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42 Cards in this Set

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What is the definition of anxiety disorders?
group of mental disorders characterized by the subjective and physiologic manifestations of fear
What are physical manfestations of anxiety?
• Dizziness
• GI disturbance (diarrhea)
• Mydriasis (pupil dilation)
• Palpitations
• Sweating
• Shakiness
• Syncope
• Tingling in the extremities
• Tachycardia
• Tremor
• Urinary urgency and frequency
What are medical conditions associated with anxiety?
• Cardiac arrhythmias
• Excessive caffeine intake
• Hypothyroidism and Hyperthyroidism
• Hypoglycemia
• Mitral valve prolapse
• Pheochromocytoma
• Substance abuse
• Vitamin B12 deficiency
What are the 5 major classifications of anxiety disorders?
• Generalized Anxiety Disorder
• Obsessive-Compulsive Disorder
• Panic Disorder
• Phobias
• Post-Traumatic Stress Disorder (PTSD)
What are characteristics of anxiety symptoms?
• Period of anxiety symptoms that have a sudden onset and increase in intensity over an approximately 10-minute period
• Occur about twice weekly and last @ 30 minutes
• Between attacks the patient fears having another attack
What is the medical condition most resembling panic disorder?
myocardial infarction
What psychological conditions are most closely associated with panic disorders?
• Depression
• Factitious disorder
• Generalized anxiety disorder
• Hypochondriasis
• Malingering
• Social or specific phobia
How can you induce a panic attack for diagnostic purposes?
• IV Sodium Lactate
• Inhalation of CO2 (breathing in & out of a bag)
Anxiety disorder is more common in which gender?
females
What first line treatment for anxiety disorders?
1st line treatment is antidepressants
• SSRI: Prozac or Paxil 20mg/day
• Tricyclics: Tofranil 150 – 300mg/day titrated slowly
• MAOI: Nardil 30 – 75 mg/day
What is the most useful benzodiazepine to treat panic disorder?
Alprazolam (Xanax) 2-6 mg/day
What is the most useful adjunct to pharmacotherapy in treating panic disorder?
cognitive therapy
What is the definition of specific phobia?
an irrational fear of certain specific things (ex. animals, heights, or needles)
What is the definition of social phobia?
an exaggerated fear of social or environmental situations (ex. public speaking or using a public restroom)
What are differential diagnosis of specific phobia?
• Hypochrondriasis
• OCD
• Paranoid personality disorder
• Panic disorder
What are differential diagnosis of social phobia?
• major depressive disorder
• normal shyness
• Schizoid personality disorder
What is the treatment options for specific phobias?
• Systematic desensitization is most effective
• Hypnosis
• Family therapy
• Psychotherapy
What are treatment options for social phobias?
• MAOIs (ex. Phenelzine/Nardil)
• Beta blockers (ex. propanolol, atenolol)
What are characteristics of obsessive-compulsive disorder?
• Recurrent thoughts, feelings, and images (obsessions) or repetitive actions (compulsions)
• Most patients know that these thoughts and behaviors are irrational
What are the most common compulsions?
• hand washing
• door locking
• checking gas jets
What are other conditions that resemble OCD?
• Schizophrenia
• Tourette disorder
• temporal lobe epilepsy
What are medical treatment options for OCD?
• Clomipramine [Anafronil] 150 – 250 mg/day
• Fluoxetine [Prozac] 40 – 80 mg/day
• Fluvoxamine [Luvox] 100 – 300 mg/day

* Behavioral therapy and supportive psychotherapy is also useful
What are symptoms of generalized anxiety disorder?
• Persistent symptoms of anxiety including hyperarousal
• Symptoms must last at least 6 months
• Anxiety symptoms may not be related to a specific person or situation (free–floating anxiety)
When does generalized anxiety disorder most commonly start?
3rd decade of life
What are treatment options for generalized anxiety disorder?
• Cognitive & behavioral therapy

• Pharmacologic treatment
- Benzodiazepines (1st line drug treatment)
- Buspirone (Buspar)
Which benzodiazepines are short-acting?
• Lorazepam (Ativan)
• Oxazepam (Serax)
• Triazolam (Halcion)
Which benzodiazepines are intermediate-acting?
• Alprazolam (Xanax)
• Temazepam (Restoril)
Which benzodiazepines are long-acting?
• Chlordiazepoxide (Librium)
• Clonazepam (Klonopin)
• Diazepam (Valium)
• Flurazepam (Dalmane)
Which benzo is used for psychotic agitation?
Lorazepam (Ativan)
Which benzos are used for alcohol withdrawal?
• Oxazepam (Serax): short-acting
• Chlordiazepoxide (Librium): long-acting
Which benzos are used for insomnia?
• Triazolam (Halcion): short-acting
• Temazepam (Restoril): intermediate-acting
• Flurazepam (Dalmane): long-acting
Which benzo is used as an antidepressant and to treat panic disorder and social phobia?
Alprazolam (Xanax)
Which benzo is used for seizures, mania, social phobia, and panic disorder?
clonazepam (Klonopin)
Which benzo is used for muscle relaxation, analgesia, and as an anticonvulsant?
Diazepam (Valium)
Which anti-anxiety agent is used for intolerance to benzodiazepines?
Meprobamate (Miltown)

* classification: Carbamate
Which antianxiety agent is used to treat anxiety in the elderly, has low abuse potential, and no sedative effects?
Buspirone (Buspar)

* classification: Azapirone
What class of medication are used primarily for the autonomic symptoms of anxiety?
beta blockers (propranolol 80-160 mg)
What is the distinguishing features between other anxiety disorders and PTSD?
presence of a catastrophic traumatic event
What are symptoms of PTSD?
• anxiety
• dissociative symptoms
• flashbacks
• numbing of affective response
• recurrent nightmares
• social withdrawal
• survivor's guilt
How long must symptoms last to have PTSD?
• symptoms must last for more than 1 month
• symptoms can last for years (in chronic form)
• if symptoms last 2 days-4 weeks, it is diagnosed as acute stress disorder
What is the most helpful treatment for PTSD?
psychotherapy, support groups, & group therapy
There are no good pharmacologic treatments for PTSD. What are some drugs that have been tried with some success?
• Imipramine (Tofranil)
• SSRIs
• Carbmazepine (used particularly for flashbacks and nightmares)