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445- Pain and Mental Health > Panic Disorder, OCD, PTSD > Flashcards

Panic Disorder, OCD, PTSD Flashcards

1
Q

panic disorder is recurrent, ______ panic attacks followed by => _____ of persistent concern or worry about additional attacks and consequences OR _________ related to attacks

A

unexpected
=>1mth
notable maladaptive behaviour changes

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2
Q

the DSM 5 dx of panic disorder includes

A

an abrupt surge of intense fear or discomfort with 4 or more sx + peak within minutes

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3
Q

panic disorder peaks within

A

minutes

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4
Q

goals in tx of panic disorder

A

Reduce frequency and severity of attacks, anticipatory anxiety, avoidance and impaired function

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5
Q

T or F: a single panic attack can be dx of panic disorder

A

F- not in isolation

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6
Q

T or F: comorbid health and mental health issues are common with panic disorder

A

T

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7
Q

describe the panic cycle

A

anxiety → panic attack → fear of another one → more anxiety → another attack

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8
Q

what is first line tx in panic disorder

A

CBT alone or with ADs
combo better for remission

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9
Q

T or F: CBT alone is enough for severe panic disorder

A

F- should add AD

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10
Q

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

A

3

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11
Q

those with ____ are very sensitive to physical experiences = can start with low dosing and stay at lower doses in general

A

panic disorder

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12
Q

what is second line tx for PD

A

TCAs, MAOi

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13
Q

most PD disorders decrease in _____ after tx initiation, continue up to ____

A

decrease in 6-12wks
continue up to 12mths

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14
Q

if anxiety is severe in PD, what should be used

A

BZs PRN to bridge gap until SSRIs kick in

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15
Q

how long should BZs be used in PD

A

first 8 wks, ST PRN

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16
Q

what is the least common anxiety disorder

A

OCD

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17
Q

mean age of onset for OCD is

A

20

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18
Q

list 2 RF for OCD

A

social isolation, hx physical abuse, negative emotionality (- emotions, poor self concept/ esteem)

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19
Q

describe obsessions

A

Recurrent, intrusive thoughts, images, or urges caused marked anxiety and stress
Ex- contamination, symmetry/ exactness, safety, sexual impulse, aggressive impulses, somatic, religious

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20
Q

describe compulsions

A

Repetitive behaviors or mental acts performed in an attempt to reduce anxiety from obsessions

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21
Q

DSM dx of OCD includes

A

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

22
Q

what is the scale used to rate OCD sx

A

yale brown obsessive compulsive scale (Y-BOCS)

23
Q

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

A

5

24
Q

tx of OCD usually includes

A

CBT and or meds

25
Q

rank the following in efficacy for OCD: meds, CBT, CBT + meds

A

CBT = CBT + meds > meds

26
Q

what is first line tx for OCD

A

SSRIs

27
Q

2nd line meds for OCD

A

clomipramine, venlafaxine, mirtazapine

28
Q

3rd line meds for OCD

A

IV clomipramine, MAOis, tramadol

29
Q

what are some other options for OCD besides meds

A

deep brain simulation, surgery, psychedelics

30
Q

T or F: because OCD is so difficult to treat, adjuncts should be started sooner rather than later

A

T

31
Q

1st line OCD adjuncts

A

risperidone, aripiprazole

32
Q

2nd line OCD adjuncts

A

quetiapine, topiramate

33
Q

T or F: OCD doses should be titrated rapidly + often v high doses of meds are required

A

T

34
Q

when should OCD pt expect to see benefit from meds

A

> 6wks, sometimes 10-12wks

35
Q

how long to treat OCD with meds?

A

min 6mths, may go 1-2yrs

36
Q

list 2 most common forms of trauma resulting in PTSD

A

unexpected death of someone close, SA, serious illness/ injury to someone close, having a child with serious illness, intimate partner or caregiver violence

37
Q

which of the following can have delayed symptom onset
1. MDD
2. anxiety
3. OCD
4. PTSD

A

4 (>6mths)

38
Q

T or F: 50% of people will have been exposed to a traumatic event severe enough to contribute to PTSD

A

T

39
Q

what are the 3 reasons some people develop chronic PTSD and not others

A

higher circulating levels of catecholamines
failure of medial prefrontal and anterior cingulate networks to regulate activity of amygdala
enhanced negative feedback of HPA axis

40
Q

T or F: early tx of PTSD doesn’t prevent chronicity

A

F

41
Q

diagnosis of PTSD has 5 sx categories

A

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

42
Q

duration of disturbance from PTSD must be ____ to be dx

A

> 1mth

43
Q

what is acute and chronic PTSD time ranges

A

acute = <3mths, chronic = >3mths

44
Q

1st line tx for PTSD

A

psychotx like CBT, EMDR, bilateral brain stimulation

45
Q

what is second line tx for PTSD

A

pharmacotx primarily SSRIs/ SNRIs

46
Q

which SSRIs/ SNRIs are used in PTSD

A

paroxetine, sertraline, fluoxetine, venlafaxine

47
Q

_____ may be used in PTSD to treat physical sx

A

propranolol

48
Q

what are some new potential tx for PTSD

A

quetiapine
cannabis- lacks direct evidence
MDMA and psychedelics

49
Q

T or F: there is little and sometimes conflicting data on using psych + pharm for PTSD

A

T

50
Q

how to tx nightmares from PTSD

A

prazosin off label, may also consider olanxapine, topiramate, nabilone

51
Q

T or F: early use of BZs use recommended in PTSD

A

F- can worsen PTSD

52
Q

T or F: many PTSD pts also have psychotic sx

A

T - ~40%

445- Pain and Mental Health (21 decks)

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