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GAD Information primarily from DSM and First and Tasman’s DSM-IV-TR MENTAL DISORDERS As of 12Jul06.
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GAD - duration Q. DSM-IV criteria expects anxiety and worry more days than not for at least how long before making the dx?
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GAD - duration Ans. Six months.
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GAD - signs Q. DSM-IV expects to find 3 or more of what 6 signs associated with the anxiety and worry to make the dx of GAD?
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GAD - signs Ans. Expects 3 or more [only one is needed in children to make the GAD dx] of the following: 1] restless or chronically keyed up 2] fatigued 3] difficulty concentrating 4] irritable 5] muscle tension 6] insomnia
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R/O - adults Q. For adults, list two very general rule outs of other psychiatric disorders, before one dxes GAD.
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R/O - adults Ans. 1] Other anxiety disorders. For example, chronically anxious from OCD or chronically anxious from PTSD is not GAD 2] Substances, e.g., coffee.
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R/O - children Q. List three common specific R/O in children?
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R/O - children Ans. -- separation anxiety disorder -- social phobia -- OCD
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Comorbidity Q. Name three most common co- morbidities with GAD.
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Comorbidity Ans. -- substance-related disorder, especially alcoholism -- another anxiety disorder -- MDD/dysthymia
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Lifetime prevalence Q. What is lifetime prevalence?
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Lifetime prevalence Ans. 5 %. Studies vary, but the right answer should be close to one in twenty.
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Familiar? Q. Twin studies suggest a genetic contribution?
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Familiar? Ans. Yes. That is as far as DSM is willing to go – no specific figures.
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Gender Q. Which gender predominates?
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Gender Ans. About 2/3 are women.
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Onset Q. Most common age of onset?
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Onset Ans. Late adolescents or early 20s is the correct multiple choice answer, but when asked, “all my life” is common answer by pts.
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Na+ lactate Q. What does Na+ lactate infusion do, if anything? In comparison to those suffering from panic attacks? In comparison to normals?
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Na+ lactate Ans. Infusion of Na+ lactate produces signs of anxiety in normals, but not as high a level as is seen in people with panic disorder.
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First-line treatment - meds Q. What is first-line meds for GAD? List three general categories.
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First line - meds Ans. 1] SSRIs [probably the right answer to examiner’s questions as to first choice] 2] CNRIs 3] Tricyclics
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FDA Q. FDA approved for GAD?
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FDA Ans. -- alprazolam -- escitalopram -- paroxetine -- venlafaxine
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Benzodiazepines? Q. What is the role of benzodiazepines?
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Benzodiazepines Ans. OK as an adjunct in the failure of first- line meds for acute anxiety reactions, but not for long-term use.
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Benzodiazepines – effect Q. Benzodiazepines act on a subunit of a receptor for?
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Benzodiazepines - effect Ans. GABA
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GABA Q. Main action of GABA?
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GABA Ans. The major inhibitory neurotransmitter in the brain.
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Next? Q. Your pt has not responded to any of the three first-line meds? What medication is next in your list of choices?
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Next? Ans. Buspirone.
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How long on meds Q. Your pt has finally responded to your choice of medications. How long should you continue on the meds before trying to taper and discontinue?
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How long on meds Ans. At least 6 to 12 months.
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Psychotherapy Q. Which form of psychotherapy has been shown to be valuable?
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Psychotherapy Ans. CBT. Relaxation and biofeedback have some empirical support, but examiner is likely to favor CBT
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Comparison of meds and CBT Q. What did studies find that compared these two approaches?
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Comparison of meds and CBT Ans. Both meds and CBT worked. CBT seem to have a longer efficacy time, i.e., after both treatments had been discontinued, med-treated pts were more likely to have a reoccurrence.
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