questions 2

Phobic Disorders

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Topic updated on 06/05/16 12:24pm

Snapshot
  • A 40-year-old male visits a psychiatrist because he feels "extremely shy." He feels anxious socializing and going to events for fear that he would be ridiculed by others. When he is forced into conversation he hyperventilates, is diaphoretic, and develops palpitations. He has been invited to deliver a lecture at his alma mater during a class reunion next week, and asks for medications to "calm him down." After questioning that reveals an unremarkable history of medical conditions or substance use, the psychiatrist prescribes the patient a short course of propranolol. The patient agrees to follow up with the psychiatrist after the reunion for cognitive behavioral therapy.
Introduction
  • Lifetime prevalence of specific phobias is 12-16%
  • Social phobia (social anxiety disorder) prevalence within 1 year is roughly 7%
    • equally affects men and women
Presentation
  • Specific phobia
    • marked and persistent (> 6 months) fear that is excessive or unreasonable
    • cued by presence or anticipation of specific object or situation
    • types: animal/insect, environment, blood/infections, situational (closed spaces), other
  • Social phobia (social anxiety disorder)
    • marked and persistent (>  6 months) fear of social or performance situations in which one is exposed to unfamiliar people or to possible scrutiny by others
    • fear of acting in humiliating or embarrassing way
      • public speaking, initiating conversation, dating, eating in public
    • may coexist with avoidant personality disorder
Evaluation
  • Exposure to stimulus almost invariably provokes immediate anxiety response
    • may present as panic attack
  • Person recognizes fear as excessive or unreasonable
  • Situations are avoided or endured with anxiety/distress
  • Significant interference with daily routine, occupational / social functioning, and/or marked distress
Treatment
  • First line: psychotherapy (more efficacious than medication)
    • cognitive behavior therapy
  • Pharmcological options
    • SSRIs/SNRIs
    • acute situations
      • short acting benzodiazepines (alprazolam) 
      • β-blocker 
        • indicated for specific performance phobia (such as speaking)  


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Qbank (2 Questions)

TAG
(M3.PY.39) A 20-year-old college student presents to her primary care physician's office for an annual check-up. She is otherwise healthy, but when asked about how classes are going, she expresses serious concern about her upcoming oral presentation for a public-speaking course. She says that she has never been a good speaker in front of other people, and even refrains from asking questions in class because of her nerves. What is the most appropriate treatment to alleviate these symptoms for her upcoming final? Topic Review Topic

1. Cognitive behavioral therapy
2. Relaxation exercises
3. Fluoxetine
4. Amitryptyline
5. Propranolol

PREFERRED RESPONSE ▶
TAG
(M2.PY.19) A 22-year-old aspiring violinist complains of extreme tremulousness and palpitations when performing in front of more than 10 people. She does not have anxiety in any other situation. She asks for a drug to help with her playing anxiety. The drug of choice in this situation acts in which manner? Topic Review Topic

1. Antagonizes adrenergic receptors
2. Increases synaptic serotonin concentrations
3. Increases synaptic norepinephrine concentrations
4. Increases synaptic acetylcholine concentrations
5. Activates GABA-A receptors

PREFERRED RESPONSE ▶


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