Mehl. anxiety disorders 04-06 (2) Flashcards
GAD, adjustment, panic, phobias (socla, speficif, agarophobia), separartion anxiety, selective mutism
GAD. What is the duration of excessive and persistent worry required for a diagnosis of GAD?
6+ months
GAD. List three physical symptoms often accompany GAD?
- Restlessness
- Fatigue
- Muscle tension
GAD. what mood change?
Patient can also have concurrent mood or psychotic disorder.
In this case, the diagnosis becomes, e.g., “GAD with comorbid MDD.”
GAD Tx? 2
CBT and SSRIs
GAD. What type of medication is buspirone?
Serotonin receptor agonist
Provide an example of a situation that may cause excessive worry in a patient with generalized anxiety disorder (GAD).
- Son going to college
- Work
- Marriage
Adjustment disorder. duration?
Socio-occupational dysfunction occurring within 3 months of one specific stressor (i.e., a breakup, loss of job, death, illness).
Adjustment disorder.
Socio-occupational dysfunction.!
.
Adjustment disorder. If it persists >6 months since the stressor, it is called?
chronic adjustment disorder.
Adjustment disorder. what is diff with GAD?
The key is the single stressor, whereas GAD is many / no specific stressor
Adjustment disorder.
The patient must not have psychosis, but can have a mood disorder, where we call it “adjustment disorder with depressed mood,” or “adjustment disorder with anxious mood,” etc. I’ve seen NBMEs, particularly on 2CK psych forms, write answers like this
.
Adjustment disorder. Tx?
First-line Tx is CBT and SSRIs.
Panic disorder. diagnostic criteria?
Panic disorder is diagnosed if patient has 2 or more panic attacks + at least one month of worry about having more attacks.
Panic disorder.
A panic attack is an episode of intense fear that triggers severe physical reactions, even though there is no real danger or apparent cause.
.
Panic disorder.
USMLE will usually give patient with hyperventilation, where he/she feels like he/she is going to die or is having an MI. The USMLE is obsessed with making you think panic attack is cardiac. Don’t get fooled
.
Panic disorder.
What cardiac finding can occur?
Vignette can mention a mid-systolic click (mitral valve prolapse) + ask you the cause of the patient’s symptoms: answer = panic disorder, not mitral valve prolapse.
Panic disorder. Tx? conservative
Tx = breathing exercises to encourage the patient to stop hyperventilating.
Breathing into a paper bag is wrong answer.
Often times they won’t have breathing exercises as an answer, where benzo is correct.
Panic disorder. Tx drug?
Often times they won’t have breathing exercises as an answer, where benzo is correct.
Social phobia. definition?
Fear of being judged, negatively evaluated, or rejected in a social or performance scenario.
Social phobia. how case presented in usmle?
Presents on USMLE as fear of public speaking.
Social phobia. first line Tx?
USMLE wants beta-blocker (propranolol or atenolol) as 1st-line Tx
Social phobia.
If Q gives you an asthma patient who has social phobia, what Tx?
choose benzo instead of propranolol.
They make this distinction on NBME.
Social phobia. Tx for longer term management?
CBT
Specific phobia. definition?
Fear of a specific object or situation leading to significant distress or functional impairment
Specific phobia. specific case in usmle?
High-yield example on USMLE is fear of flying
Specific phobia. Tx in acute?
USMLE wants benzo for acute relief
Specific phobia. Mx for longer-term?
CBT for longer-term.
Agoraphobia. definition?
Fear of being in places or situations from which escape might be difficult or embarrassing, or where help might not be available if one were to have a panic attack.
Agoraphobia. in what specific cases?
- This usually refers to crowded, open spaces.
Separation anxiety disorder. definition?
Excessive distress with separation from home or major attachment figure.
Separation anxiety disorder. peaks at what age?
Peaks at 12-18 months of age
Separation anxiety disorder. subsides at what age?
usually subsides by 2-3 years, but children can still get this up into their teenage years.
Separation anxiety disorder. USMLE can give a vignette of a child going to summer camp or school who gets stomach aches on arrival.
.
Selective mutism. definition?
Disorder where patient fails to speak in certain situations, such as when confronted with new people, despite being able to speak in other situations
Excessive distress with separation from home or major attachment figure. name?
Separation anxiety disorder
Disorder where patient fails to speak in certain situations, such as when confronted with new people, despite being able to speak in other situations. Name?
Selective mutism
Fear of being in places or situations from which escape might be difficult or embarrassing, or where help might not be available if one were to have a panic attack. Name?
Agoraphobia
Fear of a specific object or situation leading to significant distress or functional impairment. name?
Specific phobia
Fear of being judged, negatively evaluated, or rejected in a social or performance scenario.?
Social phobia
2 or more panic attacks + at least one month of worry about having more attacks. name?
Panic disorder
attack - only one episode
episode of intense fear that triggers severe physical reactions, even though there is no real danger or apparent cause. Name?
panic attack
Socio-occupational dysfunction occurring within 3 months of one specific stressor (i.e., a breakup, loss of job, death, illness). name?
Adjustment disorder
6+ months of excessive and persistent worry about various aspects of life, often accompanied by physical symptoms like restlessness, fatigue, and muscle tension. name?
Generalized anxiety disorder (GAD)
NBME 10 192Q.
Panic disorder features panic attacks that occur unexpectedly and are associated with worry about future panic attacks or changes in behavior to avoid panic attack triggers
.
NBME 10 192Q.
Panic attacks feature acute fear or anxiety that peaks within minutes and is associated with four additional physical symptoms or associated mental states. These additional symptoms may include heart palpitations or tachycardia, shortness of breath, chest pain, dizziness, the sensation of choking, gastrointestinal distress, paresthesia, sweating, chills, trembling, derealization, the fear of dying, and/or the fear of losing control.
.
NBME 10 192Q.
Panic disorder Tx?
Treatment typically includes psychotherapy, long-term selective serotonin reuptake inhibitors, and potential short-term benzodiazepines.
NBME 10 192Q. kiti ats.
onset of disproportionate distress within 3 months of an identifiable stressor and may be associated with anxiety, depression, and/or conduct disturbances. What Dx?
Adjustment disorder
NBME 10 192Q. kiti ats.
features persistent and excessive worrying about a range of topics with associated functional impairment. Dx?
Generalized anxiety disorder
NBME 10 192Q. kiti ats.
persistently excessive anxiety and preoccupation about the possibility that they may have or acquire a serious illness such that they perform frequent health-related behaviors or exhibit maladaptive avoidance. Dx?
Patients with illness anxiety disorder (Choice C), formerly known as hypochondriasis
NBME 10 192Q. kiti ats.
Patients with illness anxiety disorder (Choice C), formerly known as hypochondriasis. Defintinion?
persistently excessive anxiety and preoccupation about the possibility that they may have or acquire a serious illness such that they perform frequent health-related behaviors or exhibit maladaptive avoidance.
NBME 10 192Q. kiti ats.
Somatization disorder (Choice E), or somatic symptom disorder, definition?
patient is excessively preoccupied with one or more somatic symptoms such that these symptoms disrupt the patient’s daily life. Patients persistently devote excessive time and energy to these symptoms or related health concerns (eg, repeatedly going to the doctor).
NBME 10 192Q. kiti ats.
patient is excessively preoccupied with one or more somatic symptoms such that these symptoms disrupt the patient’s daily life. Patients persistently devote excessive time and energy to these symptoms or related health concerns (eg, repeatedly going to the doctor). Dx?
Somatization disorder or somatic symptom disorder
