First Aid for the Psychiatry Clerkship - "Anxiety, Obsessive-Compulsive, Trauma, and Stressor-Related Disorders" Flashcards
In treating a patient with insomnia who has a history of substance abuse, consider ____________________.
giving them a nonaddictive substance like diphenhydramine or hydroxyzine for PRN use
What is the mechanism of buspirone?
5HT-1A partial agonist
Why is buspirone not commonly used as monotherapy?
It has been shown to have less efficacy than SSRIs (it can be used to augment SSRI therapy).
Beta-blockers can be used to treat what two psychiatric conditions?
- Panic attacks
* Performance anxiety
Go through the mnemonic for panic attack symptoms.
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
______________ is a risk factor for panic attacks.
Smoking
Give the diagnostic criteria for panic attacks.
- Recurrent panic attacks without an identified trigger
- Fear of future attacks with maladaptive/avoidant behavior
- Not due to a substance
What are the diagnostic criteria for agoraphobia?
- 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
__________________ has a heritability of up to 60%.
Agoraphobia
Almost all patients with agoraphobia started by _______________.
having a panic attack
Give the criteria for specific phobia disorder.
■ 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
How long does selective mutism need to be present for a true diagnosis?
One month
______________ anxiety usually presents between 7 and 9 months of age, while ______________ anxiety usually presents around 1 year and peaks at 18 months.
Stranger; separation
How is separation anxiety in an older child treated?
- CBT
- Family therapy
- SSRIs
What is a good mnemonic for GAD symptoms?
Worry WARTS • Worrier • Wound-up or Worn-out •Absent-minded • Restless • Tense • Sleepless
The median age of onset for GAD is ______.
30
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?
To qualify as OCD, the obsessions and compulsions need to be time-consuming, distressing, and impair normal living.
What is the typical course of obsessive-compulsive disorder?
The symptoms will usually wax and wane, but fewer than 20% of those with OCD will have remission without treatment.
If SSRIs don’t help a person with OCD, then _______________ can be added or tried.
TCAs (usually clomipramine because it is the most serotonin-selective) or atypical antipsychotics
What do the terms ego-dystonic and ego-syntonic mean?
- 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.
Trichotillomania can be treated with _______________.
SSRIs, SGAs, lithium, or N-acetylcysteine
What symptoms are suggestive of PTSD and acute stress disorder?
Experience of life-threatening event or trauma followed by these symptoms: •Avoidance •Hypervigilance •Intrusive thoughts • Negative mood/cognitions
___% of those with PTSD will recover in 3 months.
50
Why are benzodiazepines not recommended in the treatment of PTSD?
There is a high rate of substance abuse among those with PTSD, and benzodiazepines are addictive.
To qualify as adjustment disorder, the symptoms need to start within __________ of the stressor.
3 months
