Psych EOR LATEST VERSION ALREADY GRADED A

Psych EOR LATEST VERSION ALREADY GRADED A Generalized anxiety disorder diagnostic criteria Excessive anxiety or worry a majority of days for 6+ months with 3+ symptoms: 1. restlessness or hypervigilance 2. easy fatiguability 3. irritability 4. sleep disturbances 5. muscle tension 6. difficulty concentrating GAD: Management - Pharmacotherapy + CBT (x6-12mo) - 1st-line: SSRIs (Fluoxetine, Paroxetine, Escitalopram, Sertraline) and SNRIs (Venlafaxine, Duloxetine) - Buspirone can be an adjunct to SSRIs or SNRIs - Beta blockers can help autonomic symptoms or performance anxiety Buspirone MOA Partial serotonin (5HT-1A) receptor agonist and dopamine receptor antagonist Panic disorder definition + tx Recurrent, unexpected panic attacks (at least 2) WITH persistent concern about future attacks, persistent worry about implication of attacks, or significant maladaptive behavior related to attacks for at least 1mo Tx: - 1st line: CBT + SSRIs (Sertraline, Citalopram, Fluoxetine) - May initiate therapy with SSRIs + benzos then taper the benzo Management of (acute) panic attacks Peaks in 10min 1st line: Benzos (Alprazolam, Lorazepam, Diazepam) Clinical note: Can use Hydroxyzine (H1 antagonist) if benzos are CI Always r/o MI, thyrotoxicosis, aortic dissection, etc. Agoraphobia: definition & tx Fear escape may be difficult or help not available if develops panic-like, embarrassing, or other incapacitating sxs in at least two specific situations: Using public transportation, being in open spaces, being in enclosed spaces, standing in line or being in a crowd, or being outside of home alone May become homebound and dependent on others for basic needs Incidence peaks late adolescence or early adulthood and 2:1 female preponderance Premorbid anxiety disorders common Subsequent development of depressive and substance use disorders Tx: CBT + SSRIs (similar to panic d/o) A 60-year-old man presents to the clinic due to panic attacks. He previously canceled three of his office visits and is very nervous about this encounter. He states that, for the past 2 months, he mostly stays home because he is afraid he will have a panic attack in public and be embarrassed. Which of the following situations is this patient also likely to avoid? - Being at home with a spouse - Driving a car - Sharing a meal with a close friend - Speaking to a group via a video conference Driving a car (Agoraphobia) Social anxiety disorder: definition & tx an anxiety disorder involving the extreme and irrational fear of being embarrassed, judged, or scrutinized by others in social situations: - Social interactions - Being observed eating or drinking - Using public restrooms - Performing in front of others Management: - CBT is mainstay - SSRIs or SNRIs - If needed, adjunctive use of benzos for faster relief until full effect of SSRIs - Performance-only: PRN beta blockers (preferred) or benzos Specific phobias: Management - Exposure & desensitization therapy - Short-term benzos or beta-blockers can be used in some pts PTSD criteria 1. Exposure to actual or threatened death, serious injury, sexual violence: - Direct experience of the event - Witness the event