USMLE Step 2 CK-Psychiatry (2022) complete solution RATED A.

What is the dx criteria for Generalized Anxiety Disorder? - anxiety on most days (six or more months) and w/ three or more somatic sx (restlessness, fatigue, difficulty concentrating, irritability, muscle tension, disturbed sleep) How is GAD tx? - Lifestyle changes psychotherapy medication - SSRIs - Venlafaxine - buspirone - Benzos for immediate sx relief How does OCD present? - Obsessions: persistent, unwanted, and intrusive ideas, thoughts, impulses, or images that lead to marked anxiety or distress and occur despite the patient's attempts to prevent them Compulsions: repeated mental acts or behaviors that neutralize anxiety from obsessions (e.g. handwashing, elaborate rituals for ordinary tasks, counting, excessive checking) Pts recognize these behaviors as excessive and irrational products of their own minds. Wish to get rid of the obsessions and/or compulsions How is OCD tx? - Pharmacotherapy - SSRIs (first line) CBT - exposure and desensitization relaxation techniquesPt education How do panic attacks present? - Discrete periods of intense fear or discomfort in which at least 4 of the following sx develop abruptly and peak w/in 10 min: - tachypnea - chest pain - palpitations - diaphoresis - nausea - trembling - dizziness - fear of dying or "going crazy" - depersonalization - hot flashes - perioral and/or acral paresthesias-->hyperventilation and low O2 sats one or more months of concern about having additional attacks or significant behavior change as a result of the attacks--avoiding situations that may precipitate attacks What other conditions should be considered when a pt presents w/ panic attack? - Angina MI arrhythmias hyperthyroidism Vita B12 deficiency pheochromocytoma substance-induced anxiety generalized anxiety disorderPTSD How are panic disorders treated? - CBT pharmacotherapy - SSRIs - TCAs Benzos - for immediate relief, but avoid long-term use - taper as soon as long term tx is on board What is the difference between OCD and OCPD? - OCD is ego-dystonic: recognize the obsessions/compulsions and want to be rid of them OCPD is ego-syntonic: do not recognize their behavior as problematic