharmacotherapy

Question 4

panic disorder 1st line meds

Answer 4

SSRI: citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline
SNRI: venlafaxine XR
2nd line: TCA, bentos, mirtazapine

Question 5

panic d/o adjunct

Answer 5

2nd: alprazolam, clonazepam
3rd: aripiprazole, olanzapine, risperidone, divalproex, pindolol

Question 6

Specific phobias

Answer 6

exposure based therapy

Question 7

Social anxiety disorder

Answer 7

1st line: CBT with cognitive restructuring and exposure

OR meds– not combined

Question 8

Social anxiety d/o 1st line meds

Answer 8

SSRI: escitalopram, fluvoxamine, paroxetine, sertraline (not fluoxetine, citalopram 2nd line)
SNRI: venlafaxine XR
Pregabalin >600mg/day

Question 9

Social anxiety adjuncts

Answer 9

3rd line: aripiprazole, risperidone, buspirone, paroxetine

Question 10

Generalized anxiety disorder

Answer 10

1st line CBT or meds– no combined

Question 11

Generalized anxiety disorder 1st line meds

Answer 11

SSRI: escitalopram, paroxetine, sertraline (not fluoxetine, citalopram– both 3rd line)
SNRI: duloxetine, venlafaxine XR, agomelatine, pregabalin

Question 12

Generalized anxiety- adjuncts

Answer 12

2nd line: pregabalin

3rd line: quetiapine XR, aripiprazole, olanzapine, risperidone

Question 13

OCD

Answer 13

1st line: CBT with exposure response prevention or combined

Question 14

OCD - 1st line meds

Answer 14

SSRI: escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline

Question 15

OCD adjuncts

Answer 15

1st: aripirazole, risperidone
2nd: memantine, quetiapine, topiramate
3rd: citalopram, pregabalin, mirtazapine, halloo, ziprasidone, olanzapine, ketamine etc

Question 16

PTSD

Answer 16

1st either psychotherapy (trauma focused CBT with exposure and cognitive restructuring; EMDR; may need DBT prior) or pharmacotherapy

Question 17

PTSD 1st line meds

Answer 17

SSRI: fluoxetine, paroxetine, sertraline
SNRI: venlafaxineXR

Question 18

PTSD adjuncts

Answer 18

2nd: eszopiclone, olanzapine, risperidone
3rd: aripiprazole, quetiapine, pregabalin, gabapentin, clonidine, reboxetine, tiagabine

Question 19

OCD- child/adolescent tx meds

Answer 19

• citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline
• Clomipramine
• aripiprazole

Question 20

Social anxiety- child/adolescent tx meds

Answer 20

escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline

• venlafaxine
• mirtazapine

Question 21

Separation anxiety- child/adolescent, meds

Answer 21

fluoxetine, fluvoxamine

Question 22

GAD, child/adolescent, meds

Answer 22

fluoxetine, fluvoxamine, sertraline

Question 23

School refusal, child/adolescent, meds

Answer 23

citalopram (sm case series), imipramine + CBT

Question 24

PTSD, child/adolescent, meds

Answer 24

sertraline NOT recommended