ILE 10 - Anxiety Disorders Dr. Jackson's Poll Everywhere

How long does anxiety have to last to meet DSM criteria for GAD?

A. 2 weeks

B. 4 weeks

C. 3 months

D. 6 months

D. 6 months

What percentage of patients with anxiety also have depression?

A. 25%

B. 30%

C. 50%

D. 80%

D. 80%

Men are at greater risk of developing anxiety than are women

A. True

B. False

B. False

Which area of the brain is associated with fear?

A. Thalamus

B. Locus ceruleus

C. Amygdala

D. Cortico-striatal thalamo-cortical (CSTC)

C. Amygdala

Which area of the brain is associated with worry?

A. Thalamus

B. Locus ceruleus

C. Amygdala

D. Cortico-striatal thalamo-cortical (CSTC)

D. Cortico-striatal thalamo-cortical (CSTC)

Which of the following medications can cause anxiety?

A. Thyroid hormone

B. Bronchodilators

C. Antidepressants

D. Steroid hormones

E. All of the above

E. All of the above

Which disease state is associated with anxiety?

A. Asthma

B. GERD

C. T2DM

D. HTN

A. Asthma

Which of the following is a first-line treatment for generalized anxiety disorder? (Select all that apply)

A. Venlafaxine

B. Escitalopram

C. Diazepam

D. Imipramine

A. Venlafaxine

B. Escitalopram

Which of the following is a second line treatment for generalized anxiety disorder (Select all that apply)

A. Paroxetine

B. Duloxetine

C. Alprazolam

D. Imipramine

C. Alprazolam

D. Imipramine

The attending asks about using hydroxyzine for a patient. Who would be appropriate to receive hydroxyzine? (Select all that apply)

A. Someone who needs immediate treatment but has a recent substance use issue

B. Someone who is stable on escitalopram

C. Someone with a very distant substance use issue

D. Some who asks about a benzodiazepine

A. Someone who needs immediate treatment but has a recent substance use issue

A patient is starting hydroxyzine and wants to know when it will start work. What do you tell him?

A. 4-6 weeks

B. 12-16 weeks

C. 4-8 weeks

D. 15-30 minutes

D. 15-30 minutes

You and the psychiatry resident see a patient with anxiety. The resident states that he wants to start an citalopram 20 mg to treat the patients anxiety. What do you tell the psychiatric resident about dosing this patient?

A. This is a good starting dose. Have the patient return for monitoring in two weeks.

B. This dose is too low. Increase the dose or it will not adequately treat anxiety.

C. This dose is too high. Decrease the dose or the patient may experience increased anxiety

D. Citalopram is not used to treat anxiety. Diazepam will be better

C. This dose is too high. Decrease the dose or the patient may experience increased anxiety

A patient with anxiety states that he started an SSRI a week and a half ago and that he feels like his skin is crawling and that he feels like he is literally crawling out of his skin. What is the name of this syndrome?

A. serotonin syndrome

B. Neuroleptic malignant syndrome

C. Jitteriness syndrome

D. Discontinuation syndrome

E. None of the above

C. Jitteriness syndrome

Symptoms of anxiety, nausea, vomiting, dizziness, and electrical shocks are associated with which of the following?

A. Use of antidepressants

B. Use of benzodiazepines

C. D/c of antidepressants

D. D/c of benzodiazepines

C. D/c of antidepressants

What is the indication for using an IM benzodiazepine versus an oral benzodiazepine?

A. Generalized Anxiety Disorder

B. Obsessive Compulsive Disorder

C. Panic Disorder

D. Agitation

D. Agitation

Which of the following symptoms are suggestive of a benzodiazepine overdose?

A. Anxiety, irritability, tremulousness

B. Slurred speech, confusion, lack of muscle coordination

C. Nausea, diarrhea, GI discomfort

D. Fatigue, tachycardia, HTN

B. Slurred speech, confusion, lack of muscle coordination

What class of medications does diazepam belong to?

A. Benzodiazepine

B. Non-benzodiazepine receptor agonist

C. Tricyclic antidepressants

D. Specific Serotonin Receptor Inhibitor

E. Serotonin Norepinephrine Reuptake Inhibitor

A. Benzodiazepine

What class of drugs does alprazolam belong to?

A. Benzodiazepine

B. Non-benzodiazepine receptor agonist

C. Tricyclic antidepressants

D. Specific Serotonin Receptor Inhibitor

E. Serotonin Norepinephrine Reuptake Inhibitor

A. Benzodiazepine

What class of drugs does duloxetine belong to?

A. Benzodiazepine

B. Non-benzodiazepine receptor agonist

C. Tricyclic antidepressants

D. Specific Serotonin Receptor Inhibitor

E. Serotonin Norepinephrine Reuptake Inhibitor

E. Serotonin Norepinephrine Reuptake Inhibitor

Which medication treats both anxiety and insomnia?

A. Escitalopram

B. Eszopiclone

C. Diphenhydramine

D. Zolpidem

B. Eszopiclone

Which of the following are associated with anxiety? (Check all that apply)

A. Omeprazole

B. Albuterol

C. Caffeine

D. Ipratropium

B. Albuterol

C. Caffeine

A patient has a Beck Anxiety Score (BAI) that initially was rated 63 and now if rated as a 7. Interpret where the patients score started and where the score is currently rated

A. Mild to severe anxiety

B. Severe to minimal anxiety

C. Severe to moderate anxiety

D. Moderate to no anxiety

B. Severe to minimal anxiety

A clinician rated scale (versus a self-rating scale) should be used in which of the following patients? (Check all that apply)

A. Patients that cannot read

B. Patients that cannot see

C. Patients that are agitated

D. Patients that cannot speak

A. Patients that cannot read

B. Patients that cannot see

C. Patients that are agitated

Which of the following ratings would indicate a moderate Beck Anxiety Scale score?

A. 26-63

B. 16-25

C. 8-15

D. 0-7

B. 16-25

Which anxiety rating scale is clinician rated?

A. Hamilton Anxiety Scale

B. Beck Anxiety Scale

C. Generalized Anxiety Scale-7

D. Zung Anxiety Scale

A. Hamilton Anxiety Scale

Which of the following is most likely to be associated with a lack of health literacy?

A. nonadherence

B. missing appointments

C. taking medication intermittently

D. taking medication as prescribed

C. taking medication intermittently

The best way to provide education to an individual who does not speak the same language as you is to provide a translator and information in the individuals language of origin

A. True

B. False

A. True

Health literacy might be a problem in which of the following

A. An individual that takes their medication daily

B. An individual that misses appointments due to lack of transportation

C. An individual who has medication but takes it intermittently

D. An individual that can't afford their medication

C. An individual who has medication but takes it intermittently

How would you counsel an individual who takes their medication intermittently?

A. If you take medication intermittently, take it at the same time each day

B. It is okay to take medication intermittently if it is too expensive

C. Medication does not work well when taken intermittently because you can't get a steady dose in your blood so every time you take the medicine it is like starting it for the first time

D. The medication works well intermittently

E. None of the above

C. Medication does not work well when taken intermittently because you can't get a steady dose in your blood so every time you take the medicine it is like starting it for the first time

When treating GAD with an antidepressant you should use the same dose that you use for depression

A. True

B. False

B. False

Which medications cause an increase in anxiety? (check all that apply)

A. SSRIs

B. Albuterol

C. Caffeine

D. SNRIs

A. SSRIs

B. Albuterol

C. Caffeine

D. SNRIs

What symptoms would you expect in a patient with an anxiety disorder who is initiated on an antidepressant dose of an SSRI?

A. increased anxiety

B. Jitteriness syndrome

C. Feeling like they are coming out of their skin

D. Feeling sedated and depressed

A. increased anxiety

B. Jitteriness syndrome

C. Feeling like they are coming out of their skin

Discontinuation syndrome with antidepressants can occur in individuals with generalized anxiety disorder

A. True

B. False

A. True

Which of the following treatments are first line for panic disorder? (Select all that apply?)

A. Sertraline

B. Paroxetine

C. Venlafaxine

D. Imipramine

A. Sertraline

B. Paroxetine

C. Venlafaxine

Which of the following would be second line treatments for panic disorder?

A. Sertraline

B. Paroxetine

C. Venlafaxine

D. Imipramine

D. Imipramine

Which medications do you use to augment a first or second line medication for panic disorder? (Select all that apply)

A. Klonopin

B. Xanax

C. Imipramine

D. Risperidone

A. Klonopin

B. Xanax

D. Risperidone

How do you decide when to try a second-line agent versus a first-line agent for panic disorder?

A. Try a 2nd line agent after using phenelzine

B. Use a 2nd line agent after trying venlafaxine and a benzo

C. Use a 2nd line agent after using two first line agents for adequate doses and adequate amounts of time

D. Use a 2nd line agent after trying gabapentin

C. Use a 2nd line agent after using two first line agents for adequate doses and adequate amounts of time

What might be a reason to use a benzodiazepine in a patient with panic disorder? (Select all that apply)

A. Patient has significant weight gain with a second line panic disorder treatment

B. The patient needs short term treatment until their first line treatment starts working

C. The patient needs to augment their panic disorder treatment and they do not have a substance use history

D. The patient needs to augment their panic disorder treatment and they have a very distant history of using marijuana

E. all of the above

E. all of the above

Once you have achieved response to treatment for social anxiety disorder, how long should you continue treatment?

A. 3 weeks

B. 12 weeks

C. 3 months

D. 12 months

D. 12 months

How long does it take to discontinue an antidepressant used for treating social anxiety when stopping therapy?

A. If an individual has social anxiety disorder you can stop the antidepressant immediately

B. If an individual has social anxiety disorder you can taper off an antidepressant over a week

C. If an individual has social anxiety disorder you can taper off an antidepressant by 20% a week

D. If an individual has social anxiety disorder you can taper off an antidepressant over 3-4 months

D. If an individual has social anxiety disorder you can taper off an antidepressant over 3-4 months

Name a physical symptom and a feared situation respectively

A. Blushing, public speaking

B. Drinking in front of others, diarrhea

C. Eating in a cafeteria, hives

D. Use of a public restroom, speaking in public

A. Blushing, public speaking

Name a intrusion symptom and a reactivity symptom respectively

A. Distress at exposure to cues, being startled

B. Dreams of the event, hypervigilance

C. Feeling like the event is happening again, decreased concentration

D. intrusive memories of the trauma, reckless behavior

E. All of the above

E. All of the above

Which of the following is a first-line treatment for PTSD?

A. Alprazolam

B. Risperidone

C. Paroxetine

D. Klonopin

C. Paroxetine

Which of the following medications can be used to treat nightmares associated with PTSD?

A. Zolpidem

B. Olanzapine

C. Prazosin

D. Propranolol

C. Prazosin

An individual with PTSD is being treated with venlafaxine 75 mg and is still experiencing PTSD. What is your best recommendation for this individual?

A. Add risperidone

B. Add diazepam

C. Increase the dose of venlafaxine

D. Switch to paroxetine

C. Increase the dose of venlafaxine

Which of the following is an obsession and a compulsion respectively

A. Praying, need for symmetry

B. Fear of contamination, washing hands

C. Hoarding, fear of throwing things away

D. Checking, cleaning

B. Fear of contamination, washing hands

What is the most appropriate dose of fluoxetine for obsessive compulsive disorder

A. 10 mg

B. 20 mg

C. 40 mg

D. 80 mg

D. 80 mg

The best therapy for obsessive compulsive disorder is:

A. Exposure and response prevention

B. Trauma focused psychotherapy

C. Eye movement desensitization and reprocessing therapy

D. Dialectical behavioral therapy

A. Exposure and response prevention