anxiety/OCD/trauma

Question 1

DDx panic disorder /med conditions

Answer 1

hypoT4/hyperT4/hyperCa/DM/migraines/Lupus/asthma/MI/TIA/vestibular dysfunction/other Psy disorders

Question 2

Panic disoerder: onset

Answer 2

late ado - early adult

Question 3

Dx panic disorder: essential

Answer 3

Unexpected PA with 1mo of worrying/implications/behavior changes

Question 4

Psychological Tx of panic disorder

Answer 4

CBT with introceptive exposure, reducing arrousal
PFPP: panic Focused Psychodynamic PsychoTx - 1 RCT

Question 5

panic disorder: pharmaco recommendations

Answer 5

1st line: SSRI/SNRI
2nd line: clomipramine, imipramine, benzos (monoTx, regu;ar, tape longer - alprazolam, Rivotril - avoid if ROH)
3rd line: MAOI, RIMA, SGA

Not recommended: bispitone, trazodone, propranolol, carbamazepine

Question 6

Specific phobia: Tx

Answer 6

exposure Tx in vivo or VR
BII
Benzos short term
D-cycloserine with wxposure Tx

Question 7

social anxiety: Tx

Answer 7

CBT, no evidence for routie combination with meds

1st line: SSRIs/SNRIs (except floxetine and citalopram)
2nd line: benzos, pregabalin, gabapentin, citaloram, phenelzine

not recommended - atenolo propranolol, imipramine, buspirone, pergolide, St John, pindolol, clonazepam

Question 8

OCD: common obcessions

Answer 8

contamination
symmetry
safety
sexual impulses
agressive impulses,
somatic,
religious

Question 9

OCD: common compulsions

Answer 9

checking
washing
repeating, ordering
counting
hoarding
touching

Question 10

OCD: improvement criteria

Answer 10

25% reduction on Y-BOCS
remission 8 or less

continued improvement seen over 6mo to 2yrs

Question 11

OCD: pharmaco

Answer 11

1st line: SSRI, high dose?
2nd line: clomipramine / adj risperidone / effexor / mirtazapine / citalopram
3rd line: adj SGA or adj mirtazapine, IV clomipramine, adj haloperidol, escitalopram

ineffective - Li, BZD, desipramine, bupropion, buspirone, naltrexone, clonidine

neuroSx: anterior cingulotomy, anterior capsultomy, subcaudate tractotomy, limbic leucotomy, DBS

Question 12

GAD: response to Tx and remission

Answer 12

HARS reduction à 50% or CGI < or = 2
remission - HARS less or equal 7

Question 13

GAD: pharmaTx

Answer 13

1st line: SSRI/SNRI (paroxetine, escitalopram, sertraline, effexor)
2nd line: BZD, buspirone, imipramine, pregabalin, bupropion
3rd line: SGA, mirtazapine, citalopram, trazodone, hydroxyzine (Atarax)

Question 14

troubles anxieux et psychoTX: avantages de combinaison

Answer 14

In general - combination is recommended to resistant Pts
CBT = pharmaco
adding psychoTx to meds may reduce relapse when Rx d/c

GAD: combinaison prevents relapse
OCD: adding CBT to pharmaco may decrease relapse
Social anxiety: no evidence to routine combination, but gains ashieved with psychoTx persist longer
Panic disorder: small benefits during acute phase, and can INCREASE relapse rate

Question 15

PTSD: Dx Sx

Answer 15

reexperiencing
avoidance/numbing
hyperarousal Sx
1mo
if >3mo = chronic

CAPS scale

Question 16

PTSD: prevention

Answer 16

no support Clinical Incident Debriefing
Brief CBT for Acute Stress Reaction > psychoeducation
BZD = no effective
weak evidence for propranolol

Question 17

PTSD: psychoTx

Answer 17

1. Stabilisation (psyched, gestion sx anxiété, DBT)
2. Intégration du trauma
   Exposition prolongée, désensibilisation syst/magique, immersion, CBT sur un trauma, EMDR plusieurs trauma
   Inoculation du stress (gestion des émotions, relaxation)
   EMDR
   Cognitive processing tu (distortions cognitives)
   Narrative Story Telling
3. Reconnection-reprise du contact avec réseau personnel et professionnel

Question 18

PTSD: pharmacoTx

Answer 18

1 line: SSRI/SNRI (fluoxetine, paroxetine, effexor, sertraline)
2 line: mirtazapine, +SGA, fluvoxamine, RIMA, MAOIs
3 line: TCA, anticonvulsants

Question 19

TAG Katzman 2014

Answer 19

1e ligne Agomelatine, duloxétine, escitalopram, paroxétine, paroxétine CR, prégabaline, sertraline, venlafaxine XR

2e ligne Alprazolam, bromazepam, bupropion XL, buspirone, diazepam, hydroxyzine, imipramine, lorazepam, quétiapine XR, vortioxétine (prioriser les benzos)

3e ligne Citalopram, divalproex chrono, fluoxétine, mirtazapine, trazodone
Adjuvant 2e ligne : pregabaline
3e ligne : aripiprazole, olanzapine, quétiapine, quétiapine XR, rispéridone
NR : ziprasidone
NR Bêta bloqueurs (propanolol), pexacerfont, tiagabine

Question 20

Approach to Tx of anxiety disorder

Answer 20

think short and long term
include relapse prevention
education and family
think bio-psycho-social

pharmaco: improvement should be seen in 6-8 wks, my take up to 10-12 wks

continue Rx until avoidance behavior is overcome

Rx for at least 12 mo

Question 21

prise en charge Tr Anxieux - principes

Answer 21

1. Dépistage anxiété et sx associés
   Début, association événement de vie/trauma, nature, impact

2-Faire DDX

3-Identifier troubles anxieux spécifiques

4-Tx psychologique et/ou pharmacologique
Base : éducation sur le trouble, l’efficacité et tolérabilité des choix de tx, facteurs aggravants et signes de rechute.
Choix de tx selon : préférence du pt, motivation, capacité à s’engager dans tx, sévérité maladie, expériences cliniciens, disponibilité tx psychologiques, réponse antérieur tx et présence de comorbidités physiques ou psychiatriques.
Survol tx psychologique : CBT et MBT surtout en groupe ou en individuel, thérapie d’exposition peut être efficace en format virtuel, efficacité rx = psychologique
5 - Faire un suivi
Utiliser des échelles pour évaluer réponse au tx (ex : CGI, HARS)