First Aid – Anxiety Disorders

Question 0

Organic causes of anxiety symptoms?

Answer 0

#Hyperthyroidism
#pheochromocytoma
#Calcium/phosphate imbalance
#Glucose imbalance

Question 1

Generalized Anxiety disorder – prevalence? Male to female ratio?

Answer 1

5%; 1:2

Question 2

Criteria for generalized anxiety disorder?

Answer 2

Excessive anxiety on more days than not for 6+9 months along with 3/6 of:

#Restlessness or the feeling of being on edge
#Easy fatigability
#Difficulty concentrating or mind going blank
#Irritability 
#muscle tension 
#sleep disturbance (insomnia)

Question 3

Treatment for anxiety disorder?

Answer 3

#Pharmacotherapy (SSRIs, venlafaxine, Buspirone)
#psychotherapy
#eliminate external stressors (caffeine, nicotine, sleep distances)
#Cognitive behavioral therapy with focus on relaxation techniques

Question 4

Short acting benzodiazepines? Half life?

Answer 4

Oxazepam, triazolam

3-8 hours

Question 5

Intermediate acting benzodiazepines? Half-life?

Answer 5

Alprazolam, lorazepam, temazepam

10-20 hours

Question 6

Long-acting benzodiazepines? Half-life?

Answer 6

Clonazepam, chlordiazepoxide, diazepam, flurazepam, clorazepate

Over 100 hours

Question 7

Mechanism of action of benzodiazepines? Side effects?

Answer 7

Increase frequency of chloride channel openings of GABA-A receptors

Sedation, slurred speech, ataxia, retrograde amnesia

Question 8

Patient with renal failure – give what benzodiazepines?

Answer 8

Chlordiazepoxide and diazepam

Question 9

Anxiety drug in a patient with a history of substance abuse?

Mechanism? Indications? (not useful for?)

Answer 9

Buspirone

Partial agonist for serotonin 1A receptors

#GAD (not useful for panic disorder because slow onset of action)
#Augmentation of antidepressant treatment in depressing or OCD

Question 10

Panic disorder criteria?

Answer 10

Recurrent, sudden, unexpected attacks that peak within 10 minutes and include 4 of:

#Palpitations, shaking, shortness of breath
#Chest pain, nausea, dizziness
#Derealization or depersonalization
#Fear of losing control or dying
#paresthesias, hot flashes

In addition, also need to have persistent worry about additional attacks

Question 11

Two diseases that have 50% comorbidity with panic attacks?

Answer 11

Major depression and Agoraphobia

Question 12

Panic disorder – most effective psychotherapy? First-line pharmacotherapy?

Answer 12

Cognitive behavioral therapy

#SSRIs
#Benzodiazepines for immediate relief (Remember: buspirone is not effective)

Question 13

Social phobia criteria?

Treatment?

Answer 13

At least six months of persistent intermittent fear of a social/public situation

#Cognitive behavioral therapy
#SSRIs
#Beta blockers for stage fright

Question 14

Ego-dystonic versus ego syntonic?

Answer 14

Patients know their behavior is problematic versus symptoms are part of the patients personality (unaware of their problematic behavior)

Question 15

Medical treatment for OCD (specific drugs)?

Answer 15

#SSRIs especially fluvoxamine 
#Clomipramine

Question 16

PTSD presentation includes?

Answer 16

#Reexperiencing of traumatic events (flashbacks, nightmares)
#Avoidance of stimuli associated with the trauma
#Numbing of responsiveness (anhedonia, amnesia, detachment)
#Increased arousal (hypervigilance, increased startle, poor concentration)

Question 17

Types of PTSD?

Answer 17

#Acute – symptoms present for under three months
#Chronic – symptoms present for over three months
#Delayed onset – symptoms start six months after the traumatic event

Question 18

Treatment for PTSD?

Answer 18

#High deuce SSRIs
#Anxiolytics (beta blockers and benzodiazepines)
#Cognitive behavioral therapy