Anxiety, OCD, trauma and stressor-related disorders

Question 1

late- onset anxiety sxs without prior or family hx. should increase suspicion of anxiety caused by

Answer 1

medical condition or substance

Question 2

most common form of psychopathology

Answer 2

anxiety

Question 3

anxiety is associated with which major ntt system?

Answer 3

norepinephrine, serotonin, and GABA

Question 4

anxiety treatment

Answer 4

• milder presentation- psychotherapy

- moderate to severe- a combination of psychotherapy and pharmacotherapy : first line tx. SSRI

Question 5

second line treatment pharmacotherapy for anxiety

Answer 5

Benzo, Buspirone, Beta-Blockers, TCAs

Question 6

Use __________ to temporarily bridge pt. until long term medication becomes effective

Answer 6

Benzodiazepines

Question 7

Use the Bs to Block the Ps

Answer 7

Beta-Blockers for Panic attacks and performance anxiety

Question 8

type of fear response involving an abrupt surge of intense anxiety which may be triggered or occur spontaneously

Answer 8

panic attack

Question 9

Sxs. of panic attacks

Answer 9

Da PANICS

• dizziness.\/disconnectedness
• palpitations/parasthesias
• abdominal distress
• numbness/nausea
• intense fear of dying, losign control or going crazy
• chills, chest pain
• sweating, chaking, SOB

Question 10

what increases the risk for a panic attack?

Answer 10

smoking

Question 11

when a patient presents with a panic attack, rule out potentially life-threatening medical conditions such as (3)

Answer 11

1. heart attack
2. thyrotoxicosis
3. thromboembolism

Question 12

carefully screen patients with panic attacks for

Answer 12

suicidality– are at an increased risk for suicide attempts

Question 13

recurrent, unexpected “out of the blue” panic attakcs without identifiable triggers

Answer 13

panic disorder

Question 14

panic disorder (1) course/prognosis (2) treatment

Answer 14

(1) chronic course with waxing and waning sxs. relapses are common esp. w. discontinuation of therapy
(2) first line– SSRIs. but can use TCAs and benzo esp. until other medications reach full efficacy

Question 15

what do we need to do in panic and snxiety disorders when starting SSRIs or SNRIs?

Answer 15

start at low doses and increase slowly b/c may worsen anxiety

Question 16

intense fear of being in public spaces where escape or obtaining help may be difficult.

Answer 16

agoraphobia

Question 17

treatment to agoraphobia

Answer 17

CBT and SSRIs

Question 18

Common domains of social anxiety disorder “social phobia” (3)

Answer 18

1. speaking in pubic
2. eating in public
3. using public restrooms

Question 19

performance anxiety is often successfully treated with

Answer 19

beta blockers

Question 20

treatment for specific phobia

Answer 20

CBT

Question 21

treatment for social anxiety diosrder

Answer 21

first-line: CBT

First-line medication: SSRIs

Question 22

patients with blood-injury injection specific phobia may experience

Answer 22

bradycardia and hypotension– vasovagal fainting

Question 23

seperation anxiety may lead to complains of _____________ sxs. to avoid school/work

Answer 23

somatic sxs

Question 24

GAD sxs

Answer 24

Worry WARTS

• worried
• worn-out
• absent-minded
• restless
• tense
• sleepless

Question 25

what can you do to reduce anxiety?

Answer 25

reduce/eliminate coffee and excercise

Question 26

recurrent , intrusive, undesired toughts that increase anxiety

Answer 26

obsessions

Question 27

repetitive behaviors or mental acts the patient feels driven to perform in repsonse to an obsession

Answer 27

compulsion

Question 28

genetic component of OCD?

Answer 28

yep, higher rates in first degree relatives

Question 29

OCD (1) course/prognosis (2) treatment

Answer 29

(1) chronic w/ waxing and waning sxs

(2) combination of psychopharmacology (SSRIs first line then TCA, clomipramine) and CBT

Question 30

acute stress disorder is diagnosed in pt. who experience a major traumatic event and suffer from similar sxs as PTSD but for shorter duration.. onset? last for?

Answer 30

onset of sxs occurs within 1 month of the trauma and sxs last for less than 1 month

Question 31

PTSD last for?

Answer 31

> 1 month

Question 32

when to use Prazosin in PTSD?

Answer 32

for nightmares

Question 33

first line treatment for PTSD

Answer 33

SSRIs or SNRIs

Question 34

addictive medications such as _________ should be avoided in the treatment of PTSD b/c of the high rate of cobormid substance use disorder

Answer 34

benzo

Question 35

occur when behavioral or emotional sxs develop after a stressful life event

Answer 35

adjustment disorder

*** stressful event is not life-threatening… in PTSD it is

Question 36

adjustment disorder (1) course/prognosis (2) treatment

Answer 36

(1) may be chronic if the stressor is chronic or recurrent– sxs resolve within 6 months of cessation of stressor
(2) supportive threapy is most effective , can use group threapy or pharmacotherapy