PSYCH - anxiety

Question 1

What are the pharm treatments for panic disorder?

Answer 1

• BDZ
  
  • TAD
  • MAOI
  • SSRI
  • SNRI

Question 2

What is the behavioral treatment for panic disorder?

Answer 2

• CBT, panic reduction therapy

Question 3

What are the three arms of cognitive behavioral therapy in anxiety disorder?

Answer 3

• Physical
		○ Pounding heart
		○ Tachypnea
		○ dizziness
	• Cognitive
		○ What if I faint
		○ What if I lose control
		○ What if a metorite from mars hits me
	• Behavioral
		○ Avoid the situation
		○ Only go if xyz
		○ Distract from anxiety

Question 4

What do behavioral therapists do in CBT for anxiety?

Answer 4

• Psychoeducation
  
  • Breathing retraining
  • Interoceptive exposure
  • Situational exposure
  • Cognitive restructuring

Question 5

What is buspirone?

Answer 5

• Treatment for generalized anxiety disorder, but not panic disorder
  
  • Anxiolytic drug
  • 5-ht1a receptor partial antagonist
  • (blocks serotonin)

Question 6

Social is social phobia?

Answer 6

• Not just shyness
  
  • OVERWHELMING anxiety in performance situations
  • Especially when others are watching

Question 7

What are some classic fears in people with social phobia?

Answer 7

• Performing in front of others
	• Being center of attention
	• Eating in public
	• Writing in public
	• Using public restroom
		○ More common in men
	• Using telephone

Question 8

What are the pharm treatments for social phobia?

Answer 8

• BDZ
  
  • Beta-blockers
  • MAOIs
  • SSRIs
  • Behavioral is CBT, group setting

Question 9

25% of childhood OCD is brought on by PANDAS. What is pandas?

Answer 9

• Pediatric autoimmune neuropsychiatric disorders associated with strep
  
  • There is also a surpisingly high co-morbidity with Tourettes (30-50%)
  • Suggesting basal ganglia disorder

Question 10

What is the OCD circuit in the brain?

Answer 10

• Normal
○ Striatum activation inhibits the direct basal ganglia pathway which disinhibits the thalamus
○ Also activates the indirect basal ganglia pathway
○ Inhibits the globus pallidus externa and results in disinhibiton or subthalamic nuclei
○ Eventually there is thalamic inhibition through the globus pallidus interna
• OCD
○ Greater tendency toward direct basal ganglia tone
○ Thalamic disinhibition results in further activation of the orbiotfrontal cortex which pushes the circuit even more toward direct pathway tone
○ The circuit leads to capture of cognition and behaviors

Question 11

What is the treatment for OCD?

Answer 11

• Clomipramine
*dibenzazepine tricyclic antidepressant. Its precise mechanism of action is unknown, but its ability to block the reuptake of serotonin (5-HT) is believed to be important
• SSRIs
• Augmentation with atypical antipsychotics
• CBT, (exposure) or neurosurgery