mood and anxiety disorder

Question 1

define: A persistent subjective state, expressed in thought, emotion, behavior, and bodily functions.

Answer 1

what is mood

Question 2

Disorders that share features of excessive and persistent bouts of fear (emotional response to real or perceived imminent threat) and anxiety (anticipation of future threat) and related behavioral disturbances.

Answer 2

what are anxiety disorders

Question 3

what are the 7 major anxiety disorders?

Answer 3

Panic Disorder
Social Anxiety Disorder (Social Phobia)
Specific (“simple”) Phobia
Agoraphobia
Generalized Anxiety Disorder
Substance-Induced Anxiety Disorders
Anxiety Disorder Due to Another Medical Condition

Question 4

disorder characterized by recurrent panic attacks, occuring over at least 1 month involving anticipatory anxiety and avoidance of situations where panic is likely to occur or help is unavailable

a discrete period of intens fear or discomfort during which at least four of the following symptoms develop within 10 minutes:

1. palpitations, pounding heart
2. sweating
3. trebmling, shaking
4. dyspnea, feeling smothered
5. choking sensation
6. chest pain, tightness
7. nausea, abdominal distress
8. dizziness, fainting
9. parasthesias
10. chills, hot flashes
11. fear of dying/going crazy
12. depersonalization/derelaziation

Answer 4

panic disorder

Question 5

onset: early teens through age 40

chronic relapsing may remit

epidemiology: prevalence: 1-3% community, 3-8% primary care
female: male: 2:1

Answer 5

panic disorder

Question 6

what is anxiety?

Answer 6

fear (fight or flight)

stress

both psychological and physiological symptoms

Question 8

fear (sometimes panic) often w/blushing, of anticipated humiliation or rejection by others in social situations
a. Avoidance prevents corrective learning and sustains impairment
b. Performance anxiety = more common and responds to treatment
c. Characterized by fear responses to cues such as: environment, situations
d.

Answer 8

social phobia

Question 9

simple phobia: characterized by fear responses to specific cues, encountered during a particularly frightening experience, environment, situations

Note that phobias need to be treated only if they interfere with important activities.
Common phobia in medical setting: Claustrophobia in MRI. Needs to be taken seriously; patient cannot “will himself” to tolerate the enclosed space. Ask for pharmacology consultation. “Open MRI” may not be a suitable alternative for making an accurate diagnosis.

Vasovagal (fainting) response involving blood, needles, and injury are common occurrences.

Answer 9

simple phobia

Question 10

Marked, persistent fear or anxiety about two or more of the following situations, accompanied by avoidance of the situations:

Using public transportation
Being in open spaces (parking lots, bridges, marketplaces)
Being in shops, theaters, cinemas
Standing in line or being in a crowd
Being outside of the home alone

Answer 10

agoraphobia

Question 11

which phobia treated this way:

Rehearsal, improved competence (“Toastmasters International”) Beta-blockers to reduce distress for public speaking

Answer 11

social phobia

Question 12

how do you tx simple phobia?

Answer 12

short-term treatment with short-acting benzos for symptomatic relief (fear of flying, claustrophobia in MRI); repeated gradual exposure (Systematic Desensitization) to feared stimulus for lasting relief.

Question 13

how do you tx agoraphobia?

Answer 13

Agoraphobia: Gradual exposure (Systematic Desensitization), plus SSRIs

Question 14

Note that somatic symptoms are very common, and often are the chief complaint. Patient does not realize the connection between anxiety and somatic symptoms, seeking help only for the somatic complaints. Inquire and pay attention to any patient’s psycho-social situation when evaluating vague symptoms that don’t seem to have a cause.

Answer 14

generalized anxiety disorder

Question 15

common symptoms include:

Checking
Washing
Counting
Confessing
Symmetry/precision
Hoarding
>50% have multiple

Answer 15

OCD

Question 16

Stimulants
Cocaine
Methamphetamine
ADHD medications
Caffeine
Alcohol (mini-withdrawals)
Over-the-counter decongestants and cough syrup

can cause which disorder?

Answer 16

Substance/Medication-Induced Anxiety Disorder(Panic Attacks Predominate)

Question 17

Endocrinopathies
Pheochromocytoma
Hyperthyroidism
Hypoglycemia
Metabolic Problems
Neurological Problems
(e.g. vestibular dysfunction)

can all cause?

how is this condition dx?

Answer 17

Anxiety Disorder Due to Another Medical Condition

Diagnosis is made if a patient’s medical condition is known to induce anxiety, and preceded the onset of the anxiety.

Question 18

An unusually intense and persistent mood that occurs out of context and compromises self-care, adaptive functioning, and the ability to effectively relate to other people.

Answer 18

mood disorder

Question 19

Note that intense sadness following “Bereavement” is not abnormal, and most people recover without psychiatric help. But “Bereavement” can morph into Major Depression (Sig-e-caps at any time). In that case, it is treated as Major Depression, regardless of the reasons.

Question 20

Low mood (Sig-e-caps) for 2 or more years; never without symptoms; causing clinically significant distress or impairment.

Answer 20

Persistent Depressive Disorder(formerly called “Dysthymia”)

Question 21

In the week before onset of menses, patient suffers from a combination of symptoms which may include:
Marked affective lability, irritability, anger, interpersonal conflicts, feeling on edge, anxiety, depression, over-eating, food cravings, sleep problems, feeling overwhelmed and out of control.
Note: Symptoms must have lasted for the better part of a year, and must be documented PROSPECTIVELY for at least 2 menstrual cycles. Symptoms must disappear shortly after onset of menses and are not just an exacerbation of ongoing interpersonal conflicts.

Answer 21

pre-menstrual dysphoric disorder

Question 22

Rapidly alternating mood states, occurring for at least 2 years, but never meeting criteria for Major Depression, Mania, or Hypomania. This disorder looks a lot like Borderline Personality Disorder; many patients may meet criteria for both diagnoses.
Note that chaotic life circumstances, self-injurious behavior, and a history of abuse may be more prominent in BPD

Answer 22

cyclothermic disorder

Question 23

Classic “Manic Depression.” Full-blown mania is a psychotic disorder (patient loses contact with reality; severely impaired judgment). Vast majority of Bipolar patients experience at least one major depressive episode in their lifetime, in addition to mania.
Note: Manic symptoms can be caused by drugs and medical conditions (e.g. stimulants; hyperthyroidism, CNS diseases, Cushing’s). Medical causes must be ruled out.

Distinct period of abnormally and persistently elevated mood, lasting at least one week.

Answer 23

bipolar I

Question 24

Distinct period of abnormally and persistently elevated , expansive, or irritable mood, and abnormal and persistently increased activity or energy, lasting at least 4 consecutive days, ** and present most of the day, nearly every day. In addition, patient must have a history of major depression that lasted at least 2 weeks.**

Answer 24

bipolar 2

Question 25

Often the chief complaint is “medical:” No energy, can’t sleep, sleeping too much; can’t eat, eating too much; aches and pains, digestive problems, can’t concentrate, can’t remember things.

ASK about life events, crises, challenges, and mood symptoms (again, Sig-e-caps). Ask about personal and family history of mood and anxiety disorders. Rule out obvious medical causes, but don’t look for “zebras.”

Answer 25

screening