Anxiety, OCD, Trauma, Stress-Related Disorders

Question 1

What is the most common form of psychopathology?

Who gets this more commonly; women or men?

Answer 1

Anxiety disorders–more common in women than men (2:1 ratio)

Question 2

What is the first line pharmacotherapy for anxiety?
How long does it take these drugs to become effective?
How do we cope with this time gap?
What kind of a dose is required?

Answer 2

SSRIs and SNRIs

• 4-6 weeks to become effective
• Administer BDZ as interim bridge
• Requires higher dose than that used to treat depression

**Note that TCAs and MAOi’s are appropriate but not chosen due to ADR profile

Question 3

What is the MOA for Busparone?

How is it used clinically?

Answer 3

5HT partial agonist–not very effective at treating anxiety on its own, so commonly used as an adjunct

Question 4

How do we treat ANS sx of anxiety (i.e. stage fright, or panic attacks?)

Answer 4

Beta Blockers

Question 5

How do we treat anxiety PRN?

Answer 5

• BDZs: never give to addicts or ppl likely to take w ETOH

Superior non-addictive substances:

• Diphenhydramine
• Hydroxazine

Question 6

When should BDZs be avoided in treating anxiety? (2)

Answer 6

• Comorbid depression (makes it worse)

- Hx of addiction

Question 7

What is the pharmacologic goal of therapy? How long should patients stay on meds?

Answer 7

Achieve sx relief–> remain on meds for at least 6 mos before titrating off

Question 8

Describe the relationship between meds and therapy for anxiety treatment (2).

What are the two types of therapy that are proven helpful in treating anxiety?

Answer 8

• *Meds help diminish sx enough for patient to participate in therapy
• • Therapy prevents relapse if meds are no longer prescribed

CBT and Psychodynamic therapy both treat anxiety

Question 9

DSM 5 Criteria for Panic Disorder:

Answer 9

1. Recurrent UNEXPECTED panic attacks WITHOUT identifiable trigger
2. 1+ panic attacks–> 1+ mos continuous worry about subsequent attacks +/- maladaptive change bx
3. No other causes

Question 10

Smoking is a risk factor for___.

Answer 10

panic attacks

Question 11

DSM 5 Criteria for Agoraphobia (4):

Answer 11

1. Intense fear/anxiety about 2+ situations due to concern about difficulty getting help in panic, or humiliation for 
6+ MONTHS 
- outside the home 
- open spaces (bridges) 
- enclosed spaces (stores) 
- public transit 
- crowds/ lines 

2. Fear out of proportion to threat posed
3. Significan functional impairment
4. No other explanation for sx

Question 12

DSM 5 Criteria for Phobia (4):

What is the best treatment for this disorder?

Answer 12

1. Persistent excessive fear elicited by specific situation/ object out of proportion to threat for 6+ MONTHS
2. Stimulus elicits immediate fear response
3. Stimulus avoided whenever possible; tolerated with intense anxiety
4. No other explanation

**Treat with CBT

Question 13

DSM 5 Criteria for Social Anxiety Disorder (3):

Answer 13

• Same as phobia
• Pertains specifically to social scrutiny/ negative evaluation
• May be isolated to public speaking or more diffuse

Question 14

What are the most common psychiatric disorders in women and second most common in men?

Answer 14

PHOBIAS
**Note that the occurrence is 2:1 female to male in general, but social anxiety disorder occurs w equal frequency in men and women

Question 15

DSM 5 Criteria for Selective Mutism:

Answer 15

1. Consistent failure to speak in social situations for
   1+ MONTHS (extending beyond 1st month of school)
2. Not due to language difficulty or communication prob.
3. Significant impairment in functioning

Question 16

DSM 5 Criteria for Separation anxiety Disorder (9):

**At what age does this typically present?

Answer 16

Typically presents between 12-18 mos
Excessive, developmentally inappropriate fear associated with separation from attachment figures + 3 of the following:
1. Separation leads to extreme anxiety
2. Excessive worry about loss or harm to attachment fig
3. Reluctance to leave home, school, work
4. Reluctance to be alone
5. Reluctance to sleep alone or away from home
6. Somatic sx. when separated from attachment fig.
7. Nightmares of separation/ refuses to sleep away from attachment fig
8. Functional impairment due to sx.
9. No other explanation

Question 17

DSM 5 Criteria for Generalized Anxiety Disorder:

What is the avg age of onset?

Answer 17

1. Excessive anxiety/ worry for 6+ MONTHS
2. Can’t control worry
3. 3+ of: fatigue, poor concentration, irritability, muscle tension, insomnia
4. No other explanation
5. Significant functional impairment

**Avg age of onset is 30 yoa w/ 2:1 F:M ratio

Question 18

Worry WARTS mnemonic for GAD:

Answer 18

• Worried
• Wound up, Worn out
• Absent minded
• Restless
• Tense
• Sleepless

Question 19

______ are commonly comorbid with GAD:

Answer 19

Depressive disorders

Question 20

DSM 5 Criteria for OCD (2):

**Define an obsession and a compulsion

Answer 20

1. Obsessions +/- compulsions that consume 1+ HOUR/ DAILY or cause significant distress or dysfunction
2. No alternative explanation

Obsession: Recurrent, intrusive, anxiety-provoking thoughts, images urges the patient attempts to suppress/ ignore/ neutralize via compulsion

Compulsion: Repetitive bx/ mental act that patient feels compelled to perform in response to obsession or rule aimed at stores reduction/ disaster prevention–not realistically linked to goal

Question 21

Clomipramine is used to treat…

Answer 21

OCD–it is the most 5HT selective TCA

**First line treatment is still SSRI

Question 22

DSM 5 Criteria for Body Dysmorphic Disorder: