Day # 68: Review Quiz -> Anxiety Part 2

Today will be our second review quiz for the anxiety disorder theme. Take a few minutes and check your learning.

1) Fill in the blanks for the diagnostic criteria of generalized anxiety disorder:

• Excessive anxiety and worry occurring more days than not about a number of things.

• Difficulty controlling the worry.

• Minimum duration = ???

• Associated with ≥ ??? of the following symptoms (1 in children):

  • W...

  • W...

  • A...

  • R...

  • T...

  • S...

2) Generalized anxiety disorder is highly comorbid with other psychiatric conditions. Which of the following has the highest rate of co-occurrence?

a) Panic disorder

b) Social anxiety disorder

c) Specific phobia

d) Major depressive disorder

3) Which of the following is first-line treatment for specific phobias?

a) SSRI's/SNRI's

b) Benzodiazepines as needed

c) Exposure therapy

d) Psychodynamic psychotherapy

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Answers

DON'T LOOK UNTIL YOU HAVE FINISHED THE ENTIRE QUIZ

Question 1:

From day #66:

Answer/Explanation:

The diagnostic criteria for GAD are as follows 1:

• Excessive anxiety and worry occurring more days than not about a number of things.

• Difficulty controlling the worry.

• Symptoms ≥ 6 months.

• Associated with ≥ 3 of the following symptoms (1 in children):

• Restlessness / keyed up / on edge.

• Easily fatigued.

• Difficulty concentrating / mind going blank.

• Irritability.

• Muscle tension.

• Sleep disturbance (difficulty falling/staying asleep or restless/unsatisfying sleep).

These criteria are commonly remembered from the following mnemonic = Worried WWARTS:

• Worried = anxious

• Wound up = irritability

• Worn-out = fatigued

• Absent-minded = impaired concentration

• Restless

• Tense = muscle tension

• Sleep disturbance

•Also remember that to make any diagnosis you need to determine that it causes significant distress or impairment, symptoms are not attributable to a substance or medical illness, and symptoms are not better explained by another mental disorder.

Question 2:

From day #66:

Answer: d

Major depressive disorder is the most common comorbidity listed. Substance use disorder is estimate to have an even higher co-occurrence (not listed).

Explanation:

Comborbid conditions with GAD 2

• GAD is highly comorbid with other anxiety, depressive, and substance use disorders.

• GAD + MDD ~ 42%.

• GAD often precedes and predicts future MDD.

• GAD + social anxiety disorder ~ 23%.

• GAD + panic disorder ~ 22%.

• GAD + specific phobia ~ 21%.

• GAD + substance use disorders ~50%. Often alcohol and benzodiazepines.

Question 3:

From day #67:

Answer: c

Exposure therapy

Explanation:

• Cognitive Behavioral Therapy (CBT): Considered first-line with strong evidence for effectiveness. CBT for phobias include exposure therapy.

• Exposure Therapy: Common examples of exposure therapy are systematic desensitization or flooding. While exposed to the stimulus the patients are coached in various grounding techniques such as breathing exercises and relaxation techniques to reduce their anxiety to a normal level.

• Other options with evidence of effectiveness: Psychodynamic Psychotherapy (PDP); Virtual Therapy (exposure through computer-generated simulations); Hypnotherapy; Family therapy.

• In general pharmacotherapy is second-line for treatment of specific phobias.

• SSRIs/SNRIs: May be used for patient's that frequently encounter the phobic stimulus so as to bring down the overall levels of anxiety. Also commonly used if comorbid anxiety disorders or depressive disorders are present.

• Some prescribers may utilize PRN medications for patients that infrequently encounter the stimulus (example: flying for a vacation). Commonly used are benzodiazepines (such as lorazepam), hydroxyzine, or beta-blockers (propranolol).

• Many providers would argue that PRN use can limit psychotherapeutic focus on not avoiding the anxious stimulus. Thus therapy should be prioritized!

CONCLUSION

If you want to see all of the weekly quizzes you can see them here. Next lesson we will discuss social anxiety disorder.