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Psychiatry clerkship > Anxiety, obsessive-compulsive, and trauma disorders > Flashcards

Anxiety, obsessive-compulsive, and trauma disorders Flashcards

1
Q

Medications/substances that cause anxiety in intoxication

A

Cannabis, hallucinogens (PCP, LSD, MDMA), stimulants, caffeine

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2
Q

Medications/substances that cause anxiety in withdrawal

A

Alcohol, sedatives/hypnotics/anxiolytics, tobacco

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3
Q

Neuro conditions that cause anxiety

A

Epilepsy, migraine, tumors, MS, HD

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4
Q

Endo conditions that cause anxiety

A

Hyperthyroid, hypoglycemia, pheo, carcinoid syndrome

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5
Q

Metabolic conditions that cause anxiety

A

B12 def, electrolyte disturbances, porphyria

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6
Q

Respiratory conditions that cause anxiety

A

Asthma, COPD, hypoxia, PE, PNA, pneumothorax

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7
Q

CV conditions that cause anxiety

A

CHF, angina, arrhythmia, MI

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8
Q

Pharmacotherapy options for anxiety

A

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)

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9
Q

Psychotherapy for anxiety

A

CBT and psychodynamic

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10
Q

Pharmacologic goal for treatment of anxiety

A

Symptomatic relief and continue tx for 6mos before trying to taper

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11
Q

What characterizes panic disorder?

A

Recurrent, spontaneous panic attacks

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12
Q

Symptoms of panic attacks

A 
"Da PANICS"
Dizziness, disconnectedness, derealization, depersonalization
Palpitations
Abdominal distress
Nausea, numbness
Intense fear (e.g. of dying)
Chills, chest pain
Sweating, shaking, SOB
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13
Q

What must you rule out when a patient presents with a panic attack?

A

Medical conditions such as MI, thyrotoxicosis, and PE

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14
Q

Criteria for panic disorder

A

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

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15
Q

Predisposing factors to panic disorder

A

Family history

Increased stressors, history of childhood trauma

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16
Q

Treatment of panic disorder

A

Pharma + CBT = most effective
SSRIs first line (then TCAs)
Benzos PRN

17
Q

Diagnostic criteria for agoraphobia

A
  • 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
18
Q

Treatment for agoraphobia

A

SSRIs and CBT

Same as panic disorder

19
Q

Diagnostic criteria for specific phobia/social anxiety disorder

A

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

20
Q

Treatment for specific phobia

A

CBT

21
Q

Treatment for social anxiety disorder

A

CBT

If meds needed: SSRIs or SNRIs, benzos if needed, beta-blockers for performance anxiety

22
Q

Diagnostic criteria for GAD

A

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

23
Q

Treatment of GAD

A

CBT + SSRIs or SNRIs

24
Q

Diagnostic criteria for OCD

A

Obsessions and/or compulsions that are time consuming or cause significant distress/dysfunction
Not caused by substance or medical condition

25
Q

Etiology of OCD

A

Strong genetic component, also shared genetic component with Tourette’s

26
Q

Course/prognosis of OCD

A

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

27
Q

Treatment for OCD

A

Drugs + CBT
SSRIs at higher doses, clomipramine (most serotonin selective TCA)
Augment with atypical antipsychotics
If severe and refractory, consider cingulotomy or ECT

28
Q

Criteria for body dysmorphic disorder

A

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

29
Q

Treatment for body dysmorphic disorder

A

SSRIs and/or CBT

Surgery/cosmetic procedures often not helpful

30
Q

Criteria for trichotillomania

A

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

31
Q

Treatment for trichotillomania

A

Meds: SSRIs, atypical antipsychotics, N-acetylcysteine, or Li
CBT

32
Q

Diagnostic criteria for PTSD

A

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

33
Q

Treatment to stop nightmares in PTSD

A

Prazosin

34
Q

Prognosis for PTSD

A

50% have complete recovery within 3 months

80% have another mental health disorder

35
Q

Pharmacologic treatment for PTSD

A

First line: SSRIs or SNRIs
Prazosin for nightmares
Augmentation with atypical antipsychotics in severe cases

36
Q

Psychotherapy treatment for PTSD

A

Exposure therapy and cognitive processing therapy (both types of CBT)

37
Q

Diagnostic criteria for adjustment disorder

A

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

Psychiatry clerkship (11 decks)

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