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MS 2 - Unit 3 > Behavioral Science - Anxiety Disorders I & II - Thomas L. Schwartz > Flashcards

Behavioral Science - Anxiety Disorders I & II - Thomas L. Schwartz Flashcards

1
Q

What are some physical symptoms of anxiety?

A

Sympathetic NS: diaphoresis, mydriasis, tachycardia,
tremor
GI/GU symptoms (diarrhea, ↑ urinary freq.)
Hyperventilation → dizziness and syncope, parasthesia
Numbness and tingling in the extremities and around the mouth.

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2
Q

What are psychological manifestations of anxiety?

A

Restlessness, Irritability, Trouble concentrating, worry

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3
Q

diagnostic criteria for anxiety disorders

A 
Symptoms must
1. Be persistent (generally ≥6 months)*.
2. Interfere with normal functioning
       (work, job, marriage, etc.)
3. Cause significant distress.
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4
Q

What are some emergency room presentations that are physical or psychological manifestations of anxiety?

A

Acute MI, Pulmonary Embolism (PE), Chronic obstructive pulmonary disease(COPD) exacerbation, asthma exacerbation

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5
Q

T/F schizophrenia is associated with anxiety

A

True

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6
Q

What are some organic causes of anxiety?

A

Caffeine, substance abuse (cocaine, amphetamines), withdrawal (alcohol, benzodiazepines, opiates), hyperthyroidism, arrythmia, Vit B12 deficiency, hypoglycemia, and pheochromocytoma

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7
Q

T/F children with persistent symptoms of anxiety for less than 6 months may still be diagnosed with anxiety

A

True

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8
Q

Name the anxiety disorder associated with:
Fear of excessive humiliation;
Fear of public speaking;
Fear of using public toilets

A

Social phobia

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9
Q 
Name the anxiety disorder associated with:
Reliving trauma
Mental stupor
Irritability
Nightmares
A

PTSD

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10
Q 
Name the anxiety disorder associated with:
Fear of using public toilets;
Obsession
Thoughts of sex
Thoughts of murder
Hallucinations
A

OCD

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11
Q 
Name the anxiety disorder associated with:
Fear of snakes; or
Fear of blood; or
Fear of elevators; or
Fear of plane flying
A

Simple phobia

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12
Q 
Name the anxiety disorder associated with:
Fear of dying;
Panic attacks;
Fear of going;
Shortness of breath;
Chest pain
A

Panic disorder

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13
Q 
Name the anxiety disorder associated with:
Anxiety
Inner tension
Depression
Increased aggression
A

Mixed anxiety and depression

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14
Q

Are durations of symptoms for children longer or shorter when diagnosing anxiety?

A

Shorter

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15
Q

What are the neurobiological factors associated with anxiety?

A

Low serotonin (5HT)
Low GABA activity
High NE
High glutamate

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16
Q

Psychosocial factors that contribute to anxiety include:

A
  1. Traumatic events or extreme stresors
  2. Maladaptive coping skills (personality traits)
  3. Learned behavior?
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17
Q

Is there a gender bias associated with anxiety disorders?

A

Yes, women>men

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18
Q

A 35 yo female comes to your office asking for help. She claims that she and her husband have been arguing a lot more lately. She says he can’t take her constant worrying. She worries about his job and whether he is making enough money, if the mail will be delivered on time, and about how well she is raising her kids in such a cruel world. She says she has worried about things for as long as she can remember. She doesn’t like that she doesn’t sleep well at night. What is the most likely diagnosis?

A

Generalized Anxiety Disorder

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19
Q

The criteria for GAD are excessive worrying (multifocal worrying) for at least 6 months, that is difficult to control, is not due to another illness or cause, causes significant impairment, and is associated with 3 or more what other symptoms?

A 
Restlessness
Easily fatigued
Difficulty concentrating
Irritability
Muscle tension
Sleep disturbances
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20
Q

What is a common way to self-medicate anxiety?

A

Alcohol

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21
Q

T/F: 50% of GAD patients have had anxiety symptoms prior to adulthood.

A

True

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22
Q

What is the prognosis for GAD if no treatment is undertaken?

A

It generally gets worse over time

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23
Q

What is the most proven therapy for GAD?

A

CBT

also Psychodynamic, but CBT has the most evidence to support its use

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24
Q

esCitalopram, Paroxetine are frontline therapies for what disorder?

A

SSRIs

Frontline therapy for GAD

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25
Q

Class and Use: VenflaxineXR

A

SNRI used for GAD

goal is to desensitize receptors over time

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26
Q

Class and Use: Duloxetine

A

SNRI for GAD

goal is to desensitize receptors over time

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27
Q

Beta blockers are only indicated for what kind of anxiety?

A

Performance anxiety

28
Q

Why are benzodiazepines not considered the first choice in anxiety therapy?

A

Addiction risk, falls, apnea are side effects

29
Q

What serotonin (5HT1a) receptor agonist is indicated for GAD?

A

Buspirone

Less sexual and weight gain side effects than SSRIs and SNRIs

30
Q

What is the diagnosis?

An abrupt surge of intense fear or discomfort, peaks within minutes, that is unexpected.

A 
Panic attack, with FOUR or more of the following:
Palpitations, pounding heart, accelerated heart rate;
Sweating;
Shaking, trembling;
Shortness of breath (sensation) or feeling of being smothered;
Choking feeling;
Chest pain;
Nausea;
Dizziness, lightheadedness, fainting;
Chills or heat;
Paresthesias;
Derealization;
Fear of losing control;
Fear of dying
31
Q

T/F: Most anxiety disorders have both physical and psychological components.

A

True

32
Q

What is the diagnosis?
Recurrent or unexpected panic attacks;
One or more attacks followed by at least a month of (1) concern about additional panic attacks, or (2) significant maladaptive changes in behavior related to the attacks;
No other explanation for symptoms

A

Panic Disorder

33
Q

Agoraphobia is what type of disorder?

A

Panic disorder

At least 6 months of symptoms must exist

34
Q

Agoraphobia needs at least 2 of the following fears:

A 
Fear of:
using public transportation;
being in open spaces;
being in enclosed spaces;
standing in line or in a crowd;
being outside or home alone
35
Q

What is the best therapy for Agoraphobia?

A

CBT - systemic desensitization or flooding

36
Q

Panic disorder sufferers like agoraphobia may benefit from what kind of medications during an acute episode?

A

Benzodiazepines (for emergencies, fast acting)

Long term tx however is SSRI, SNRI, and secondly a long-acting benzo

37
Q

Diagnosis of a specific phobia requires how many months of symptoms?

A

At least 6 months

causes significant impairment
marked fear about an object or situation
object/situation almost always provokes fear/anxiety
active avoidance of trigger
fear and anxiety out of proportion to the actual danger
no other explanation for symptoms

38
Q

What is the diagnosis?
Persistence of at least 6 months of:
Market fear/anxiety when exposed to social situations with possible scrutiny by others;
Fear of acting in ways that will be negatively scrutinized;
Social situations provoke fear;
Avoidance of social situations;
Fear and anxiety is out of proportion to the actual threat;
No other explanation exists for the symptoms.

A

Social Anxiety Disorder

**Comorbidities with anxiety and depression

39
Q

What is the occurrence of social phobia between men and women?

A

About equal

40
Q

What is the treatment for social anxiety disorder?

A

CBT, assertiveness training, group therapy;
SSRI/SNRI - first line for example Paroxetine or VenlafaxineER;
MAOI (Phenelzine, Tranylcypromine);
Beta blockers for performance anxiety (propranolol)

41
Q

Therapy targeted at treating specific phobias includes:

A

Flooding;
Systemic Desensitization;
CBT

42
Q

For OCD criteria, obsessions and compulsions must be either ______ or _______.

A

Time consuming;

Cause significant distress

43
Q

What is an obsession?

A

A recurrent or persistent thought, urge, image, for example, fear of contamination
An obsession is intrusive and unwanted
Ego-dystonic, meaning the person is aware the thought is weird or unwanted
Patient tries to neutralize the thought with an action, or to ignore or suppress the thought

44
Q

What is this?
A repetitive behavior or activity that a patient forms in response to an obsession or as a set of rules that must be strictly adhered to. In this way, the behavior reduces anxiety associated with the obsession.

A

Compulsion

45
Q

What percentage of the population is affected by OCD?

A

2-3%

men and women are equally affected

46
Q

OCD can pop up specifically when?

A

After a stressful event

Mean onset is 19 (men) and 17 (women)

47
Q

What is the most difficult kind of anxiety to treat?

A

OCD

48
Q

What are the comorbidities associated with OCD?

A

1/3 also have depression
2/3 of patients with Tourette’s also have OCD
Suicide risk is high

49
Q

These therapies are specifically good at treating _____:

  1. CBT
  2. Acceptance and Commitment therapy (ACT)
  3. Supportive Psychotherapy, Dynamic Psychotherapy
A

OCD

50
Q

What the first-line medication for OCD?

A

SSRIs, at a higher dose than MDD

2nd line is a tricyclic, Clomipramine
3rd line is antipsychotics

51
Q

T/F: Benzodiazepines are effective at treating OCD.

A

FALSE

52
Q

What else is in the differential for OCD?

A

Tourette’s
Temporal Lobe Epilepsy
OCPD (**These patients DO NOT have insight into their behavior)

53
Q

What is one of the most common causes of PTSD?

A

Death of a loved one
Other causes: assault, combat, physical abuse or rape

Must higher likelihood if repeated trauma, or persistent proximity to the trauma, or if the trauma is severe

54
Q

If you get a fracture in a car crash, what is the likelihood you will develop PTSD?

A

15%

55
Q

How long must symptoms exist for a diagnosis of PTSD?

A

1 month or greater

56
Q

What are 4 modes of exposure to PTSD?

A
  1. Directly experiencing the events
  2. Witnessing events as they occur to others
  3. Learning that a family member or friend experienced a traumatic event
  4. Directly experiencing repeated/extreme exposure to horrific details of an event

EXPOSURE is all criterion A

57
Q

Distressing memories of the event;
Dreams/nightmares of the event;
reliving the event;
dissociative reactions (flashbacks) where the patient is unaware of their surroundings;
psychological distress from cues (external/internal) of the event;
distinct psychological reactions to the event

This is all what criterion for PTSD?

A

Criterion B

58
Q

What is criterion C for PTSD diagnosis?

A

Avoiding stimuli associated with the traumatic event

59
Q

Criterion D for the diagnosis of PTSD is at least 2 of what symptoms?

A
  1. Dissociative amnesia, repression
  2. Paranoia (exaggerated beliefs)
  3. Blame of self and others, distortion of memories
  4. Negative emotional state
  5. Decreased interest in daily activities
  6. Feelings of detachment from others
  7. Inability to experience positive emotions
60
Q

Alterations in arousal such as aggression, irritability, hypervigilance concentration and sleep problems, angry outbursts, and self-destructive behavior, characterize what?

A

Criterion E for PTSD

61
Q

What is the difference between Acute Stress Disorder and PTSD?

A

Criteria B-D must persist for 3 days up to 1 month after the exposure in ASD
ASD is a percursor to PTSD

62
Q

T/F: Earlier treatment can decrease the risk of full-onset PTSD.

A

True

63
Q

Are women more likely than men to experience PTSD and ASD?

A

Yes

Lifetime prevalence in the population is 8% for PTSD, 5-15% for ASD

64
Q

When SSRIs are not effective at treating PTSD, what ia the next option?

A

2nd line: Tricyclic antidepressants such as Amitryptaline and Imipramine, or atypical antipsychotics

3rd line: MAOIs, Trazodone, Anticonvulsants, Clonidine, Propranolol

65
Q

What medication is effective at reducing nightmares in individuals with PTSD?

A

Prazosin - an alpha-1 inhibitor

66
Q

These therapies are effective for what diagnosis?

Following models of crisis intervention - validation, support, grounding
Eye Movement Desensitization Therapy, Psychodynamic Psychotherapy
Support groups and family therapy
Cognitive therapy, Behavioral therapy

A

PTSD

MS 2 - Unit 3 (45 decks)

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