Anxiety, OCD

Question 1

Primary anxiety disorders can only be diagnosed if:

Answer 1

-it is determined that anxiety isn’t caused by a medical condition or substance

Question 2

What anxiety treatment should be avoided if comorbid depression is present?

Answer 2

benzos

Question 3

First line anxiety treatment

Answer 3

-SSRIs, SNRIs

Question 4

Benzos may be used PRN for anxiety, but what are alternatives that aren’t addicting?

Answer 4

-diphenhydramine, hydroxyzine

Question 5

Busprione:

• MOA
• USE

Answer 5

partial 5HT agonist

used as adjunct therapy for anxiety (not primary treatment) … add to SSRI or SNRI

Question 6

Treatment for performance anxiety

Answer 6

BBers

Question 7

If SSRIs and SNRIS are not effective, what are second line options for treatment of anxiety?

Answer 7

• TCAs
• MAOis

(very effective but their side effect profile makes them less desireable as first line treatment)

Question 8

What three substances can cause anxiety both with withdraw and with intoxication?

Answer 8

1) alcohol
2) stimulants
3) tobacco

Question 9

What distinguishes “having a panic attack” from having “panic disorder”

Answer 9

-panic disorder= fear of the fear

patients live in constant worry ABOUT the panic attacks

Question 10

Time requirement for diagnosing panic disorder

Answer 10

1 month

Question 11

Panic disorder increases risk for?

Answer 11

suicide

Question 12

Agoraphobia criteria

Answer 12

-fear about more than two situations
(being outside of home, being in an open space, being in a closed space, being in crowds, etc)
-must last at least six months

Question 13

Treatment for Agoraphobia

Answer 13

-CBT, SSRIs

Question 14

Special caviat to SSRI/SNRI treatment of anxiety?

Answer 14

-must start low and go slow because anxiety may initially worsen before it improves

Question 15

Social anxiety is the fear of:

Answer 15

-acting in an embarrassing way in public that lasts for at least six months

Question 16

#1 psych disorder in women
#1 psych disorder in men

Answer 16

• women: specific phobia

- male: substance use

Question 17

Treatment for specific phobia:

Answer 17

CBT first –> if ineffective try SSRIs, SNRIs, BBers, PRN benzos

Question 18

Criteria for selective mutisim

Answer 18

Failure to speak in specific situation for at least one month. (usually assc with social anxiety)

Question 19

Treatment for selective mutism

Answer 19

CBT + SSRIs

Question 20

When does stranger anxiety peak?

Answer 20

6-9 months

Question 21

When does separation anxiety peak in development?

Answer 21

12-18 months

Question 22

Separation Anxiety Disorder (pathologic) criteria:

Answer 22

• must be developmentally inappropriate (not in 12-18 month time period)
• children: 4 weeks
• adults: 6 months

Question 23

Treatment for Social anxiety disorder

Answer 23

CBT + SSRI

Question 24

Length of time required for dx of GAD

Answer 24

6 months

Question 25

OCD is characterized by

Answer 25

obsessions and or compulsions
(can have one but not the other!)
taking up at least one hour of the day

Question 26

What is the triad of uncontrollable urges?

Answer 26

• OCD
• ADHD
• tics/tourettes

Question 27

First line treatment for OCD is SSRI, what are second lines?

Answer 27

• clomipramine (most serotonin selective TCA)

- atypicals

Question 28

Treatment for hoarding

Answer 28

mostly therapy like personality disorders, meds not often helpful

Question 29

What sex most commonly suffers from body dysmorphic disorder? trichotillomania? skin picking?

Answer 29

women!

Question 30

Treatments for trichotillomania

Answer 30

• SSRIs
• atypicals
• NAC
• lithium

Question 31

Skin picking (excoriation) disorder treatment

Answer 31

CBT + SSRIs

Question 32

Contrast PTSD and Acute Stress Disorder

Answer 32

• PTSD = 1 month

- ASD = less than one month

Question 33

Treatment for night mares in PTSD?

this is used for real in clinic

Answer 33

prazosin (a1 antagonist)

Question 34

In addition to SSRIs/SNRIs and prazosin, what drugs may be used to treat PTSD?

Answer 34

atypicals

Question 35

What treatment should be AVOIDED in PTSD?

Answer 35

Benzos, because very high rate of comorbid substance abuse

Question 36

Criteria for adjustment disorder

Answer 36

• not life threatening trigger
• starts within 3 months of life event
• lasts less than 6 months

*Might become chronic only if stressor is chronic