Panic Disorders (Quiz 2)

Question 1

T/F? Patients with panic disorder take more disability days than those with diabetes, cardiac disease, or renal disease.

Answer 1

True

Question 2

How much more do patients with panic disorder utilize primary care than other patients?

Answer 2

3x more

Question 3

What percentage of people have experienced an anxiety disorder in their lifetime? In the last 12 months?

Answer 3

24. 9%

17. 2%

Question 4

What is the most common anxiety disorder?

Answer 4

Social phobia

Question 5

What is the least common anxiety disorder?

Answer 5

Panic disorder

Question 6

Rank the following disorders from most to least prevalent.
Panic disorder
Social phobia
Simple phobia
GAD

Answer 6

Social phobia
Simple phobia
GAD
Panic disorder

Question 7

Criteria for a panic attack includes _____ or more of the panic attack symptoms that develop abruptly and peak within _____ minutes.

Answer 7

4

10

Question 8

What are the panic attack symptoms?

There are a lot, sorry

Answer 8

Palpitations
Sweating
Trembling
SOB
Feeling of choking
Chest pain
Nausea
Dizzy
Derealization
Fear of losing control/going crazy
Fear of dying
Paresthesias
Chills or hot flashes

Question 9

Panic disorder criteria

Answer 9

Recurrent, unexpected panic attacks
No organic factor
Panic attacks not accounted for by another disorder
At least 1 of the attacks followed by a month of more of: concern for additional attacks, worry about implications or consequences of attacks, significant change in behavior related to the attacks.

Question 10

Top 5 panic disorder symptoms for men

Answer 10

Heart pounding
Sweating
Perceive time slower/quicker
Chest pain
trembling/shaking

Question 11

Top 5 panic disorder symptoms in women

Answer 11

Heart pounding
Trembling/shaking
Perceive time slower/quicker
Sweating
Chest pain

Question 12

What cardiac condition is associated with panic disorder?

Answer 12

PSVT-67% met criteria for panic disorder in a study

Question 13

The treatment for PSVT is ablation. Does this also treat the panic disorder?

Answer 13

Yes

Question 14

Differential diagnosis of panic disorder?

Answer 14

Endocrine disorders
Vestibular dysfunction
Seizure disorders
CNS stimulants or depressants
Cardiac conditions
Hypoglycemia

Question 15

First line options for treatment of panic disorder?

Answer 15

SSRIs and SNRIs

Question 16

T/F? SNRIs, SSRIs, TCAs, and benzos are all comparable in their efficacy for panic disorder?

Answer 16

True

Question 17

Why are SSRIs or SNRIs preferred over TCAs and benzos for treatment of panic disorder?

Answer 17

Side effect profile of SSRIs and SNRIs are better

Question 18

Nonpharmacologic treatment for panic disorder?

Answer 18

CBT

Question 19

What benzodiazepines can be used to treat panic disorder?

Answer 19

Alprazolam (Xanax)

Clonazepam (Klonopin)

Question 20

Benefits of benzos in treatment of panic disorder?

Answer 20

Short latency of onset
Lack of antidepressant side effects
Can be used as needed
Easy to add to SSRIs SNRIs

Question 21

Drawbacks of using benzos in panic disorder?

Answer 21

Sedation
Discontinuation difficulties
Potential for abuse
Not effective for comorbid depression

Question 22

Benefits of SSRIs in treatment of panic disorder?

Answer 22

Low cardiovascular effects
Absence of anticholinergic activity or weight gain
Low overdose and seizure potential

Question 23

Drawbacks of SSRIs in panic disorder?

Answer 23

Initial anxiety and jitteriness

Nausea, nervousness, insomnia, sexual dysfunction, and headache are common

Question 24

Benefits of combining antidepressants with benzos for treatment of panic disorder?

Answer 24

Provides rapid anxiolysis during antidepressant lag

decrease early anxiety associated with initiation of antidepressant

Question 25

How would you discontinue a benzo in a patient with dependence?

Answer 25

Start antidepressant and maximize effect over 12 weeks Reduce benzo gradually by 10-20% at 2-4 week intervals May substitute a long acting for a shorter acting benzo

Question 26

What can patients with agoraphobia have fear or anxiety about?

Answer 26

``` Using public transportation Being in open spaces Being in enclosed spaces Standing in line or being in a crowd Being outside of home alone ```

Question 27

Criteria to diagnose agoraphobia?

Answer 27

``` 2 or more of the following: Using public transportation Being in open spaces Being in enclosed spaces Standing in line or being in a crowd Being outside of home alone ``` Patient fears of avoids these situations Diagnosed irrespective of the presence of panic disorder

Question 28

Panic disorder can be comorbid with what conditions?

Answer 28

MDD Irritable bowel syndrome Bipolar disorder

Question 29

What are the benefits of providing patient education to patients with panic disorder?

Answer 29

Education alone may relieve some symptoms of panic disorder

Question 30

2 most common errors made by anxious patients?

Answer 30

Blowing things out of proportion | Jumping to conclusions

Question 31

If first line treatment of panic disorder is unsuccessful, what can you do next?

Answer 31

Switch to another first line treatment Add a benzo Monotherapy or augmentation with gabapentin or a second generation antipsychotic

Question 32

What other medications can be used to treat panic disorder when patients have failed treatment of several standard treatments?

Answer 32

Mirtazipine | Anticonvulsants such as gabapentin

Question 33

What is the most common anxiety disorder in bipolar patients?

Answer 33

Panic disorder

Question 34

What needs to be done before giving a patient with bipolar and panic disorder an antidepressant?

Answer 34

Mood stablization

Question 35

What type of antidepressants are best in patients with Bipolar and panic? SSRIs or TCAs

Answer 35

SSRIs

Question 36

What medication prevents lactate induced panic attacks?

Answer 36

Divalproex

Question 37

How long should treatment of panic be continued before considering discontinuation? Why?

Answer 37

At least 1 year to promote further symptom reduction and decrease risk of recurrence

Question 38

What therapy can be added to facilitate withdrawal from benzos?

Answer 38

CBT