Mehl. anxiety disorders 04-19 (3)

Question 1

GAD. What is the duration of excessive and persistent worry required for a diagnosis of GAD?

Answer 1

6+ months

Question 2

GAD. List three physical symptoms often accompany GAD?

Answer 2

• Restlessness
• Fatigue
• Muscle tension

Question 3

GAD. what mood change?

Answer 3

Patient can also have concurrent mood or psychotic disorder.

In this case, the diagnosis becomes, e.g., “GAD with comorbid MDD.”

Question 4

GAD Tx? 2

Answer 4

CBT and SSRIs

Question 5

GAD. What type of medication is buspirone?

Answer 5

Serotonin receptor agonist

Question 6

Provide an example of a situation that may cause excessive worry in a patient with generalized anxiety disorder (GAD).

Answer 6

• Son going to college
• Work
• Marriage

Question 7

Adjustment disorder. duration?

Answer 7

Socio-occupational dysfunction occurring within 3 months of one specific stressor (i.e., a breakup, loss of job, death, illness).

Question 8

Adjustment disorder.
Socio-occupational dysfunction.!

Answer 8

.

Question 9

Adjustment disorder. If it persists >6 months since the stressor, it is called?

Answer 9

chronic adjustment disorder.

Question 10

Adjustment disorder. what is diff with GAD?

Answer 10

The key is the single stressor, whereas GAD is many / no specific stressor

Question 11

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

Answer 11

.

Question 12

Adjustment disorder. Tx?

Answer 12

First-line Tx is CBT and SSRIs.

Question 13

Panic disorder. diagnostic criteria?

Answer 13

Panic disorder is diagnosed if patient has 2 or more panic attacks + at least one month of worry about having more attacks.

Question 14

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.

Answer 14

.

Question 15

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

Answer 15

.

Question 16

Panic disorder.
What cardiac finding can occur?

Answer 16

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.

Question 17

Panic disorder. Tx? conservative

Answer 17

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.

Question 18

Panic disorder. Tx drug?

Answer 18

Often times they won’t have breathing exercises as an answer, where benzo is correct.

Question 19

Social phobia. definition?

Answer 19

Fear of being judged, negatively evaluated, or rejected in a social or performance scenario.

Question 20

Social phobia. how case presented in usmle?

Answer 20

Presents on USMLE as fear of public speaking.

Question 21

Social phobia. first line Tx?

Answer 21

USMLE wants beta-blocker (propranolol or atenolol) as 1st-line Tx

Question 22

Social phobia.

If Q gives you an asthma patient who has social phobia, what Tx?

Answer 22

choose benzo instead of propranolol.

They make this distinction on NBME.

Question 23

Social phobia. Tx for longer term management?

Answer 23

CBT

Question 24

Specific phobia. definition?

Answer 24

Fear of a specific object or situation leading to significant distress or functional impairment

Question 25

Specific phobia. specific case in usmle?

Answer 25

High-yield example on USMLE is fear of flying

Question 26

Specific phobia. Tx in acute?

Answer 26

USMLE wants benzo for acute relief

Question 27

Specific phobia. Mx for longer-term?

Answer 27

CBT for longer-term.

Question 28

Agoraphobia. definition?

Answer 28

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.

Question 29

Agoraphobia. in what specific cases?

Answer 29

- This usually refers to crowded, open spaces.

Question 30

Separation anxiety disorder. definition?

Answer 30

Excessive distress with separation from home or major attachment figure.

Question 31

Separation anxiety disorder. peaks at what age?

Answer 31

Peaks at 12-18 months of age

Question 32

Separation anxiety disorder. subsides at what age?

Answer 32

usually subsides by 2-3 years, but children can still get this up into their teenage years.

Question 33

Separation anxiety disorder. USMLE can give a vignette of a child going to summer camp or school who gets stomach aches on arrival.

Answer 33

.

Question 34

Selective mutism. definition?

Answer 34

Disorder where patient fails to speak in certain situations, such as when confronted with new people, despite being able to speak in other situations

Question 35

Excessive distress with separation from home or major attachment figure. name?

Answer 35

Separation anxiety disorder

Question 36

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?

Answer 36

Selective mutism

Question 37

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?

Answer 37

Agoraphobia

Question 38

Fear of a specific object or situation leading to significant distress or functional impairment. name?

Answer 38

Specific phobia

Question 39

Fear of being judged, negatively evaluated, or rejected in a social or performance scenario.?

Answer 39

Social phobia

Question 40

2 or more panic attacks + at least one month of worry about having more attacks. name?

Answer 40

Panic disorder attack - only one episode

Question 41

episode of intense fear that triggers severe physical reactions, even though there is no real danger or apparent cause. Name?

Answer 41

panic attack

Question 42

Socio-occupational dysfunction occurring within 3 months of one specific stressor (i.e., a breakup, loss of job, death, illness). name?

Answer 42

Adjustment disorder

Question 43

6+ months of excessive and persistent worry about various aspects of life, often accompanied by physical symptoms like restlessness, fatigue, and muscle tension. name?

Answer 43

Generalized anxiety disorder (GAD)

Question 44

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

Answer 44

.

Question 45

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.

Answer 45

.

Question 46

NBME 10 192Q. Panic disorder Tx?

Answer 46

Treatment typically includes psychotherapy, long-term selective serotonin reuptake inhibitors, and potential short-term benzodiazepines.

Question 47

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?

Answer 47

Adjustment disorder

Question 48

NBME 10 192Q. kiti ats. features persistent and excessive worrying about a range of topics with associated functional impairment. Dx?

Answer 48

Generalized anxiety disorder

Question 49

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?

Answer 49

Patients with illness anxiety disorder (Choice C), formerly known as hypochondriasis

Question 50

NBME 10 192Q. kiti ats. Patients with illness anxiety disorder (Choice C), formerly known as hypochondriasis. Defintinion?

Answer 50

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.

Question 51

NBME 10 192Q. kiti ats. Somatization disorder (Choice E), or somatic symptom disorder, definition?

Answer 51

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).

Question 52

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?

Answer 52

Somatization disorder or somatic symptom disorder