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100 Cards in this Set

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Q: How often and how long should symptoms for anxiety disorders be?
A: Symptoms occur more days than not for a period of at least 6 months
Q: According to psychodynamic theory, in anxiety, what is used unconsiously used by the individual to deal with the conflict between the id and superego?
A: Defense Mechanisms
Q: Behavioral manifestations of anxiety disorders stem from the pathological overuse of what?
A: Defense mechanisms
Q: Which type of anxiety is denoted by triggering the ANS, flight or fight response, pupils dilated, VS increases, diaphoresis, rigid muscles, decreased hearing, increased pain threshold, diarrhea, and urinary frequency
A: Severe level
Q: Which level of anxiety is denoted by the patient being pale, hypotensive, poor eye-hand coordination, muscle pains, marked decreased in hearing, dizziness, and shortness of breath?
A: Panic level
Q: According to interpersonal theory, anxiety arises when what happens?
A: An individual's needs are not met
Q: According to interpersonal theory, when does one first experience anxiety?
A: The infant's interactions with his or her mother
Q: With pathological levels of anxiety, where are neurological deficits in the brain?
A: Limbic system, Midline brainstem area, sections of the cortex
Q: With anxiety, what does hyperactive autonomic nervous systems cause symptomatically?
A: Increased heart rate and blood pressure, diaphoresis, papillary dilation, tremors, and increased respiratory rate
Q: According to the HPA axis, what happens when a threat is perceived?
A: Amygdala signals the hypothalamus to secrete CRH. The amygdala also activates the SNS to start the flight or fight response. The pituitary is stimulated to release ACTH. The adrenals are stimulated to release cortisol which restores the body to homeostasis
Q: In anxiety, what does neurobiological deficits result in in terms of neurotransmitters?
A: Low levels of GABA and high levels of NE
Q: What are the two neurotransmitters involved in suppressing the HPA axis?
A: Serotonin and GABA
Q: There are many physical ways anxiety can manifest. Name five or six starting from head moving down.
A: Pupillary dilation, tachycardia, increased muscle tone, headaches, hypertension, motor restlessness, diaphoresis, palpitations or chest tightness, GI problems, dizziness or lightheadness
Q: Some patients during anxiety may have labs that reflect compensated respiratory alkalosis. What labs would represent this?
A: Decreased carbon dioxide levels, decreased bicarbonate levels, normal pH
Q: Name two endocrine disorders that mimic anxiety disorders.
A: Hyperthyroidism, Hyperparathyroidism, Cushing's disease
Q: Name two or three neurological conditions that can mimic anxiety.
A: Seizures, TIA's, CVA's, Encephalitis, CNS neoplasm
Q: Name two metabolic conditions that can mimic anxiety.
A: Hypoglycemia, Vitamin B deficiency, Porphyria
Q: Substances or Substance Abuse/Dependency can cause anxiety symptoms. Provide two substances that cause anxiety with intoxication and two substances that cause anxiety with withdrawal.
A: Intoxication: CNS stimulants: cocaine, amphetamines, caffeine

Withdrawal: CNS depressants: alcohol, marijuana
Q: What are first line agents for anxiety?
Q: What are the advantages of Benzo's with short half-lives?
A: less daytime sedation, less drug accumulation, quick onset of action, useful for insomnia
Q: What are the disadvantages of benzo's with short half lives?
A: Increased risk of addiction, more intense withdrawal symptoms
Q: In children, what two alpha agonists are used for anxiety and hyperarousal?
A: Catapres (clonidine) and Tenex (guanfacine)
Q: Which medication is used for anxiety, neuropathic pain, and as an anti-craving medication? What are the major side effects of this drug?
A: gabapentin (Neurontin): ataxia and decreased coordination and sedation
Q: Name three behavioral therapies for the treatment of anxiety.
A: Systematic desensitization, exposure therapy, relaxation techniques, biofeedback
Q: Anxiety can have medical comorbities. Name five.
A: Anemia, cardiac disorders and dysrhythmias, cushing's disease, hyperthyroidism, hypoglycemia, COPD, asthma, pulmonary embolism, pneumothorax, or adverse med rxn's such as anticholinergics, antihistamines, antipsychotics, steroids, bronchodilators, and anesthetics
Q: What should you assess for during anxiety symptoms exacerbation periods?
A: Suicidality
Q: Panic attack is usually self-limiting and subsides with what time frame?
A: Usually within 10 minutes
Q: The diagnosis of panic disorder involves discrete episodes having a sudden onset and peaking within 10 minutes of onset. There needs to be 4 symptoms present for the diagnosis out of 10. Name five or six symptoms.
A: Parasthesias, chills or hot flushing, fear of losing control or going crazy, fear of dying, SOB or smothering sensation, palpitations or accelerated heart rate, chest pain or tightness, sweating, trembling or shaking, nausea or abdominal distress
Q: True or False: After the first panic attack, there is persistent concern over having another attack.
A: True
Q: In 2/3 of cases of panic disorder, what other disorders occurs first?
A: Major depression
Q: This type of anxiety attack has no associated internal or external trigger and required as criteria for panic disorder.
A: Uncued
Q: This kind of anxiety attack occurs immediately and invariably on exposure to or in anticipation of a situational cue or trigger.
A: Cued
Q: This kind of anxiety attack is not immediate and not invariably cued to trigger.
A: Situationally Cued
Q: A client's anxiety attack type is determined by the assessment of four things. What are they?
A: Client's focus of anxiety, type and number of attacks, number of situations avoided by client, level of anxiety experienced between panic attacks
Q: Name three specific findings you would expect on physical exam for panic attacks that would bring a person into treatment.
A: Chest pain, SOB, Numbness
Q: You would consider a general medical disorder if the first episode panic attack symptoms occurred after what age?
A: Age 45
Q: Name four to five general medical conditions that can produce similar panic attack symptoms
A: Hyperthyroidism, Hyperparathyroidism, Pheochromocytosis, Vestibular dysfunction, Seizures, SVT cardiac arrhythmias, cocaine, amphetamines, caffeine, vertigo, LOC, incontinence, H/A, Slurred speech, Amnestic pattern after attacks
Q: What meds are used to treat panic disorder?
A: SSRI's, Benzo's short term, Buspar adjunctively with antidepressants
Q: What is a frequent psychiatric comorbidity for panic disorder?
A: Major depressive disorder
Q: This kind of anxiety related with panic disorder usually leads to avoidant behavior and impairs the individual in traveling, working, and daily living responsibilities
A: Agoraphobia (not a diagnosis in itself)
Q: True or False: Persons with agoraphobia do better when left by themselves
A: False, they do better when accompanied by a trusted companion
Q: What two things could a person with panic disorder with agoraphobia have for this diagnosis?
A: Anxiety about being in places or situations from which they cannot escape or in which help is not available in the event of a panic attack
Q: What would be the proper diagnosis for a person who only has met criteria for agoraphobia but not panic disorder?
A: Agoraphobia without history of panic disorder
Q: True or False: In specific phobias, children are able to make conscious recognition that their fear is excessive or unreasonable.
A: False, only adults can recognized their fear is excessive or unreasonable
Q: There are four risk factors for specific phobias. Can you name them?
A: Traumatic past exposure, observation of another's trauma, excessive informational transmission (e.g. repeated graphic parental warnings), and genetic loading
Q: What is the most familial type of specific phobia?
A: Blood-injection-injury subtype
Q: A phobic diagnosis should occur only when accompanied by what?
A: Significant functional impairment (e.g. avoidance of school related to fear of encountering cockroach)
Q: What are the five subtypes of specific phobias?
A: Situational (most common), Natural Environment, Blood-Injection-Injury, Animal, Other (e.g. fear of choking, fear of loud sounds or costumed characters)
Q: With blood-injection-injury type, there is a strong vasovagal component. What happens symptomatically?
A: Paroxysmal tachycardia, hypertension followed by deceleration of heart rate and drop in blood pressure leading to fainting
Q: What is the pharmacological management of specific phobias? Psychological management?
A: SSRI's. TCA's, Benzo's (short term)

CBT, Biofeedback, Desensitization Therapy
Q: This disorder is pertains to a marked and persistent fear of social or performance situations in which embarrassment may occur
A: Social Anxiety Disorder
Q: How long must symptoms be for a diagnosis of social phobia?
A: Longer than 6 months
Q: True or False: Persons with social phobia do not feel better or experience decreased anxiety when accompanied by a trusted companion
A: True
Q: What are some psychological self attributes of those with social anxiety disorders?
A: Hypersensitivity to criticism, negative self-evaluations, sensitivity to rejection, low self-esteem, inferiority feelings, lack of assertiveness, anticipatory anxiety occurring days or weeks before the feared social situation
Q: What is the pharmacological management of social phobia?
A: SSRI's, Benzo's short term, beta blockers such as propranolol before attending a social function or for performance anxiety
Q: In OCD, the person's experience is ego-syntonic or ego-dystonic?
A: Ego-dystonic
Q: In OCD, rates are higher in persons who have a first-degree relative with which disorder?
A: Tourette's syndrome
Q: For a diagnosis of OCD, you must have both obsessions and compulsions.
A: False, presence of either obsessions or compulsions
Q: True or False: In OCD, the person realizes that the obsessions or compulsions are excessive or unreasonable
A: True
Q: Do obsessions usually involve real-world worries or concerns such as finances?
A: No
Q: At what level of anxiety does a person with compulsions have?
A: Severe (Level III)
Q: What is the pharmacological management of OCD? Nonpharm management?
A: SSRI's, TCA's (clomipramine/Anafranil)

CBT, Behavioral Techniques
Q: What are the most common behavioral manifestations of OCD in children?
A: Washing, checking and ordering
Q: Name two common comorbidities of children with OCD?
A: Learning disorders, disruptive behavioral disorders, Tourette's syndrome
Q: What is a medical condition in children that can mimic OCD symptoms?
A: Group A Beta-hemolytic streptococcal infections (scarlet fever, strep throat)
Q: True or false: In older adults with OCD, there are usually more compulsions than obsessions.
A: False, more obsessions
Q: What is generally the content of obsessions and compulsions in the older adult with OCD?
A: Obsessions: Dying

Compulsions: Washing and cleaning
Q: What are the three hallmark symptoms that accompany PTSD?
A: Re-experiencing, Avoidance of stimuli associated with trauma, hyperarousal symptoms
Q: True or False: Traumas in PTSD can either be experienced or witnessed
A: True
Q: True or False; There is an increase in the likelihood of symptom onset in PTSD with increasing closeness to the physical proximity to the traumatic event
A: True
Q: For PTSD, symptoms must be for 1 month or longer. There are three subtypes of PTSD according to duration of symptoms. What are they?
A: Acute--symptoms less than 3 months
Chronic--symptoms lasting 3 months or longer
Delayed onset--At least 6 months between traumatic event and onset of symptoms
Q: In PTSD, the traumatic event is re-experienced in one or more ways for the diagnosis. Name some ways re-experiencing can occur.
A: Flashbacks, dreams, acting or feeling traumatic event is occurring, intense psychological distress at exposure to cues, physiological reactivity to exposure to cues
Q: In PTSD, there are avoidant symptoms. Three or more are required for diagnosis. Name some.
A: Avoidance of stimuli associated with trauma, avoids talking or thinking about traumatic event, avoids places, people or activities that arouse recollection of traumatic event, inability to recall important aspect of the event, marked decreased interest or participation in activities, feelings of detachment or estrangement from others, restricted affect, sense of foreboding, shortening future or early death and no expectation for success or happiness
Q: In PTSD there needs to be two or more increased arousal symptoms. Name some.
A: Difficulty falling asleep, irritability or anger outburst, difficulty concentrating, hypervigilance, exaggerated startle response
Q: When do symptoms of PTSD usually start?
A: Within 3 months of the trauma
Q: What is the most frequent chief complain for those with PTSD on initial evaluation?
A: Insomnia
Q: What is the pharmacological management for PTSD?
A: SSRI's, TCA's, Benzo's short term, antipsychotics for flashbacks
Q: Besides CBT, group therapy, and relaxation therapies, what is a unique to PTSD nonpharmacological therapy for this disorder?
A: Eye movement desensitization and reprocessing (EMDR)
Q: What are two common comorbities (psychiatric) in PTSD?
A: Major depression and substance abuse or dependence
Q: What are some behaviors common with children who have PTSD?
A: Disorganized or agitated behavior, repetitive play shows themes or aspects of trauma, frightening dreams
Q: How long must excessive worry, apprehension, or anxiety about events or activities must occur for generalized anxiety disorder?
A: More days than not for a period of at least 6 months
Q: True or False: In GAD, there is a clear link for the anxiety to life events or stressors.
A: False, no clear link
Q: In GAD, does the nature and focus of worry shift frequently?
A: Yes
Q: Name some differential diagnoses for GAD.
A: PTSD, Adjustment disorder with anxiety, Obsessions in OCD, Hypochondriasis or Social Phobia causing anxiety
Q: Name two health related illnesses that can be attributed to GAD.
A: Irritable bowel syndrome and Migraine and other headache disorders
Q: There are a boat load of physical signs of anxiety. Can you name six?
A: Muscle tension, muscle ache, tremors, twitching, shakiness, SOB, tachycardia, tachypnea, dizziness, numbness, easily fatigued, sleep disturbances
Q: What is the one anxiety disorder that is a good candidate for therapy as a single-treatment modality?
A: Generalized Anxiety Disorder
Q: What is the pharmacological management of generalized anxiety disorder?
A: SSRI's, Buspar, Benzo's as PRN agents
Q: What kinds of things do children worry about with generalized anxiety?
A: Excessive worry over school, work, sports performance, and punctuality or natural castastrophes
Q: In children, what sort of compensatory behaviors would they display with generalized anxiety?
A: Overly conforming behavior, perfectionistic self-expectations, excessive seeking approval of others, and need for frequent reassurance about performance
Q: How long must children meet the diagnostic criteria for specific phobia?
A: At least 6 months
Q: In social phobia, anxiety must occur in interactions with adults and what other setting and for how long?
A: In peer settings, at least 6 months
Q: In children and adolescents, what type of meds should be considered for insomnia, hyperstartle, and hyperarousal? Name two specific medications.
A: Alpha-agonists: clonidine (Catapres) and guanfacine (Tenex)
Q: What drug can be used for mild ADHD in children and adolescents?
A: Effexor
Q: What is the mechanism of action for benzodiazepines?
A: Potentiates GABA, which inhibits neurotransmission in limbic system and cortex
Q: What are four side effects of benzodiazepines?
A: Drowsiness, fatigue, depression, dizziness, ataxia, slurred speech, weakness, forgetfulness
Q: Which kind of benzo's are good for the treatment of insomnia?
A: Benzo's with short half-lives and rapid onset
Q: What does discontinuation syndrome in benzo's depend on?
A: Length of time on drug, the dose, rate of taper, and the half life
Q: What are some withdrawal symptoms from benzo's?
A: Anxiety, nervousness, diaphoresis, restlessness, irritability, fatigue, light-headedness, tremor, insomnia, weakness, risk of seizures and death
Q: Name 3 ways beta-blockers such as propranolol are useful in anxiety?
A: Performance anxiety where tremor might be a problem, tremor side effect of meds, anxiety in pt. with substance abuse/dependence