Behav. Sci. Anxiety

Question 1

what are physical manifestations of anxiety?

Answer 1

sympathetic NS: diaphoresis, mydriasis, tachycardia, tremor, GI/GU symptoms (diarrhea, increased urinary frequency), hyperventilation, dizziness, syncope, parasthesia, numbness and tingling in the extremities and around the mouth

Question 2

what are the psychological manifestations of anxiety?

Answer 2

restlessness, irritability, trouble concentrating, worry

Question 3

what are the 5 main classifications of anxiety disorder?

Answer 3

generalized anxiety disorder, panic disorder (w and w/o agoraphobia), specific phobia/social anxiety disorder, OCD, ASD/PTSD

Question 4

DD for anxiety: medical causes

Answer 4

medical causes (caffeine, substance abuse, withdrawal, hyperthyroid, arrhythmia, vit B12 deficiency, hypoglycemia, pheochromocytoma

Question 5

what are often seen in ED setting presenting as anxiety?

Answer 5

acute MI, pulmonary embolism, COPD, asthma exacerbation

Question 6

which psychiatric disorders are associated with anxiety?

Answer 6

depression, schizophrenia, eating disorders, personality disorders, substance dependence

Question 7

diagnosing anxiety

Answer 7

symptoms must:

1. be persistent (>6 months) - shorter for children
2. interfere with normal functioning
3. cause significant distress

Question 8

etiology psychosocial factors for anxiety

Answer 8

• traumatic events or extreme stressors (PTSD, panic attack) may help create the anxiety disorder
• maladaptive coping skills/personality traits make people vulnerable

Question 9

etiology biologic factors for anxiety

Answer 9

• greater prevalence in populations of family members with anxiety orders (genetics may play role, environment you grew up in)
• gender bias towards women (except OCD)

Question 10

neurobiological factors for anxiety

Answer 10

• lowered serotonin and GABA activity

- increased NE and glutamate activity

Question 11

diagnostic criteria for general anxiety disorder

Answer 11

excessive anxiety/worry occurring more days than not for more than 6 months about more than 1 event/activity - difficult to control this worry

Question 12

what are the symptoms associated with general anxiety disorder? how many symptoms are needed to diagnose?

Answer 12

more than 3 symptoms

1. restlessness
2. easily fatigued
3. difficulty concentrating
4. irritability
5. muscle tension
6. sleep disturbance

Question 13

prognosis for general anxiety disorder

Answer 13

without treatment tends to worsen esp during stressful times

Question 14

treatment for general anxiety disorder

Answer 14

best/most studied: cognitive behavioral therapy

• psychodynamic (childhood trauma, unconscious thoughts)
• antidepressents: SSRIs frontline
• buspirone
• benzodiazepines

Question 15

what is the mechanism to giving SSRIs in general anxiety disorder

Answer 15

increases SR or NE or both by downregulating or desensitizing receptors (needs to be done slowly)

Question 16

buspirone in general anxiety disorder mechanism

Answer 16

initially lowers SR activity as autoreceptors are stimulated, but eventually renders them inactive allowing increases in SR output (has less sexual and weight gain side effects)

Question 17

what is second line pharmacologic treatment for general anxiety disorder? why second line?

Answer 17

benzodiazepines - highly addictive, falls, apnea

Question 18

when are beta blockers used?

Answer 18

symptomatic relief of PERFORMANCE ANXIETY ONLY

Question 19

panic disorder

Answer 19

an abrupt surge of intense fear or discomfort, peaks within minutes and is UNEXPECTED - recurrent - more than one attack followed by more than one month of concern about additional panic attacks or consequences and/or significant maladaptive change in behavior related to attacks

Question 20

what symptoms are associated with panic disorder? how many required to diagnose?

Answer 20

need more than 4

• palpitations
• sweating
• shaking
• sensation of SOB
• choking feeling
• chest pain/discomfort
• nausea
• dizziness, lightheadedness, fainting
• chills/heat
• paresthesias
• derealization
• fear of losing of control
• fear of dying

Question 21

agoraphobia

Answer 21

fear/anxiety about more than 2 of the following for more than 6 months

• using public transportation
• being in open spaces
• being in enclosed spaces
• standing in line or in a crowd
• being outside the home alone
• fear of not being able to escape situation

Question 22

treatment for panic disorder

Answer 22

cognitive behavioral therapy (esp systemic desensitization or flooding), benzodiazepine, SSRI, benzos

Question 23

what is the emergency treatment for panic disorder? long term 1st line?

Answer 23

emergency benzodiazepine

first line long term SSRI

Question 24

specific phobia diagnostic criteria

Answer 24

• more than 6 months
• causes significant impairment
• marked by fear/anxiety about specific object/situation
• object/situation almost always provokes fear/anxiety
• actively avoids object/situation
• fear/anxiety out of proportion to actual danger

Question 25

social anxiety disorder diagnostic criteria

Answer 25

- more than 6 months - significant impairment - marked fear/anxiety when exposed to social situation with possible scrutiny by others - fear of acting in ways that will be negatively scrutinized - social situation provokes fear - avoids social situations - fear/anxiety out of proportion to actual threat -can have PERFORMANCE ONLY - public speaking/performing

Question 26

treatment for specific phobia

Answer 26

1st line: flooding, systemic desensitization | medications: maybe sedatives?

Question 27

treatment for social anxiety disorder

Answer 27

CBT, assertiveness training, group therapy | -meds: SSR 1st line, MAOI, beta blocker for performance only**