Module 3: Anxiety disorders and OCD Flashcards
What is the length of time for separation anxiety symptoms to occur in adults and children?
Children at least 4 weeks and Adults greater than 6 months
What treatments are available for separation anxiety disorder?
Psychoeducation for the family, CBT/Play therapy, SSRI’s
What SSRI’s are first line for separation anxiety?
fluoxetine, fluvoxamine, sertraline, paroxetine
What is the main criteria for selective mutism?
failure to speak in specific social situations for which there is an expectation despite speaking other situations and having no difficulty with speaking or language for at least one month
What is the main differential diagnosis for selective mutism?
social anxiety disorder
What is the treatment for selective mutism?
Psychoeducation for the family, CBT/Play therapy, SSRI’s
What SSRI’s are used to treatm selective mutism?
fluoxetine, fluvoxamine, sertraline, and paroxetine
What is the length of time that symptoms should be present to diagnose a specific phobia?
6 months or more
How prevalent are specific phobias?
One of the most common mental disorders in the US
How likely are patients with specific suicide more likely to commit suicide?
60% more than people without the condition
What is the nonpharmacologic treatment for specific phobias?
behavior therapy, insight oriented psychotherapy, virtual therapy hypnosis, supportive therapy, and family therapy?
What are the pharmocologic treatments for specific phobias?
beta adrenergic receptor antagonists such as propranolol, benzodiazepines in addition to therapy. Do not prescribe benzos alone..
What are the main criteria for diagnosing social anxiety disorder?
individual is exposed to possible scrutiny by others causing fear/anxiety and lasts for more than 6 months
What is the nonpharmacologic treatment for social anxiety disorder?
behavioral and cognitive methods, exposure therapy with performance anxiety
What are pharmacologic treatments for social anxiety disorder?
SSRI’s are first line. SNRI (venlafaxine), Buspirone (in augmentation with SSRI), Benzodiazepine (Alprazolam, Lorazepam, and clonazepam), beta-adrenergic receptor antagonists (atenolol 50 to 100 mg or propranolol 20-40 mg
Combination of pharm and nonpharm is best
What are the 3 main criteria for panic disorder?
- recurrent unexpected panic attack but can occur from calm or anxious state 2. must have 4+ symptoms, 3. must have at least one attack that has been followed by 1 month or more of persistent worry about other panic attacks or a maladaptive change in behavior related to the attacks
What are the main things to think about when diagnosing panic disorder?
be sure to ask about substance use including caffeine and other substances (20-40% have substance abuse disorder), be sure to ask about sleep
What are some differential diagnoses for panic disorder?
thyroid disorder, hyperparathyroidism, pheochromocytomas, hypoglycemia, neuropathological process such as seizure disorder, vestibular dysfunction, neoplasms, and substance use/abuse; cardiac arrhythmias, COPD, and asthma
What is the nonpharmacologic treatment for panic disorder?
CBT (superior to just taking meds alone), and family therapy
How long should pharmacotherapy be used for panic disorder once the effective medication and dose has been found?
6-12 months
What medications are effective for treating panic disorder?
SSRI 1st line treatment (paroxetine, sertraline, citalopram, escitalopram, fluvoxamine, fluoxetine
SNRI (venlafaxine)
Buspirone
Benzodiazepine (alprazolam, lorazepam)
TCA’s clomipramine and imipramine common but can use other
MAOI’s
Mood stabilizer can be used as adjunct
How long should patients be on benzodiazepines in panic disorder?
4-12 weeks
How long should benzos be tapered off with panic disorder?
4-10 weeks
what are some things to consider when using TCA’s for panic disorder?
slowly titrate up (can take up to 8-12 weeks and high doses are often needed but can cause problematic side effects)
What is the main panic attack specifier criteria?
this is different that panic disorder but must still have 4+ symptoms. This is added to the diagnosis (ie. major depressive disorder with panic attack)
What is included in the diagnosis of panic attack specifier?
other paroxysmal episodes such as anger or grief, anxiety disorder due to another medical condition, substance/medication induced anxiety disorder, panic disorder
What is the treatment for panic attack specifier?
Same as panic disorder treatment
How many criteria must be met to diagnose agoraphobia?
2+ out of 5
What are the 5 situations used for diagnosing agoraphobia?
fear or anxiety in 2 of these 5 situations: using public transportation, being in open spaces, being in enclosed places, standing in line or being in a crowd, being outside of the home alone
What is the treatment for panic attack specifier?
treat the primary disorder then adjunct as needed
Diagnosis of agoraphobia include what main two things?
fits DSM criteria and oftentimes has another mental illness such as anxiety disorder, MDD, PTSD panic disorder, etc.
What is the nonpharmacologic treatment for agoraphobia?
supportive or insight-oriented psychotherapy, cognitive or behavioral therapy, or virtual therapy
What is the pharmacologic treatment for agoraphobia?
SSRI’s are first line. Benzodiazepines and TCA’s including clomipramine and imipramine
What are the three main criteria necessary to meet diagnosis for generalized anxiety disorder?
excessive anxiety and worry more days than not for more than 6 months
difficult to control the worry
Have had 3+ symptoms for the past 6 months
What are the 6 possible symptoms used for diagnosing general anxiety disorder?
being restless or feeling keyed up or on edge, being easily fatigued, difficulty concentrating or mind going blank, irritability, muscle tension, sleep disturbance