Sept 3 - Anxiety and Depression Flashcards
Describe the ABC model of anxiety.
A: Alarm - What triggers the anxiety for the patient
B: Beliefs - What background does the patient have about the trigger of the anxiety
C: Coping - can be positive or negative mechanisms
List 5 common chief complaints related to anxiety.
racing thoughts, can’t focus, headache, chest pain, palpitations
What is critical to understand to identify the cause of a person’s anxiety?
identify cause and effect - ex, did anxiety cause lack of sleep or vice versa?
What is required for symptoms to lead to a diagnosis of anxiety disorder?
Are symptoms impacting their daily life and functioning?
List 5 physical exam findings that may be consistent with anxiety disorder.
lack of eye contact, fidgeting, nail biting, pacing, sweaty hands
What labs/diagnostic tests are important when a diagnosis of anxiety is considered?
thyroid panel, ECG
What is required for a diagnosis of separation anxiety disorder?
- Separation from what brings comfort, distress/fear, somatic symptoms (N/V, diarrhea, sweating, etc.)
- Present for 4 weeks in children and 6+ months for adults
What is required for a diagnosis of selective mutism?
Lack of speech at expected times with language skills usually intact. Also inc social anxiety
What is required for a diagnosis of phobias?
- Disproportionate fear/anxiety the vast majority of times exposed to a specific trigger with active avoidance
- Must be present for 6 months or more
What is required for a diagnosis of social anxiety disorder?
Fear and anxiety related to scrutiny of others lasting for 6+ months - prevalence increases with age.
What is required for a diagnosis of panic disorder?
Recurrent, unexpected panic attacks. Prevalence peaks in adulthood and is less likely < 14 y/o
What is required for a diagnosis of generalized anxiety disorder?
restlessness, easy fatigue, difficulty concentrating, irritability, sleep difficulty lasting 6+ months - prevalence peaks in mid life then declines
What substance is known (anecdotally) to trigger anxiety disorder?
Wellbutrin
T/F: Phobias are more common in men than women.
F: more common in women
T/F: Social anxiety disorder is more common in men.
F: more common in women
T/F: Social anxiety disorder is more common in men.
F: more common in women
T/F: Panic attacks may last for hours.
F: typically short duration, but may recur often
List 5 signs or symptoms of a panic attack.
palpitations, tachycardia, sweating, dyspnea, paresthesia
T/F: Generalized anxiety disorder is more common in females.
T: females twice as likely as males
What medical conditions can induce anxiety disorder? List four specified in the DSM-5.
Pheochromocytoma, DM, epilepsy, hyperthyroid, carcinoid, ETOH withdrawal, arrhythmias
DSM-5 specifies: asthma, HTN, ulcers, arthritis
List medications that may be used to manage anxiety disorder.
- SSRIs: sertraline/zoloft, paroxetine/paxil
- SNRIs: venlafaxine/effexor, duloxetine/cymbalta, desvenlafaxine/pristiq
- pregabalin/lyrica
- TCAs: elavil
- buspirone
- benzodiazepines
List 4 types of psychotherapy that may be used to manage anxiety disorder.
supportive therapy
exposure therapy
response prevention
cognitive behavioral therapy (CBT)
List three physical exam findings consistent with depression.
appears distracted, poor affect, poor hygiene (more severe)
List two important labs to order when depression is suspected.
Thyroid panel (hypo) and B12 (deficiency)
What is required for a diagnosis of disruptive mood dysregulation disorder?
- Chronic severe irritability
- Present for 1+ year and in 1+ setting
- Verbal outbursts with irritability/anger in between
- Symptom onset must be before 10 years of age and Dx must be made between ages 6 and 18
What is required for a diagnosis of major depressive disorder?
Depressed mood most of day for 2+ weeks and 4 of:
- Change in weight or appetite
- Change in sleep
- Change in psychomotor activity
- Decreased energy
- Felling worthless, guilt
- Difficulty thinking or concentrating
- Recurrent thoughts of death/suicide
What is the prevalence of major depressive disorder in the US?
7% –> 18-29 y/o much more common, females > males
When is suicide risk a concern in major depressive disorder?
always
What is required for a diagnosis of dysthymia?
Depressed mood most of day for 2+ years and no asymptomatic period > 2 months plus 2 of:
- Change in appetite
- Sleep disturbances
- Low energy
- Low self-esteem
- Poor concentration
- Feeling of hopelessness
What is required for a diagnosis of premenstrual dysphoric disorder?
Irritability, dysphoria, anxiety that repeatedly occurs around pre-menstrual cycle and resolves after
Prevalence: 1.8% - 5.8% of menstruating women
List medications that may be used to manage depression.
SSRIs: sertraline/zoloft, paroxetine/paxil escitalopram/lexapro, fluoxetine/prozac
SNRIs: venlafaxine/effexor, duloxetine/cymbalta, desvenlafaxine/pristiq
NDRIs: wellbutrin (Norepi DA Reuptake Inhibitors)
TCAs
Tetracyclic Antidepressants: mirtazapine/remeron
2nd Gen Antipsychotics: aripiprazole/abilify, quetiapine/seroquel
MAOIs: phenelzine/nardil
List three types of psychotherapy that may be used to manage depression.
CBT
Interpersonal therapy,
Psychodynamic therapy - addressing childhood issues that impact adult functioning
