Canadian Clinical Practice Guidelines for Treatment of Anxiety, OCD, and PTSD: Part 2 (Special Populations)

Question 1

are anxiety and related disorders more prevalent in the peripartum period

Answer 1

some studies say yes, some say no

Question 2

maternal anxiety disorders are associated with which 3 adverse pregnancy outcomes

Answer 2

elective c section

premature delivery

shorter gestational age

*however, a meta analysis found no relationship between anxiety symptoms per se and adverse pregnancy outcomes

Question 3

maternal anxiety and related disorders have been associated with what challenges/adverse outcomes with regard to parenting

Answer 3

mothers with anxiety and related disorders may be:

-less promoting of psychological autonomy

-associated with behavioural/emotional problems in kids

-subsequent development of anxiety in the kid

Question 4

which antidepressant in particular appears to have risk of congenital cardiac malformations in exposued fetuses

Answer 4

paroxetine

Question 5

fetal exposure to what antidepressant has been linked to childhood ADHD

Answer 5

buproprion (needs more study)

Question 6

prenatal antidepressant exposure has been linked to what neurodevelopmental disorder

Answer 6

autism spectrum disorder (needs more study)

Question 7

which antidepressants are preferred if mother must use while breastfeeding

Answer 7

sertraline or paroxetine

Question 8

what is the risk associated with prenatal benzo exposure

Answer 8

oral cleft increased risk (absolute risk is small… another case control study did not find this association)

there is risk of neonatal withdrawal or toxicity syndrome

*no increased risk found of major malformations or cardiac defects

Question 9

what are the risks associated with exposure to antipsychotics in pregnancy (for the infant)

Answer 9

potential risk for abnormal muscle movements and withdrawal symptoms in infants exposure to APs during 3rd trimester

Question 10

what are the most common phobias reported in pediatric populations

Answer 10

blood/injury/injection and animal fears

Question 11

anxiety and related disorders among younger patients are associated with high rates of what issues/disorders in addition

Answer 11

comorbid psych conditions

SUD

sleep problems

somatic symptoms

suicidality

problems with cognition/attention

problems with academic performance

problems with peer relationships

Question 12

is there a benefit to universal anxiety prevention programs for preventing childhood anxiety and related disorders? what about indicated prevention programs (targeted to children demonstrating highly anxious symptoms)?

Answer 12

both have evidence of benefit–> indicated programs have larger effect sizes than universal programs

Question 13

is CBT effective for treatment of pediatric anxiety

Answer 13

yes, across symptom/dx clusters

Question 14

name a commonly used pediatric CBT protocol

Answer 14

“coping cat” program–> was as effective as pharmacotherapy with SSRI but less effective than combo therapy

Question 15

list some other psychological approaches that have been effective in treating anxiety in kids and teens

Answer 15

attention bias modification, social effectiveness therapy, MBCT–> for social anxiety disorder

ERP, family based CBT, meta cognitive therapy–> for OCD

cognitive behavioural writing therapy, spiritual hypnosis assisted therapy, emotion regulation therapy, exposure therapy, EMDR–> for PTSD

exposure therapy–> specific phobias

Question 16

is there benefit to parental training only in managing pediatric anxiety disorders

Answer 16

yes

Question 17

name 6 ADs with evidence for treatment of OCD in kids and teens

Answer 17

fluoxetine + clomipramine = level 1

citalopram, fluvoxamine, paroxetine, sertraline = level 2

Question 18

name 3 ADs with evidence for treatment of GAD in kids and teens

Answer 18

fluoxetine

fluvoxamine

sertraline

all level 2

Question 19

name two medications with evidence for treatment of school refusal in kdis

Answer 19

citalopram = level 4

adjunctive imipramine = level 2

Question 20

list two medications with evidence in kids for separation anxiety disorder

Answer 20

fluoxetine

fluvoxamine

both level 2

Question 21

list 7 medications with evidence in kids/teens for social anxiety disorder

Answer 21

fluoxetine = level 1

fluvoxamine, paroxetine, venlafaxine XR = level 2

escitalopram, sertraline, mirtazapine = level 3

Question 22

name 2 medications for treatment of panic disorder in kids and teens

Answer 22

clonazepam and alprazolam have level 4 evidence

Question 23

name a medication that can be used adjunctively in treatment of pediatric OCD

Answer 23

abilify (level 3)

Question 24

is sertraline helpful in pediatric PTSD

Answer 24

seems to have level 2 NEGATIVE evidence

Question 25

what two disorders have decent evidence for use of SSRIs in kids and teens

Answer 25

most evidence is in OCD and social anxiety disorder

Question 26

what is the perspective of the canadian guidelines on the use of benzos in youth with anxiety and related disorders

Answer 26

“benzos have limited utility in youth”

may be useful for short term therapy in specific situations where there is a need to achieve rapid reduction in severe anxiety symptoms to allow exposure related psychotherapy i.e panic disorder, school refusal disorder

Question 27

what type of medication is riluzole

Answer 27

glutamate antagonist (may have some efficacy in pediatric OCD, not alot of evidence)

Question 28

what are the most common antidepressant adverse events in children

Answer 28

activation

vomiting

somnolence in adolescents

Question 29

how do the prevalence rates of anxiety and related disorders generalyl change as progress into old age

Answer 29

generally decrease prevalence rates

may be related to age biases in the assessment of anxiety and the masking effect of other risk factors that increase with aging

under diagnosis is common

Question 30

how does having an anxiety or related disorder affect elderly populations compared to those elderly who do not have an anxiety disorder

Answer 30

those with anxiety disorders have higher rates of SLEEP DISTURBANCE and greater IMPAIRMENT in COGNITIVE FUNCTIONING compared to those without anxiety disorders

also impacts physical functioning and mobility and health related QoL

Question 31

older patients with anxiety and related disorders report higher rates of which medical problems

Answer 31

diabetes

GI conditions

dementia

Question 32

what medical problems were associated with elevated rates of anxiety and related disorders in the elderly (i.e risk factors for anxiety in the elderly)

Answer 32

chronic urinary incontinence

hearing impairment

HTN

resp disease

poor sleep

Question 33

how does comorbid anxiety affect outcomes in cardiovascular disease in the elderly

Answer 33

increased risk of mortality

Question 34

is CBT as effective for anxiety symptoms in older adults compared to younger adults?

Answer 34

may be slightly less effective in older adults –> may benefit from inclusion of learning and memory aids with standard CBT

Question 35

CBT has evidence for efficacy for treatment of which anxiety and related disorders in older adults

Answer 35

GAD and panic disorder

Question 36

is pharmacotherapy for anxiety and related disorders as effective in older adults as it is in working age adults

Answer 36

yes it appears it is as effective

Question 37

what medication for GAD has the most robust evidence in older adults

Answer 37

pregabalin

also good evidence for velafaxine and duloxetine (and citalopram and escitalopram)

Question 38

what is the most common comorbidity in bipolar disorder

Answer 38

anxiety and related disorders

Question 39

name a medication with evidence for improving both ADHD symptoms and social anxiety symptoms in kids

Answer 39

atomoxetine