Panic Disorder, OCD, PTSD Flashcards
panic disorder is recurrent, ______ panic attacks followed by => _____ of persistent concern or worry about additional attacks and consequences OR _________ related to attacks
unexpected
=>1mth
notable maladaptive behaviour changes
the DSM 5 dx of panic disorder includes
an abrupt surge of intense fear or discomfort with 4 or more sx + peak within minutes
panic disorder peaks within
minutes
goals in tx of panic disorder
Reduce frequency and severity of attacks, anticipatory anxiety, avoidance and impaired function
T or F: a single panic attack can be dx of panic disorder
F- not in isolation
T or F: comorbid health and mental health issues are common with panic disorder
T
describe the panic cycle
anxiety → panic attack → fear of another one → more anxiety → another attack
what is first line tx in panic disorder
CBT alone or with ADs
combo better for remission
T or F: CBT alone is enough for severe panic disorder
F- should add AD
which of the following is false about panic disorder
1. self help books help as much as face to face CBT
2. CBT + AD combo is better than CBT alone
3. antipsychotics may be added adjunct
4. should start with lower dosing + keep at lower dose
5. 3+4
3
those with ____ are very sensitive to physical experiences = can start with low dosing and stay at lower doses in general
panic disorder
what is second line tx for PD
TCAs, MAOi
most PD disorders decrease in _____ after tx initiation, continue up to ____
decrease in 6-12wks
continue up to 12mths
if anxiety is severe in PD, what should be used
BZs PRN to bridge gap until SSRIs kick in
how long should BZs be used in PD
first 8 wks, ST PRN
what is the least common anxiety disorder
OCD
mean age of onset for OCD is
20
list 2 RF for OCD
social isolation, hx physical abuse, negative emotionality (- emotions, poor self concept/ esteem)
describe obsessions
Recurrent, intrusive thoughts, images, or urges caused marked anxiety and stress
Ex- contamination, symmetry/ exactness, safety, sexual impulse, aggressive impulses, somatic, religious
describe compulsions
Repetitive behaviors or mental acts performed in an attempt to reduce anxiety from obsessions
DSM dx of OCD includes
obsessions that cause marked anxiety/ stress AND/OR compulsions aimed at preventing/ reducing anxiety related to obsessions/ preventing situation
time consuming (>1hr/d) + causes clinically sig distress/ functional impairment
what is the scale used to rate OCD sx
yale brown obsessive compulsive scale (Y-BOCS)
which of the following is true about the Y-BOCS
1. it is administered by the clinician but initially done by the pt
2. is diagnostic
3. picks out which sx should be targeted for tx
4. all of the above
5. 1, 3
5
tx of OCD usually includes
CBT and or meds
rank the following in efficacy for OCD: meds, CBT, CBT + meds
CBT = CBT + meds > meds
what is first line tx for OCD
SSRIs
2nd line meds for OCD
clomipramine, venlafaxine, mirtazapine
3rd line meds for OCD
IV clomipramine, MAOis, tramadol
what are some other options for OCD besides meds
deep brain simulation, surgery, psychedelics
T or F: because OCD is so difficult to treat, adjuncts should be started sooner rather than later
T
1st line OCD adjuncts
risperidone, aripiprazole
2nd line OCD adjuncts
quetiapine, topiramate
T or F: OCD doses should be titrated rapidly + often v high doses of meds are required
T
when should OCD pt expect to see benefit from meds
> 6wks, sometimes 10-12wks
how long to treat OCD with meds?
min 6mths, may go 1-2yrs
list 2 most common forms of trauma resulting in PTSD
unexpected death of someone close, SA, serious illness/ injury to someone close, having a child with serious illness, intimate partner or caregiver violence
which of the following can have delayed symptom onset
1. MDD
2. anxiety
3. OCD
4. PTSD
4 (>6mths)
T or F: 50% of people will have been exposed to a traumatic event severe enough to contribute to PTSD
T
what are the 3 reasons some people develop chronic PTSD and not others
higher circulating levels of catecholamines
failure of medial prefrontal and anterior cingulate networks to regulate activity of amygdala
enhanced negative feedback of HPA axis
T or F: early tx of PTSD doesn’t prevent chronicity
F
diagnosis of PTSD has 5 sx categories
Exposure to actual or threatened death, serious injury, or sexual violation via ≥ 1 way
At least one intrusion sx
Persistent avoidance of ≥ 1 stimuli associated with the trauma
Negative alterations in cog and mood assoc with trauma, including ≥ 2 of the following
Marked alterations in arousal and reactivity associated with the trauma, including ≥ 2 of the following
duration of disturbance from PTSD must be ____ to be dx
> 1mth
what is acute and chronic PTSD time ranges
acute = <3mths, chronic = >3mths
1st line tx for PTSD
psychotx like CBT, EMDR, bilateral brain stimulation
what is second line tx for PTSD
pharmacotx primarily SSRIs/ SNRIs
which SSRIs/ SNRIs are used in PTSD
paroxetine, sertraline, fluoxetine, venlafaxine
_____ may be used in PTSD to treat physical sx
propranolol
what are some new potential tx for PTSD
quetiapine
cannabis- lacks direct evidence
MDMA and psychedelics
T or F: there is little and sometimes conflicting data on using psych + pharm for PTSD
T
how to tx nightmares from PTSD
prazosin off label, may also consider olanxapine, topiramate, nabilone
T or F: early use of BZs use recommended in PTSD
F- can worsen PTSD
T or F: many PTSD pts also have psychotic sx
T - ~40%
