Term
| What is the structure of the amygdala fear-processing circuit (3 inputs and 3 outputs) |
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Definition
Inputs
1) Visual Cortex
2) Auditory Cortex
3) Interoceptive Stimuli
Outputs
1) Hypothalamus (HPA and Adrenergic stimulation)
2) PFC/Anterior cingulate (fear, acute anxiety, escape)
3) Spinal cord (via thalamus) for startle |
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Term
| According to the DSM-IV, what do all 5 major anxiety disorders share in common? |
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Definition
Panic/GAD/PTSP/Specific Phobia/OCD
1) Both psychological and physiological manifestations of anxiety
2) More likely in women
3) High rates of comorbidity with other anxiety/mood disorders
4) Chronic waxing/waning
5) Need for combined therapy/medication |
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Term
A patient has been experiencing fearful symptoms seemingly "out of the blue," while in class and on airplanes.
He reports feeling "dizzy and nauseous with chest pain and shortness of breath" at least 4 times each week. The attacks tend to last 15-20 minutes and then resolve rapidly.
Which of the following anxiety disorders does the patient have? How could you treat?
a. Panic Disorder
b. GAD
c. PTSD
d. Specific Phobia
e. Social Phobia
f. OCD |
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Definition
A. Panic disorder (90% chance of comorbidity)
Treat with SSRIs or any other anti-depressant (not bupropion) and/or Benzos (quicker, but with abuse) or CBT. |
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Term
A women comes to you complaining that she just "can't stop worrying." She feels tense and is terrified that she has developed a number of rare medical conditions.
Which of the following anxiety disorders does the patient have?
a. Panic Disorder
b. GAD
c. PTSD
d. Specific Phobia
e. Social Phobia
f. OCD |
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Definition
| B) GAD fits (90% comorbidity and 3-8% prevalence) |
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Term
A patient presents to your office complaining of irritability, and night terrors. After speaking with him, you discover that he has been re-living a particular event from his childhood where he witnessed a murder.
Which of the following anxiety disorders does the patient have? How can you treat?
a. Panic Disorder
b. GAD
c. PTSD
d. Specific Phobia
e. Social Phobia
f. OCD |
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Definition
C- PTSD fits (Re-experiencing, Hyper-arousal and Avoidance)
Treat with 5-HT anti-depressents, with exposure-based CBT and eye-movement desensitization and reprocessing (EMDR)
** Treatment outcomes tend to be worse then other anxiety conditions** |
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Term
Since early adulthood, your patient has had a profound fear of clowns outside of the circus.
Which of the following anxiety disorders does the patient have? How can you treat?
a. Panic Disorder
b. GAD
c. PTSD
d. Specific Phobia
e. Social Phobia
f. OCD |
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Definition
D- Specific phobia
Treat with straight behavioral approach (not pharmacotherapy).
Repeated encounter tends not to help unless it is exposure-based CBT |
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Term
| How do you treat a case of social phobia? |
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Definition
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Term
A patient must mentally count up to any number that he hears spoken out loud. Which of the following anxiety disorders does the patient have? How can you treat?
a. Panic Disorder
b. GAD
c. PTSD
d. Specific Phobia
e. Social Phobia
f. OCD |
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Definition
F- OCD fits
Treat with Serotonergic anti-depressants or exposure and response prevention (Placebo is useless) |
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Term
| What is the pathophysiological basis of OCD as it is currently understood? |
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Definition
More of a disease of "impulse and compulsion" than anxiety, involving Striatum and OF-PFC
Male and Female prevalence equal at 2-3% lifetime. |
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Term
| How might a physician open a conversion about a patient's apparent anxiety? |
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Definition
"I'd like to talk to you about stress. It is a very common issue. Could you tell me a little about how you feel when you are under stress?"
Avoid stigma and fear and normalize experience. |
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Term
| How can you screen for Anxiety? |
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Definition
1) Are you a worrier? (GAD)
2) Have you ever had an anxiety attack?
3) Are you uncomfortable in social situations? (Social Phobia)
4) Do you have any special fears, such as fear of flying? (Specific Phobia)
5) Rituals or habits? (OCD)
6) Painful memories associated with terrible experience? (PTSD) |
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Term
| What pharmacologic Treatments are available for Anxiety disorders? |
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Definition
1) SSRIs (Paroxetine/Escitalopram)- Long-term
- potent anti-anxiety
- 4-6 weeks before full response
2) Benzodiazepines (Diazepam or Alprazolam)- Short-term
- Act instantaneously once absorbed in blood
- Sedative/hypnotic issues
- Good for all EXCEPT OCD/PTSD
- Addictive potential
- Motor effects bad for Elderly
- Lack of DURABLE response |
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Term
| What Psychotherapeutic Treatments are available for Anxiety disorders? |
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Definition
1) CBT (especially "exposure CBT")
- Great for "fear disorders" such as Panic Disorder and GAD
- Can also help with depression
- Not great for PTSD (super-specialized)
2) Psychoanalytic
3) Interpersonal therapy (anxiety)
4) Supportive therapy not particularly suited |
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Term
Which of the following illnesses is mot likely to be associated with agoraphobia?
a. Specific phobia
b. PTSD
c. Substance induced anxiety disorder
d. Panic disorder |
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Definition
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Term
Which of the following is most likely to be associated with PTSD?
a. Family member with PTSD
b. Natural disaster
c. Work related stress
d. Lower socioeconomic groups |
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Definition
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Term
Social phobia is characterized by all of the following EXCEPT:
a. Prefers to be alone
b. Excessive anxiety in social situations
c. Responsive to SSRIs
d. “stage fright” |
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Definition
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Term
Which of the following is NOT a feature of PTSD?
a. Hypervigilance
b. Flashbacks
c. Easily treated
d. Psychological numbing |
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Definition
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Term
A 20-year-old male with sudden onset of shortness of breath, palpitations, muscle tightening, and tremor is brought to the emergency room for evaluation of chest pain. Cardiac enzyme studies are normal along with EKG and baseline labs. What would be the most likely diagnosis?
a. Agoraphobia
b. Panic Attack
c. Opiate overdose
d. Generalized Anxiety Disorder |
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Definition
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Term
Which of the following symptoms would most likely be seen in obsessive-compulsive disorder?
a. Inability to grieve (e.g., repetitive thoughts about a lost loved one)
b. Repetitive hair pulling
c. Checking over and over again to make sure a door is locked
d. Fear of going out in public |
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Definition
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Term
First-line treatment for most anxiety disorders would be:
a. SSRI
b. Neuroleptic
c. Psychodynamic psychotherapy
d. Abreaction |
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Definition
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Term
Patients with which of these conditions would you MOST LIKELY want to refer to a psychiatrist as opposed to managing yourself?
a. Generalized Anxiety Disorder
b. Panic disorder
c. Adjustment disorder with anxious mood
d. Obsessive Compulsive Disorder |
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Definition
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Term
What part of the brain is most associated with integrating and activating the fear response?
a. amygdala
b. temporal cortex
c. reticular activating system
d. corpus callosum |
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Definition
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