questions 4

Generalized Anxiety Disorder

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Topic updated on 11/12/17 9:27pm

Snapshot
  • A 38-year-old female comes to your office complaining of poor work performance.  She is concerned about her performance despite reassurance from her boss. Upon further questioning, she reveals that she is also very concerned about paying bills, if the bus will be on time, if her children are happy in addition to a myriad of other things.  She has been anxious "as long as she can remember."
Introduction
  • Clinical definition
    • excessive, poorly controlled anxiety that tends to occur daily for > 6 months
    • anxiety is not related to a specific focus, but rather is generalized to most issues 
Presentation
  • Symptoms 
    • sleep disturbance/fatigue
    • difficulty concentrating
    • autonomic hyperactivity
      • similar to other anxiety/panic disorders
    • motor excitation
      • jumpy, fidgety
    • constant surveillance/vigilance
Treatment
  • Psychotherapy
  • Pharmacologic
    • SSRIs 
      • take several weeks to work
    • buspirone
      • can be used as an adjunct to SSRIs
    • venlafaxine
    • benzodiazepines
      • used in the interim until SSRI response is seen
      • not used for long term management as a result of abuse potential
  • Herbal 
    • kava plant has been shown in verified studies to have mild beneficial effect for patients with generalized anxiety disorder
      • kava toxicity manifests as liver failure, hepatitis, or cirrhosis 


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Qbank (1 Questions)

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(M3.PY.106) A 46-year-old female presents to her family physician with a chief complaint of high levels of anxiety over the past year. Her anxiety has started to affect her performance at work, making her even more anxious and concerned that she will lose her job. She started psychotherapy several months ago and has experienced minimal improvement in her symptoms from this treatment. The patient is vehemently opposed to beginning any pharmacologic treatment for anxiety; however, she is interested in potential herbal remedies. She asks her doctor about the kava plant as a treatment for anxiety. Which of the following is an adverse event or complication associated with the use of this herbal supplement? Topic Review Topic

1. Liver failure
2. Gingival hyperplasia
3. Cardiac arrhythmia
4. Seizure
5. Hypertension

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