Anxiety, obsessive-compulsive, and trauma disorders Flashcards
Medications/substances that cause anxiety in intoxication
Cannabis, hallucinogens (PCP, LSD, MDMA), stimulants, caffeine
Medications/substances that cause anxiety in withdrawal
Alcohol, sedatives/hypnotics/anxiolytics, tobacco
Neuro conditions that cause anxiety
Epilepsy, migraine, tumors, MS, HD
Endo conditions that cause anxiety
Hyperthyroid, hypoglycemia, pheo, carcinoid syndrome
Metabolic conditions that cause anxiety
B12 def, electrolyte disturbances, porphyria
Respiratory conditions that cause anxiety
Asthma, COPD, hypoxia, PE, PNA, pneumothorax
CV conditions that cause anxiety
CHF, angina, arrhythmia, MI
Pharmacotherapy options for anxiety
SSRIs and SNRIs = first line
Benzos for quick and effective anxiolysis
Buspirone (5-HT1 partial agonist, not commonly used)
Beta-blockers for autonomic symptoms, panic attacks, or performance anxiety
TCAs and MAOIs if refractory (bad side effect profile)
Psychotherapy for anxiety
CBT and psychodynamic
Pharmacologic goal for treatment of anxiety
Symptomatic relief and continue tx for 6mos before trying to taper
What characterizes panic disorder?
Recurrent, spontaneous panic attacks
Symptoms of panic attacks
"Da PANICS" Dizziness, disconnectedness, derealization, depersonalization Palpitations Abdominal distress Nausea, numbness Intense fear (e.g. of dying) Chills, chest pain Sweating, shaking, SOB
What must you rule out when a patient presents with a panic attack?
Medical conditions such as MI, thyrotoxicosis, and PE
Criteria for panic disorder
Recurrent, unexpected panic attacks with no identifiable trigger
Panic attacks followed by >1month of continuous worry and/or maladaptive change in behavior
Not substance/medical related
Predisposing factors to panic disorder
Family history
Increased stressors, history of childhood trauma
Treatment of panic disorder
Pharma + CBT = most effective
SSRIs first line (then TCAs)
Benzos PRN
Diagnostic criteria for agoraphobia
- Intense fear/anxiety about >2 situations due to fear of difficulty escaping/getting help (outside of home alone, open spaces, enclosed spaces, public transport, or crowds)
- Fear is out of proportion to potential danger posed
- > 6 months
Treatment for agoraphobia
SSRIs and CBT
Same as panic disorder
Diagnostic criteria for specific phobia/social anxiety disorder
Fear of specific situation or object out of proportion to actual threat
Exposure to situation triggers immediate fear response
Situation/object avoided when possible
>6 months, dysfunction, etc
Treatment for specific phobia
CBT
Treatment for social anxiety disorder
CBT
If meds needed: SSRIs or SNRIs, benzos if needed, beta-blockers for performance anxiety
Diagnostic criteria for GAD
Excessive anxiety about variety of daily events/activities for >6mos
Difficulty controlling the worry
At least 3 symptoms (restlessness, fatigue, impaired concentration, irritability, muscle tension, insomnia)
Cause dysfunction, not substance-induced, etc
Treatment of GAD
CBT + SSRIs or SNRIs
Diagnostic criteria for OCD
Obsessions and/or compulsions that are time consuming or cause significant distress/dysfunction
Not caused by substance or medical condition
Etiology of OCD
Strong genetic component, also shared genetic component with Tourette’s
Course/prognosis of OCD
Chronic, waxing and waning
<20% remission rate without treatment
Suicidal ideation in 50%, attempts in 25%
High comorbidity with other anxiety disorders, depressive or bipolar, OCPD, and tic disorders
Treatment for OCD
Drugs + CBT
SSRIs at higher doses, clomipramine (most serotonin selective TCA)
Augment with atypical antipsychotics
If severe and refractory, consider cingulotomy or ECT
Criteria for body dysmorphic disorder
Preoccupation with one or more perceived deficits or flaws in physical appearance
Repetitive behaviors in response to appearance concerns
Preoccupation causes significant distress or dysfunction
Not better explained by concerns with weight/eating disorder
Treatment for body dysmorphic disorder
SSRIs and/or CBT
Surgery/cosmetic procedures often not helpful
Criteria for trichotillomania
Recurrent hair-pulling-out leading to hair loss
Repeated attempts to stop/decrease hair pulling
Causes distress/dysfunction
Involves scalp, eyebrows, eyelashes, but may involve other body hair
Treatment for trichotillomania
Meds: SSRIs, atypical antipsychotics, N-acetylcysteine, or Li
CBT
Diagnostic criteria for PTSD
Exposure to death, serious injury, or sexual violence through experiencing or witnessing
Recurring intrusions or re-experiencing (memories, nightmares, dissociative reactions)
Active avoidance of triggering stimuli
At least two negative cognitions: dissociative amnesia, negative feelings of self/others, self-blame, negative emotions, anhedonia, detachment
At least two symptoms of increased arousal/reactivity: hypervigilance, exaggerated startle response, irritability/outbursts, impaired concentration, insomnia
Not substance or medical
Treatment to stop nightmares in PTSD
Prazosin
Prognosis for PTSD
50% have complete recovery within 3 months
80% have another mental health disorder
Pharmacologic treatment for PTSD
First line: SSRIs or SNRIs
Prazosin for nightmares
Augmentation with atypical antipsychotics in severe cases
Psychotherapy treatment for PTSD
Exposure therapy and cognitive processing therapy (both types of CBT)
Diagnostic criteria for adjustment disorder
Development of emotional or behavioral symptoms within 3 months in response to an identifiable stressful life event
-Marked distress in excess of what would be expected
-Dysfunction
Not symptoms of normal bereavement
Resolve within 6 months after stressor has terminated
