Module 14 - Anxiety

Question 1

Anxiety disorder criteria

Answer 1

1. be out of proportion with situation
2. hinder ability to function normally

Question 2

• All anxiety disorders must exhibit these two symptoms

Answer 2

anxiety (fear)
worry

Question 3

• Leading diagnosis of anxiety disorders

Answer 3

Panic Disorder
GAD

Question 4

Implicit neurotransmitters *

Answer 4

Dopamine: essential role in movement. also influences motivation and plays a role in how person perceives reality
- too much dopamine can contribute to worsening OCD

Serotonin: helps regularly mood sleep and appetite, inhibits pain

Norepinephrine: constricts blood vessels and raises BP, excess can increase anxiety

Question 5

GAD-7*

Answer 5

ANXIETY measurement
refer 10 or greater
5=mild
10=moderate
15=severe anxiety

Question 6

Management of Chronic Anxiety *

Answer 6

Mild: CBT first (can add pharm if doesnt work)

Mod-Sev: Use pharm with or without CBT

Question 7

Buspirone *

Answer 7

• Effective ONLY for GAD, not indicated for anxiety subtypes
• NOT an acute drug
• Non addictive
• Does not work well for people who have had benzo exposure
• NOT FOR AS NEEDED USE
• Onset 7-10 days, (peak 3-4 weeks)

Question 8

When to use Benzos *

Answer 8

• Primarily for acute episodes
  pts acutely fearful
• Patients who have panic attacks
  impending doom
  tachy/palps
  diaphoresis
  SOB
• not indicated for most anxiety disorders BUT are second line option for GAD and panic disorder when appropriate

Question 9

DSM5 Criteria *

Answer 9

• excessive anxiety and worry occuring more days than not for 6 mo
• difficult to control
• anxiety and worry associated with 3 or more of the following symptoms

(note: only 1 item required for children)
- restlessness, feeling keyed up or on edge
- being easily fatigued
- difficult concentrating or blank mind
- irritability
- muscle tension
- sleep disturbance

Question 10

Response to Treatment *

Answer 10

• remember to follow highly anxious patients closely (higher risk of suicide)
• GAD7 score < 5 as indicator for remission
• partial response 25-75% reduction on GAD7 score
• no response < 25% reduction on GAD7 score
• AFTER ADEQUATE DOSE/TIME
  (usually 4-8weeks)

Question 11

Know questions on CAGE questionnaire and alcohol use disorder identification (AUDIT)

Question 12

Change Theory

Question 13

DSM5 diagnostic criteria and symptoms for alcohol abuse

Question 14

Alcohol abuse treatment

Question 15

Disfusilarm reaction (buspar?)

Question 16

National Institute of alcohol abuse definition of low risk drinking

Question 17

BMI

Question 18

Weight loss Meds:
contraindications
precautions
AE
frequencies

Answer 18

phentermine
liraglutide
naltrexone-bupropion
phentermine-topiramate
orlistat