First Aid for the Psychiatry Clerkship - "Anxiety, Obsessive-Compulsive, Trauma, and Stressor-Related Disorders"

Question 1

In treating a patient with insomnia who has a history of substance abuse, consider ____________________.

Answer 1

giving them a nonaddictive substance like diphenhydramine or hydroxyzine for PRN use

Question 2

What is the mechanism of buspirone?

Answer 2

5HT-1A partial agonist

Question 3

Why is buspirone not commonly used as monotherapy?

Answer 3

It has been shown to have less efficacy than SSRIs (it can be used to augment SSRI therapy).

Question 4

Beta-blockers can be used to treat what two psychiatric conditions?

Answer 4

• Panic attacks

* Performance anxiety

Question 5

Go through the mnemonic for panic attack symptoms.

Answer 5

Da PANICS
D: depersonalization, derealization, disconnectedness
P: paresthesia, palpitations
A: abdominal distress
N: numbness, nausea
I: intense fear of going crazy or dying
C: chills
S: sweating, shaking

Question 6

______________ is a risk factor for panic attacks.

Answer 6

Smoking

Question 7

Give the diagnostic criteria for panic attacks.

Answer 7

• Recurrent panic attacks without an identified trigger
• Fear of future attacks with maladaptive/avoidant behavior
• Not due to a substance

Question 8

What are the diagnostic criteria for agoraphobia?

Answer 8

• Fear of not being able to escape or obtain help in two or more situations outside the home due to fear of panic or embarassment
• Symptoms lasting longer than six months
• Symptoms not better explained by another mental disorder
• The fear/anxiety is out of proportion to the actual danger posed

Question 9

__________________ has a heritability of up to 60%.

Answer 9

Agoraphobia

Question 10

Almost all patients with agoraphobia started by _______________.

Answer 10

having a panic attack

Question 11

Give the criteria for specific phobia disorder.

Answer 11

■ Persistent, excessive fear elicited by a specific situation or object which is out of proportion to any actual danger/threat
■ Exposure to the situation triggers an immediate fear response
■ Situation or object is avoided when possible or tolerated with intense anxiety
■ Symptoms cause significant social or occupational dysfunction
■ Duration ≥ 6 months
■ Symptoms not solely due to another mental disorder, substance (medication or drug), or another medical condition

Question 12

How long does selective mutism need to be present for a true diagnosis?

Answer 12

One month

Question 13

______________ anxiety usually presents between 7 and 9 months of age, while ______________ anxiety usually presents around 1 year and peaks at 18 months.

Answer 13

Stranger; separation

Question 14

How is separation anxiety in an older child treated?

Answer 14

• CBT
• Family therapy
• SSRIs

Question 15

What is a good mnemonic for GAD symptoms?

Answer 15

Worry WARTS
• Worrier
• Wound-up or Worn-out
•Absent-minded 
• Restless
• Tense
• Sleepless

Question 16

The median age of onset for GAD is ______.

Answer 16

30

Question 17

Why would checking the stove before you leave or double-checking that a letter has fallen into the mailbox not necessarily qualify for a diagnosis of OCD?

Answer 17

To qualify as OCD, the obsessions and compulsions need to be time-consuming, distressing, and impair normal living.

Question 18

What is the typical course of obsessive-compulsive disorder?

Answer 18

The symptoms will usually wax and wane, but fewer than 20% of those with OCD will have remission without treatment.

Question 19

If SSRIs don’t help a person with OCD, then _______________ can be added or tried.

Answer 19

TCAs (usually clomipramine because it is the most serotonin-selective) or atypical antipsychotics

Question 20

What do the terms ego-dystonic and ego-syntonic mean?

Answer 20

• Ego-dystonic: the person perceives the issue as a problem or finds it distressing
• Ego-syntonic: the person does not see the issue as distressing

Example: Obsessive-compulsive disorder is an ego-dystonic disease, while obsessive-compulsive personality disorder is usually ego-syntonic.

Question 21

Trichotillomania can be treated with _______________.

Answer 21

SSRIs, SGAs, lithium, or N-acetylcysteine

Question 22

What symptoms are suggestive of PTSD and acute stress disorder?

Answer 22

Experience of life-threatening event or trauma followed by these symptoms: 
•Avoidance
•Hypervigilance
•Intrusive thoughts
• Negative mood/cognitions

Question 23

___% of those with PTSD will recover in 3 months.

Answer 23

50

Question 24

Why are benzodiazepines not recommended in the treatment of PTSD?

Answer 24

There is a high rate of substance abuse among those with PTSD, and benzodiazepines are addictive.

Question 25

To qualify as adjustment disorder, the symptoms need to start within __________ of the stressor.

Answer 25

3 months