Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
144 Cards in this Set
- Front
- Back
|
What are the classes of symptoms of anxiety? |
- Cardiac - Pulmonary - Neurologic - Psychological - Other |
|
|
What are the cardiac symptoms of anxiety? |
- Palpitations - Tachycardia - Hypertension |
|
|
What are the pulmonary symptoms of anxiety? |
- SOB - Choking sensation |
|
|
What are the neurologic symptoms of anxiety? |
- Dizziness - Light-headedness - Hyperreflexia - Mydriasis (pupil dilation) - Tremors - Tingling in the peripheral extremities |
|
|
What are the psychological symptoms of anxiety? |
- Restlessness (pacing) - Butterflies in the stomach |
|
|
What are the other symptoms of anxiety? |
- Sweating - GI - Urinary urgency and frequency |
|
|
What is anxiety? |
Subjective experience of fear and its physical manifestations |
|
|
Is anxiety normal? |
Anxiety can be normal if in response to a perceived threat |
|
|
When is anxiety pathological? |
If inappropriate - there is no real source of fear or the source is not sufficient to account for the severity of the symptoms
Anxiety disorders - symptoms interfere with daily functions and interpersonal relationships |
|
|
What causes anxiety disorders? |
Combination of genetic, environmental, biological, and psychosocial factors |
|
|
What are the neurologic changes in anxiety? |
Neurotransmitter imbalances: - Increased activity of NE - Decreased activity of GABA - Decreased activity of serotonin |
|
|
What are the biological causes of anxiety? |
- Medical causes - Substance induced |
|
|
What are the medical causes of anxiety disorders? |
- Hyperthyroidism - Vitamin B12 deficiency - Hypoxia - Neurological disorders (epilepsy, brain tumors, MS, cerebrovascular disease) - Cardiovascular disease - Anemia - Pheochromocytoma - Hypoglycemia |
|
|
What are the substance induced causes of anxiety disorders? |
- Caffeine intake and withdrawal - Theophylline - Amphetamines - Alcohol and sedative withdrawal - Other illicit drug withdrawal - Mercury or arsenic toxicity - Organophosphate or benzene toxicity - Penicillin - Sulfonamides - Sympathomimetics - Antidepressants |
|
|
What is the lifetime prevalence of anxiety by gender? |
- Women: 30% - Men: 19% |
|
|
Who is more likely to develop anxiety? |
- Women (30% vs 19% in men) - Higher socioeconomic groups |
|
|
What are the types of anxiety disorders? |
- Panic disorder - Agoraphobia - Specific and social phobias - OCD - PTSD - Acute stress disorder - Generalized anxiety disorder - Anxiety disorder secondary to general medical condition - Substance induced anxiety disorder |
|
|
What is the term for a discrete period of heightened anxiety and fear? |
Panic attacks |
|
|
Who gets panic attacks? |
Classically occurs in patients with panic disorder, but can be seen with other anxiety disorders (phobic disorders, PTSD) |
|
|
What is the timeline of a panic attack? |
- Peak within 10 minutes - Usually lasts <25 minutes |
|
|
What can cause a panic attack? |
May be provoked by triggers (eg, stressor or phsyical exertion or specific situations) or come on spontaneously |
|
|
How do you diagnose a panic attack? |
Must have at least 4 of the following: - Palpitations - Sweating - Shaking - SOB - Choking sensation - Chest pain - Nausea or abdominal distress - Light-headedness - Depersonalization (feeling detached from oneself) - Derealization (feeling out of reality) - Fear of losing control or "going crazy" - Fear of dying - Numbness or tingling - Chills or hot flushes |
|
|
What is meant by the term "depersonalization"? |
Feeling detached from oneself |
|
|
What is meant by the term "derealization"? |
Feeling out of reality |
|
|
What is the mnemonic to remember the panic attack criteria? |
PANICS: - Palpitations - Abdominal distress - Numbness, nausea - Intense fear of death - Choking, chills, chest pain - Sweating, shaking, shortness of breath |
|
|
Panic attacks are associated with what medical conditions? |
- Mitral valve prolapse - Asthma - Pulmonary embolus - Angina - Anaphylaxis |
|
|
Subsequent panic attacks usually occur when? |
Spontaneously, but may be associated with specific situations |
|
|
Patients with panic disorder get panic attacks how often?
|
Recurrent, on average 2-3/week up to several per day to a few times per year |
|
|
How long do panic attacks last in panic disorder? |
Usually 20-30 minutes |
|
|
What symptoms, if any, do patients with panic disorder have between attacks? |
Anticipatory anxiety about having another attack |
|
|
What are the DSM-IV criteria for panic disorder? |
1. At least one of the attacks must be followed by a minimum of 1 month of the following: - Persistent concern about having additional attacks - Worry about implications of attack (eg, losing control or going crazy) - Significant change in behavior related to attacks (avoidance of situations that may provoke attacks)
2. Rule out other causes of anxiety 3. Specify whether panic disorder is with agoraphobia or without agoraphobia |
|
|
How common is panic disorder in patients presenting with chest pain with a normal angiogram? |
>40% |
|
|
What is the differential diagnosis of panic attacks / disorder? |
- Medical - Medications / drugs - Other psychiatric disorders |
|
|
What medical conditions can cause symptoms similar to panic attacks / disorder? |
- CHF - Angina / MI - Thyrotoxicosis - Temporal lobe epilepsy - Multiple sclerosis - Pheochromocytoma - Carcinoid syndrome - COPD |
|
|
What medications / drugs can cause symptoms similar to panic attacks / disorder? |
- Amphetamine - Caffeine - Nicotine - Cocaine - Hallucinogen - Alcohol or opiate withdrawal |
|
|
What other psychiatric conditions can cause symptoms similar to panic attacks / disorder? |
- Depressive disorders - Phobic disorders - OCD - PTSD |
|
|
What is the classic example of panic disorder? |
Female who repeatedly visits the ER with episodes of a racing heart, sweating, SOB, and a fear of going crazy or of dying |
|
|
What factors contribute to the development of panic disorder? |
- Biological factors - Genetic factors - Psychosocial factors |
|
|
What biological factors may be involved in the etiology of panic disorder? |
- Dysregulation of autonomic nervous system, central nervous system, and cerebral blood flow - Changes in NT activity (increased activity of NE, decreased activity of serotonin and GABA) |
|
|
What may induce panic attacks? |
- Caffeine - Nicotine - Hyperventilation |
|
|
How common is panic disorder? |
Lifetime prevalence: 2-5% |
|
|
How is the prevalence of panic disorder affected by gender? |
2-3x more common in females than males |
|
|
How is the prevalence of panic disorder affected by genetics? |
4-8x greater risk of panic disorder in first-degree relatives |
|
|
When is the typical onset of panic disorder? |
Late teens to early 30s (average age 25), may occur at any age |
|
|
What is the prognosis of panic disorder? |
- Variable but chronic course - Relapses are common w/ discontinuation of medical therapy - 10-20% have significant symptoms that interfere with daily functioning - 50% continue to have mild, infrequent symptoms - 30-40% remain free of symptoms after treatment |
|
|
What is the best long-term treatment of panic disorder? |
SSRIs - especially paroxetine (paxil) and sertraline (zoloft) |
|
|
What are the pharmacologic treatment options for panic disorder? |
- SSRIs (paroxetine/paxil and sertraline/zoloft) - best long-term - Other antidepressants (clomipramine and imipramine) may also be used - Benzodiazepines are effective immediately but are best used temporarily due to risk of tolerance and dependency - Continue treatment 8-12 months at least, relapse is common after discontinuation |
|
|
What are the non-pharmacologic treatment options for panic disorder? |
- Relaxation training - Biofeedback - Cognitive therapy - Insight-oriented psychotherapy |
|
|
When starting SSRIs in patients with panic disorder, what approach should you take to dosing? Why? |
Start at low dose and increase slowly; some SSRIs can have side effects that may initially worsen anxiety |
|
|
What is agoraphobia? |
Fear of being in alone in public places |
|
|
What are the characteristic situations avoided in patients with agoraphobia? |
Places or situations in which escape or help might be difficult: - Bridges - Crowds - Buses - Trains - Any open areas outside the home |
|
|
What typically leads to agoraphobia? |
Secondary to panic attacks due to apprehension about having subsequent attacks in public places where escape may be difficult |
|
|
What is the relationship of agoraphobia to panic disorder? |
Agoraphobia can be diagnosed alone or as panic disorder with agoraphobia (50-75% have coexisting panic disorder) |
|
|
How do you treat agoraphobia? |
If coexisting panic disorder is treated, agoraphobia usually resolves
When not associated with panic disorder, agoraphobia can be chronic and debilitating |
|
|
What is a phobia? |
Irrational fear that leads to avoidance of the feared object or situation |
|
|
What are the types of phobias? |
- Specific phobia: strong exaggerated fear of a specific object or situation - Social phobia (aka Social Anxiety Disorder): fear of social situations in which embarrassment can occur |
|
|
What are common specific phobias? |
- Fear of animals - Fear of heights - Fear of blood or needles - Fear of illness or injury - Fear of death - Fear of flying |
|
|
What are common social phobias? |
- Speaking in public - Eating in public - Using public restrooms |
|
|
What are the DSM-IV criteria for specific phobias? |
1. Persistent excessive fear brought on by a specific situation or object 2. Exposure to the situation brings about an immediate anxiety response 3. Patient recognizes that the fear is excessive 4. Situation is avoided when possible or tolerated with intesnse anxiety 5. If person is <18y, duration must be at least 6 months |
|
|
What are the DSM-IV criteria for social phobia? |
1. Persistent excessive fear brought on by social situations in which the patient may be embarrassed or humiliated 2. Exposure to these situations brings about an immediate anxiety response 3. Patient recognizes that the fear is excessive 4. Situation is avoided when possible or tolerated with intesnse anxiety 5. If person is <18y, duration must be at least 6 months |
|
|
What disorders are often comorbid with phobias? |
- Substance disorders (especially alcohol dependence) - Up to 1/3 also have major depression |
|
|
How can you treat performance anxiety? |
Beta blockers |
|
|
What makes "shyness" a social phobia? |
- The anxiety has to interfere with their daily functioning - With social phobia there is complete avoidance of scrutiny and exaggerated fears in day-to-day life that cause significant distress and/or disability |
|
|
What is the most common mental disorder in the U.S.? How prevalent? |
Phobias - 5-10% of population |
|
|
Which is more common, specific phobias or social phobia? |
Specific phobia |
|
|
When is the typical age of onset of phobias? |
- Specific phobias: as early as 5y for phobias such as seeing blood, and as old as 35y for situational fears (eg, fear of heights) - Social phobia: usually mid-teens |
|
|
How does gender affect the prevalence of specific and social phobias? |
- Specific phobia: women 2x as likely as men - Social phobia: equally in women and men |
|
|
What is the etiology of phobias? |
Multifactorial - Genetic factors - Neurochemical factors |
|
|
How do you treat specific phobias? |
- Pharmacological treatment has not been found effective - Behavioral therapy is most effective, including systmemic desensitization - If necessary, short course of benzodiazepines or beta blockers may be used during desensitization to help control autonomic symptoms |
|
|
How do you treat social phobia? |
- Paroxetine (Paxil), an SSRI, is FDA approved for treating social anxiety disorder - Beta-blockers are frequently used to control symptoms of performanc anxiety - Cognitive and behavioral therapies are useful adjuncts |
|
|
What happens in systemic desensitization therapy? |
Gradual exposure to the feared object or situation while teaching relaxation and breathing techniques. |
|
|
What is the opposite of systemic desensitization? |
Flooding - directly confronting the patient with their full fear |
|
|
What is an obsession? |
Recurrent and intrusive thought, feeling, or idea that is egodystonic |
|
|
What is a compulsion? |
Conscious repetitive behavior linked to an obsession that, when performed, functions to relieve anxiety caused by the obsession |
|
|
What form do compulsions often take? |
- Repeated checking (e.g., front door is locked, oven is turned off) - Very specific rituals (e.g., excessive hand washing, having to turn doorknobs three times) |
|
|
What kind of disorder is OCD? |
Axis I |
|
|
What are the basic components of OCD? |
- Recurrent intrusive thoughts (obsessions) that increase their anxiety level - Relieve anxiety with recurrent standardized behaviors (compulsions) |
|
|
Are patients with OCD aware that their thoughts/behaviors are irrational? |
In general they are aware (they have insight); the symptoms cause significant distress in their lives, and patients wish they could get rid of them (i.e., their obsession and compulsions are ego-dystonic) |
|
|
How can being OCD affect someone's life? |
Can cause significant impairment of daily functioning, as behaviors are often time consuming and interfere with routines, work, and interpersonal relationships |
|
|
What are the DSM-IV criteria for obsessions in OCD? |
- Recurrent and persistent intrusive thoughts or impulses that cause marked anxiety and are not simply excessive worries about real problems - Person attempts to suppress the thoughts - Person realizes thoughts are products of his or her own mind |
|
|
What are the DSM-IV criteria for compulsions in OCD? |
- Repetitive behaviors that the person feels driven to perform in response to an obsession - The behaviors are aimed at reducing distress, but there is no realistic link between the behavior and the distress |
|
|
What are the DSM-IV criteria for OCD? |
1. Either obsessions or compulsions 2. The person is aware that the obsessions and compulsions are unreasonable and excessive 3. The obsessions cause marked distress, are time consuming, or significantly interfere with daily functioning |
|
|
Patients with OCD often initially seek help from whom? |
Non-psychiatric physicians - Eg, may visit a dermatologist complaining of skin problems on their hands (related to frequent hand washing) |
|
|
How common is it to have both obsessions and compulsions in OCD? |
75% have both |
|
|
What disorders are often comorbid with OCD? |
- Tourette syndrome - ADHD - Major depressive disorder - Eating disorders - Other anxiety disorders - Obsessive compulsive personality disorder |
|
|
How prevalent is OCD? |
Lifetime population prevalence: 2-3% |
|
|
When does OCD typically begin? |
Onset usually in early adulthood |
|
|
How does gender affect prevalence of OCD? |
Men and women affected equally |
|
|
How do genetics affect the prevalence of OCD? |
Rate of OCD is higher in patients with first-degree relatives who have Tourette syndrome |
|
|
What are common patterns of obsessions and compulsions? |
- Obsessions about contamination - Obsessions about doubt, with compulsions to check - Obsessions about symmetry or order, with compulsions causing slow performance - Intrusive thoughts with no compulsion (often sexual or violent) - Somatic obsessions |
|
|
A patient with OCD who has obsessions about contammination may have what compulsions? |
Excessive washing or compulsive avoidance of the feared contaminant |
|
|
A patient with OCD who has obsessions about doubt may experience what? |
- May obsess over whether they forgot to turn off the stove, lock the door, etc - Compulsive checking to avoid potential danger |
|
|
A patient with OCD who has obsessions about symmetry or order may experience what? |
Compulsively slow performance of a task (eg, eating, showering, lining items exactly in place) |
|
|
A patient with OCD who has intrusive thoughts may experience what? |
May have thoughts that are sexual or violent; may have no compulsions |
|
|
A patient with OCD who has somatic obsessions may experience what? |
May cause them to view their body wastes or secretions as "abnormal" |
|
|
How do you distinguish OCD from OCPD? |
In OCPD they are excessively preoccupied with details, lists, and organization; these patients do not perceive there to be a problem (ego-syntonic)
OCD patients are distressed by their symptoms (ego-dystonic) |
|
|
What factors are thought to contribute to the development of OCD? |
- Neurochemical - Genetic - Medical conditions - Psychosocial factors |
|
|
What is the neurochemical explanation for OCD? |
Abnormal regulation of serotonin |
|
|
What is the genetic explanation for OCD? |
Rates of OCD are higher in first-degree relatives and monozygotic twins than in the general population |
|
|
What medical conditions are related to OCD? |
OCD is associated with head injury, epilepsy, basal ganglia disorders, and postpartum conditions |
|
|
What is the psychosocial explanation for OCD? |
Onset of OCD is triggered by a stressful life event in approximately 60% of patients |
|
|
What is the prognosis of OCD? |
Course is variable and chronic, with only about 30% showing significant improvement with treatment
40-50% remain significantly impaired or experience worsening of their symptoms |
|
|
What are the treatment modalities for OCD? |
- Pharmacologic - Behavioral treatment - ECT or surgery (cingulotomy) - last resort |
|
|
What are the pharmacologic approaches to treating OCD? |
- SSRIs are first line treatment, but higher-than-normal doses may be required to be effective - TCAs (clomipramine) are also effective |
|
|
What are the behavioral approaches to treating OCD? |
- Behavioral therapy is considered as effective as pharmacotherapy, but best outcomes achieved when both used - Exposure and response prevention (ERP), involves prolonged exposure to ritual-eliciting stimulus and prevention of relieving compulsion (eg, patient must touch the dirty floor without washing his or her hands) - Relaxation techniques to help patient manage anxiety that occurs when compulsion is prevented |
|
|
What occurs in the ERP therapy for OCD? |
- Prolonged exposure to ritual-eliciting stimulus and prevention of relieving compulsion (eg, patient must touch the dirty floor without washing his or her hands) - Relaxation techniques to help patient manage anxiety that occurs when compulsion is prevented |
|
|
What is the last resort treatment for OCD if pharmacologic and behavioral approaches fail? |
ECT or surgery (cingulotomy) |
|
|
Case: 26 yo man brought in by his gf for frequent nightmares, persistent symptoms of anxiety, and insomnia for past 3 months. She reports he is usually social and extroverted but lately has been withdrawn and unwilling to engage much. On further questioning, she mentions he was in a car accident several months ago in which he sustained minor injuries but witnessed his brother die.
What is the most likely diagnosis? |
PTSD - symptoms present for >1 month |
|
|
What causes PTSD? |
A catastrophic (life-threatening) life experience in which the patient re-experiences the trauma, avoids reminders of the event, and experiences emotional numbing or hyperarousal |
|
|
What do the diagnostic criteria for PTSD require? |
- Presence of traumatic experience - Persistent avoidance - Hyperarousal (or increased psychological and/or physiological tension) - Re-experiencing the traumatic event - >1 month |
|
|
What are the DSM-IV criteria for PTSD? |
Symptoms >1 month: - Pt experienced or witnessed traumatic event - Event was potentially harmful or fatal and initial reaction was intense fear or horror - Persistent re-experiencing of event - Avoidance of stimuli assoicated with trauma - Numbing of responsiveness - Persistent symptoms of increased arousal |
|
|
How might a patient with PTSD re-experience their traumatic event? |
- Dreams - Flashbacks - Recurrent recollections - Intense psychological distress to cues that relate to the traumatic event |
|
|
How might a patient with PTSD demonstrate numbing? |
- Limited range of affect - Feelings of detachment or estrangement from others |
|
|
How might a patient with PTSD demonstrate increased arousal? |
- Difficulty sleeping - Outbursts of anger - Hypervigilance - Exaggerated startle response - Difficulty concentrating
|
|
|
What comorbidities are associated with PTSD? |
- Depression - Substance abuse |
|
|
What factors should make you screen a patient for PTSD? |
A patient who is experiencing recurrent thoughts and nightmares about a past trauma |
|
|
What is the prognosis for PTSD? |
1/2 of patients remain symptom free after 3 months of treatment |
|
|
What are the treatment approaches to PTSD? |
- Pharmacological: anti-depressants and anti-convulsants - Therapy - Relaxation training - Support groups, family therapy - Eye movement desensitization and reprocessing (EMDR) |
|
|
What pharmacological treatments can treat PTSD? |
- Antidepressants: SSRIs, TCAs (imipramine, doxepin), MAOIs - Anticonvulsants (for flashbacks and nightmares) |
|
|
How can anticonvulsants help a patient with PTSD? |
Reduce flashbacks and nightmares |
|
|
What are the non-pharmacologic approaches to treating PTSD? |
- Therapy: cognitive behavioral, supportive, psychodymanic - Relaxation training - Support groups, family therapy - Eye movement desensitization and reprocessing (EMDR) |
|
|
What approach can be taken for therapy for a patient with PTSD? |
Cognitive processing therapy (modified form of cognitive-behavioral therapy) in which thoughts, feelings, and meanings of the event are revisited and questioned |
|
|
How do you distinguish PTSD from acute stress disorder? |
- PTSD: event occurred at any time in past, symptoms last >1 month - Acute stress disorder: event occured <1 month ago and symptoms last <1 month |
|
|
What medications should not be used in patients with PTSD? Why? |
Benzodiazepines (and other addictive meds) because PTSD has a high rate of substance abuse |
|
|
What are the DSM-IV criteria for acute stress disorder? |
- Symptoms begin <1 month after a major traumatic event - Symptoms last <1 month - Symptoms are similar to PTSD (eg, re-experiencing - dreams, flashbacks, recurrent recollections, psychological distress to cues; avoidance of stimuli; numbing; hyperarousal) |
|
|
How should you treat acute stress disorder? |
Same as for PTSD - Pharmacological: anti-depressants (SSRIs, TCAs, MAOIs) and anti-convulsants - Therapy: cognitive-behavioral, supportive, psychodymanic - Relaxation training - Support groups, family therapy - Eye movement desensitization and reprocessing (EMDR) |
|
|
Case: Patient is exhibiting anxiety and dysfunction 2 weeks after watching his friend die in a car accident.
What is the most likely diagnosis? |
Acute stress disorder (symptoms are <1 month) |
|
|
Case: 24-yo law student presents with husband. Complains of difficulty falling asleep. She feel sstressed about school work and worries about failing her exams. She says she is tired and can't concentrate. She has frequent headaches and muscle spasms that usually resolve with naproxen. Her husband tells her to relax and describes her as a "worrier". Her husband says she worries about him getting in a car accident, not getting the job she wants, not making enough money, etc. These symptoms have been present for many years and have worsened in last 6 months.
She denies any other symptoms but reports a history of depression treated with antidepressants in the past. Family history reveals mother is being treated for OCD. Physical exam demonstrates tachycardia and sweating. Lab results are pending.
What is the most likely diagnosis? |
Generalized Anxiety Disorder (GAD) - She is worrying excessively about a number of events and activities - Unsuccessful in controlling worries - Also has sleep disturbance, fatigue, muscle tension, decreased concentration - Symptoms for many years, worsening in last 6 mo. - Somatic symptoms of GAD: tachycardia, sweating
Also need to rule out depression |
|
|
Case: 24-yo law student presents with husband. Complains of difficulty falling asleep. She feel sstressed about school work and worries about failing her exams. She says she is tired and can't concentrate. She has frequent headaches and muscle spasms that usually resolve with naproxen. Her husband tells her to relax and describes her as a "worrier". Her husband says she worries about him getting in a car accident, not getting the job she wants, not making enough money, etc. These symptoms have been present for many years and have worsened in last 6 months.
She denies any other symptoms but reports a history of depression treated with antidepressants in the past. Family history reveals mother is being treated for OCD. Physical exam demonstrates tachycardia and sweating. Lab results are pending.
What medical conditions should be ruled out? |
Hyperthyroidism or substance use |
|
|
Case: 24-yo law student presents with husband. Complains of difficulty falling asleep. She feel sstressed about school work and worries about failing her exams. She says she is tired and can't concentrate. She has frequent headaches and muscle spasms that usually resolve with naproxen. Her husband tells her to relax and describes her as a "worrier". Her husband says she worries about him getting in a car accident, not getting the job she wants, not making enough money, etc. These symptoms have been present for many years and have worsened in last 6 months.
She denies any other symptoms but reports a history of depression treated with antidepressants in the past. Family history reveals mother is being treated for OCD. Physical exam demonstrates tachycardia and sweating. Lab results are pending.
What are her treatment options? |
- SNRIs (venlafaxine) - SSRIs - Benzodiazepines and buspirone - Cognitive-behavioral therapy |
|
|
What are the characteristics of GAD? |
Persistent, excessive hyperarousal and anxiety about general daily events. |
|
|
What typically causes a patient with GAD to initially seek help? |
Help with somatic complaints, such as muscle tension or fatigue |
|
|
What are the DSM-IV criteria for diagnosing GAD? |
- Excessive anxiety and worry about daily events and activities (that is difficult to control) for at least 6 months - Must be associated with at least 3 of the following: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep distrubance |
|
|
What are the symptoms of GAD needed for diagnosis? |
At least 3 of the following: - Restlessness - Fatigue - Difficulty concentrating - Irritability - Muscle tension - Sleep disturbance |
|
|
What do you need to rule out before diagnosing GAD? |
Medical conditions that produce anxiety states such as hyperthyroidism
Also ask about caffeine intake |
|
|
How common is GAD? |
Lifetime prevalence is 45% |
|
|
How does gender affect prevalence of GAD? |
Women are 2x as likely to have GAD than men |
|
|
When is the typical age of onset for GAD? |
Before age 20 |
|
|
What comorbid conditions are associated with GAD? |
50-90% have a coexisting mental disorder, especially major depression, social or specific phobia, or panic disorder |
|
|
What is the prognosis for GAD? |
Chronic, lifelong, fluctuating symptoms in 50% of patients
The other 50% will fully recover within several years of therapy |
|
|
How should you treat GAD? |
Most effective approach is a combination of psychotherapy (cognitive-behavioral therapy) and pharmacotherapy |
|
|
What pharmacologic therapies are beneficial for GAD? |
- Antidepressants: SSRIs, buspirone, venlafaxine - If benzodiazepines (clonazepam, diazepam) are used, they should be tapered off when possible because of risk of tolerance and dependence |
|
|
What antidepressants are best for GAD? |
- SSRIs - Buspirone (BuSpar) - Venlafaxine (Effexor) |
|
|
Which benzodiazepines are used in GAD (but should be tapered ASAP)? |
- Clonazepam (Klonopin) - Diazepam (Valium) |
