Anxiety Disorders Overview

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Questions and Answers

Which of the following is NOT a psychosocial stressor that can contribute to anxiety?

  • Genetic predisposition (correct)
  • Marital discord
  • Job and/or school-related stress
  • Medical illness

Which neurotransmitter is NOT directly implicated in the biological theories of anxiety disorder etiology?

  • Gamma-aminobutyric acid (GABA)
  • Serotonin
  • Dopamine (correct)
  • Norepinephrine

Which age group has the highest prevalence of anxiety disorders?

  • 6-11 years old
  • 65 years old and older
  • 20-45 years old (correct)
  • 1-5 years old

Which psychiatric disorder is NOT listed as a risk factor for anxiety?

<p>Bipolar disorder (A)</p> Signup and view all the answers

Which of the following is a possible organic cause of anxiety?

<p>All of the above (D)</p> Signup and view all the answers

Which of the following is a potential medication withdrawal symptom that can lead to anxiety?

<p>All of the above (D)</p> Signup and view all the answers

Which of these is NOT considered a common assessment finding in children with anxiety?

<p>Aversion to social situations (D)</p> Signup and view all the answers

Which of the following is the most common reason given for school refusal in children with anxiety?

<p>Separation anxiety (C)</p> Signup and view all the answers

Which of the following somatic complaints are NOT commonly associated with anxiety disorders?

<p>Shortness of breath (B)</p> Signup and view all the answers

Which of the following conditions should be considered in the differential diagnosis of anxiety disorders?

<p>All of the above (D)</p> Signup and view all the answers

What kind of medical assessments are typically needed to rule out potential physical causes of anxiety symptoms?

<p>All of the above (D)</p> Signup and view all the answers

Which of the following is a potential medication side effect that can mimic the symptoms of anxiety disorder?

<p>All of the above (D)</p> Signup and view all the answers

What is the term for the excessive and persistent worry that characterizes anxiety disorder?

<p>Rumination (B)</p> Signup and view all the answers

Which of the following is NOT a symptom commonly associated with anxiety disorders?

<p>Hallucinations (A)</p> Signup and view all the answers

Which of the following is a potential medical condition that could mimic anxiety symptoms?

<p>All of the above (D)</p> Signup and view all the answers

Which of the following factors can increase the risk of developing an anxiety disorder?

<p>All of the above (D)</p> Signup and view all the answers

What is one of the primary criteria for diagnosing depression in adults?

<p>The presence of anhedonia (A)</p> Signup and view all the answers

How long must symptoms persist to be categorized as Persistent Depression Disorder?

<p>At least two years (C)</p> Signup and view all the answers

Which of the following is NOT a symptom included in the diagnostic criteria for depression in adults?

<p>Positive self-esteem (D)</p> Signup and view all the answers

What physiological factors are often implicated in the etiology of depression?

<p>Impaired metabolism of neurotransmitters (C)</p> Signup and view all the answers

Which symptom is associated with anhedonia in depression?

<p>Loss of pleasure in previously enjoyable activities (D)</p> Signup and view all the answers

What is the initial recommended dosage of the solution for weight loss?

<p>10-20 mg PO daily (C)</p> Signup and view all the answers

When can the dosage of the solution for weight loss be increased to 20 mg/day?

<p>After one week if clinical response is insufficient (D)</p> Signup and view all the answers

In which patients should the weight loss solution be used with caution?

<p>Patients with renal dysfunction (D)</p> Signup and view all the answers

What is the maximum daily dosage for the weight loss solution?

<p>80 mg (B)</p> Signup and view all the answers

What age group can begin treatment with the weight loss solution at 10 mg/day?

<p>Children aged 12 years and older (A)</p> Signup and view all the answers

Which of the following is a contraindication for the use of the medication Escitalopram?

<p>Patients with uncontrolled narrow-angle glaucoma (C)</p> Signup and view all the answers

What is the typical time frame for increasing the dosage of Escitalopram?

<p>One week if no improvement (B)</p> Signup and view all the answers

What should be considered when discontinuing treatment in older adults?

<p>Discontinue gradually to avoid complications (B)</p> Signup and view all the answers

What percentage of major depressive disorder cases is believed to be linked to genetic predisposition?

<p>30-40% (B)</p> Signup and view all the answers

Which neurotransmitter is primarily responsible for producing feelings of calmness?

<p>GABA (C)</p> Signup and view all the answers

What is the estimated prevalence of major depressive disorder in the U.S. population at some point in their lives?

<p>5-20% (B)</p> Signup and view all the answers

Which of the following factors is primarily linked to the environmental causes of depression?

<p>Childhood adversity (B)</p> Signup and view all the answers

Which of the following neurotransmitters is classified as excitatory?

<p>NMDA (A)</p> Signup and view all the answers

What percentage of adolescents aged 16-25 experience major depressive disorder?

<p>5% (C)</p> Signup and view all the answers

What role do norepinephrine and dopamine play in mood regulation?

<p>Enhance productivity and pleasure (B)</p> Signup and view all the answers

Which statement about the incidence of major depressive disorder in preadolescents is correct?

<p>It affects 2% of preadolescents (A)</p> Signup and view all the answers

Which of the following is a significant risk factor for experiencing domestic violence?

<p>Being female (A)</p> Signup and view all the answers

What emotional symptom might indicate a history of domestic violence?

<p>Chronic fatigue (C)</p> Signup and view all the answers

What type of injury pattern is indicative of a struggle between a victim and an assailant?

<p>Subconjunctival hemorrhage (A)</p> Signup and view all the answers

Which psychosocial indicator is associated with intimate partner violence?

<p>Sleep deprivation (C)</p> Signup and view all the answers

Which condition should be included in the differential diagnoses when treating possible domestic violence injuries?

<p>Chronic fatigue (A)</p> Signup and view all the answers

When should routine screening for domestic violence occur during pregnancy?

<p>At least once per trimester and at postnatal visits (A)</p> Signup and view all the answers

What is a crucial step when providing nonpharmacologic management to a victim of domestic violence?

<p>Maintaining a supportive and nonjudgmental attitude (D)</p> Signup and view all the answers

Why should professionals use qualified language interpreters in domestic violence situations?

<p>To ensure patient’s confidentiality (B)</p> Signup and view all the answers

Which of the following is a recommended prevention strategy for intimate partner violence?

<p>Promoting respectful relationships in families (C)</p> Signup and view all the answers

What factor significantly increases the likelihood of neglect in children?

<p>Single-parent families (B)</p> Signup and view all the answers

Which injury description may suggest abuse rather than an accident?

<p>Multiple injuries in various sites and stages of healing (D)</p> Signup and view all the answers

What should be prioritized when developing a safety plan for a victim of domestic violence?

<p>Safety of the victim and their children (B)</p> Signup and view all the answers

Which of the following findings may indicate a history of family violence in an individual?

<p>Fear or unwillingness to disclose causes of injuries (C)</p> Signup and view all the answers

Flashcards

Behavioral theory of anxiety

Anxiety is a conditioned response to specific environmental stimuli.

Genetic risk factor

Having a first-degree relative increases the likelihood of anxiety eightfold.

Biologic theories of anxiety

Poor regulation of norepinephrine, serotonin, and GABA relates to anxiety disorders.

HPA axis

The hypothalamic pituitary adrenal axis is highly implicated in anxiety disorders.

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Lifetime prevalence of anxiety

7.7% of the U.S. population experiences anxiety disorders in their lifetime.

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Separation anxiety in children

Excessive anxiety about separation, common in children ages 3-4.

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Common risk factors

Organic causes, psychosocial stressors, and psychiatric disorders can contribute to anxiety.

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Age of anxiety onset

The average age of onset for anxiety disorders is 11 years.

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Escitalopram Dosage

Initial dosage of Escitalopram is 10 mg PO daily, may increase up to 20 mg based on clinical response after weeks.

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Dosage Adjustment

If initially on 10 mg/day, may increase to 20 mg after 1 week if clinically insufficient response.

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Maximum Dosage

The maximum dosage of Escitalopram is 80 mg daily, but should be achieved gradually.

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Children's Dosing

Children above 12 years may start with 10 mg/day PO; may increase based on response.

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Renal Function Consideration

Dosage adjustments may be required for patients with renal dysfunction.

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Avoiding in Glaucoma

Escitalopram should be avoided in patients with uncontrolled narrow-angle glaucoma.

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Administration Frequency

Escitalopram can be administered as a single dose or BID (twice daily).

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Increasing Doses Over Weeks

After starting treatment, dosages may be increased gradually over several weeks based on efficacy and tolerability.

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Diagnostic Criteria for Depression

Involves anhedonia or depression plus 4 symptoms for 2 weeks.

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Symptoms of Depression

Includes depressed mood, loss of interest, and changes in sleep or appetite.

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Persistent Depression Disorder

Chronic depressed mood lasting at least 2 years with other symptoms.

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Anhedonia

Loss of pleasure or interest in previously enjoyable activities.

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Neurotransmitters in Depression

Impairment in norepinephrine, serotonin, or dopamine synthesis/metabolism.

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Generalized Anxiety Disorder (GAD)

Characterized by excessive anxiety and worry about multiple events or activities.

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Physical symptoms of anxiety

Includes fatigue, headaches, palpitations, and gastrointestinal issues.

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Sleep issues in anxiety

Insomnia and easily fatigued are common complaints among adults with anxiety.

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Somatic complaints

Physical symptoms that arise from psychological anxiety, like dizziness and nausea.

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Differential diagnoses for anxiety

Conditions to rule out include depression, OCD, and PTSD.

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Psychosocial stressors

Life stressors and past traumas that increase anxiety risk.

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Medical conditions associated with anxiety

Conditions like hyperthyroidism and arrhythmias can mimic anxiety symptoms.

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Role of medications in anxiety

Substance use and medication effects must be considered when assessing anxiety.

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GABA

Gamma-aminobutyric acid, a neurotransmitter that promotes calmness.

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NMDA

N-methyl-D-aspartate, an excitatory neurotransmitter in the brain.

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Serotonin

A neurotransmitter that induces calmness and a relaxed state.

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Norepinephrine

A neurotransmitter that boosts productivity, concentration, and pleasure.

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Depression incidence in adults

Major depressive disorder affects 16 million adults annually in the U.S.

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Genetic predisposition to depression

30-40% of depression cases are influenced by genetic factors.

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Environmental factors in depression

60-70% of depression cases are linked to environmental stressors.

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Childhood trauma impact

Adverse childhood events can increase depression risk significantly.

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Risk Factor: Being Female

Women are statistically at higher risk for intimate partner violence.

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History of Violence

Past exposure to violence can increase risk of future victimization.

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Low Education Level

Limited education may correlate with increased IPV risks.

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Substance Abuse

Abuse of drugs or alcohol by either victim or perpetrator can escalate violence.

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Isolation

Isolation from family or friends increases vulnerability to IPV.

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Signs of Neglect

Poor hygiene, nutritional deficits, or lack of medical care indicate potential abuse.

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Pattern Injuries

Specific marks or designs on skin indicating intentional harm.

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Psychosocial Indicators

Depression, anxiety, and PTSD signal the psychological impact of IPV.

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Consultation in Private

Confidential discussions are crucial for safe reporting of IPV.

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Mandatory Reporting

Certain professionals are required by law to report suspected abuse.

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Safety Plan

A strategy to ensure victim's safety, including essentials for escape.

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Empowerment Counseling

Support that enables victims to make informed decisions about their safety.

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Public Awareness

Raising society's understanding of IPV aids prevention and support.

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Prevention Strategies

Interventions aimed at reducing risk factors and fostering healthy relationships.

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Chronic Fatigue

Extended tiredness that could signal unrecognized IPV.

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Study Notes

Anxiety Disorders

  • Anxiety is a psychic and physical experience of dread, apprehension, or panic, potentially chronic or acute, often stemming from emotional or physiologic stimuli
  • Common types include separation anxiety disorder (excessive anxiety separating from attachment figures), selective mutism (consistent failure to speak), specific phobia (extreme fear of a specific object or situation), social anxiety disorder/social phobia (extreme fear of social situations), panic disorder/panic attacks (recurring, unanticipated attacks of intense fear), and agoraphobia (intense fear of places or situations where escape might be difficult)
  • Generalized anxiety disorder (GAD) involves excessive anxiety occurring more days than not concerning a wide range of events or activities
  • Substance/medication-induced anxiety disorder arises as a result of substance use or medication
  • Anxiety can be caused by another medical condition

Etiology of Anxiety

  • Behavioral theory postulates anxiety as a conditioned response to environmental stimuli
  • Genetic components play a role, with first-degree relatives increasing the likelihood of anxiety, often eight-fold.
  • Environmental factors contribute to anxiety development

Incidence and Risk Factors

  • Anxiety is a prevalent psychiatric disorder
  • Prevalence in U.S. population is 7.7%
  • Incidence is higher in women
  • Most common in 20–45-year-olds
  • Average age of onset is 11 years
  • Separation anxiety is the most common reason given for school refusal (mean age 9 years)
  • Organic causes can include endocrinopathies, respiratory disorders, anemia, and medication/substance use or withdrawal
  • Family history and psychosocial stressors (marital discord, medical illness, job/school-related stress, financial problems) increase risk

Differential Diagnoses

  • Obsessive-compulsive disorder
  • Oppositional defiant disorder
  • Personality disorders
  • Depression
  • Bipolar disorder
  • Attention deficit disorder
  • Cognitive disorders (such as delirium)
  • Substance intoxication or withdrawal
  • Posttraumatic stress disorder
  • Medical conditions (e.g., arrhythmias, thyroid disorders, electrolyte imbalances)
  • Certain medications or withdrawal states

Diagnostic Studies

  • Ruling out medical causes for symptoms
  • Considering substance use and effects of medications or withdrawal
  • Assessing symptoms via DSM-5 criteria
  • Utilizing screening tools
  • Analyzing patient history and experiences (family/social, and medical)

Non-pharmacological Management

  • Psychotherapy, particularly CBT (cognitive behavioral therapy)
  • Education, treatment plan explanation, and prognosis
  • Patient support and empathic listening
  • Relaxation techniques for stress reduction

Pharmacologic Management

  • Antidepressants (first-line treatment)
  • Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • Benzodiazepines (for short-term management)
  • Other medications (e.g., Buspirone),
  • Dosage adjustments and monitoring essential
  • Anxiety in children, often characterized by excessive worry and anxiety about separation, past behavior or future events, and performance concerns
  • Anxiety in adults exhibits as persistent worry about various events or activities, accompanied by complaints such as apprehension, restlessness, and sleeplessness

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