Anxiety, OCD Flashcards
Primary anxiety disorders can only be diagnosed if:
-it is determined that anxiety isn’t caused by a medical condition or substance
What anxiety treatment should be avoided if comorbid depression is present?
benzos
First line anxiety treatment
-SSRIs, SNRIs
Benzos may be used PRN for anxiety, but what are alternatives that aren’t addicting?
-diphenhydramine, hydroxyzine
Busprione:
- MOA
- USE
partial 5HT agonist
used as adjunct therapy for anxiety (not primary treatment) … add to SSRI or SNRI
Treatment for performance anxiety
BBers
If SSRIs and SNRIS are not effective, what are second line options for treatment of anxiety?
- TCAs
- MAOis
(very effective but their side effect profile makes them less desireable as first line treatment)
What three substances can cause anxiety both with withdraw and with intoxication?
1) alcohol
2) stimulants
3) tobacco
What distinguishes “having a panic attack” from having “panic disorder”
-panic disorder= fear of the fear
patients live in constant worry ABOUT the panic attacks
Time requirement for diagnosing panic disorder
1 month
Panic disorder increases risk for?
suicide
Agoraphobia criteria
-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
Treatment for Agoraphobia
-CBT, SSRIs
Special caviat to SSRI/SNRI treatment of anxiety?
-must start low and go slow because anxiety may initially worsen before it improves
Social anxiety is the fear of:
-acting in an embarrassing way in public that lasts for at least six months
#1 psych disorder in women #1 psych disorder in men
- women: specific phobia
- male: substance use
Treatment for specific phobia:
CBT first –> if ineffective try SSRIs, SNRIs, BBers, PRN benzos
Criteria for selective mutisim
Failure to speak in specific situation for at least one month. (usually assc with social anxiety)
Treatment for selective mutism
CBT + SSRIs
When does stranger anxiety peak?
6-9 months
When does separation anxiety peak in development?
12-18 months
Separation Anxiety Disorder (pathologic) criteria:
- must be developmentally inappropriate (not in 12-18 month time period)
- children: 4 weeks
- adults: 6 months
Treatment for Social anxiety disorder
CBT + SSRI
Length of time required for dx of GAD
6 months
OCD is characterized by
obsessions and or compulsions
(can have one but not the other!)
taking up at least one hour of the day
What is the triad of uncontrollable urges?
- OCD
- ADHD
- tics/tourettes
First line treatment for OCD is SSRI, what are second lines?
- clomipramine (most serotonin selective TCA)
- atypicals
Treatment for hoarding
mostly therapy like personality disorders, meds not often helpful
What sex most commonly suffers from body dysmorphic disorder? trichotillomania? skin picking?
women!
Treatments for trichotillomania
- SSRIs
- atypicals
- NAC
- lithium
Skin picking (excoriation) disorder treatment
CBT + SSRIs
Contrast PTSD and Acute Stress Disorder
- PTSD = 1 month
- ASD = less than one month
Treatment for night mares in PTSD?
this is used for real in clinic
prazosin (a1 antagonist)
In addition to SSRIs/SNRIs and prazosin, what drugs may be used to treat PTSD?
atypicals
What treatment should be AVOIDED in PTSD?
Benzos, because very high rate of comorbid substance abuse
Criteria for adjustment disorder
- not life threatening trigger
- starts within 3 months of life event
- lasts less than 6 months
*Might become chronic only if stressor is chronic
