Chapter Seven
Summary
Second only to depression and alcohol abuse, anxiety disorders are commonly presented in both mental health
and medical/surgical settings. The etiology of most anxiety disorders may include environmental triggers or stressors,
as well as physiological dysregulation of neurosubstances such as serotonin, GABA, and glutamate.
Anxiety symptoms may result from other physical conditions as well. These may include tumors, alcoholism,
angina, sinus conditions, sugar/diabetic concerns, hyperthyroidism, PMS, and seizure disorder just to name a few.
Also, other substances can cause or worsen a patient’s anxiety states. These may include amphetamines and other
stimulants, diet medications, asthma medications, decongestants, cocaine, caffeine, and steroids. In some cases,
withdrawal from antidepressants and other anxiety medications can trigger anxiety.
Treatment depends on the type and intensity of the anxiety state. The clinician must be accurate in diagnosing
the type of disorder present to tailor the appropriate intervention. Talk therapies; namely cognitive, and cognitive–
behavioral approaches, and relaxation training have been shown to be most effective. For patients presenting with
panic disorders, the use of approved antidepressants and benzos is indicated. For most chronic or generalized anxiety,
the use of antidepressants or buspirone is indicated. For those with PTSD, antidepressants, benzos, and certain mood–
regulators may be indicated. OCD patients are best helped with the use of anti-obsessional medications, which include
most of the SSRIs. Patients with Social Anxiety Disorder may be helped with a variety of antidepressants.
Specific Discussion Questions:
1. Discuss the physiology of the chloride–ion channels and their role in panic.
2. How do environmental stressors play a role in triggering anxiety responses?
3. Explain which medical conditions and other medications can contribute or cause a patient’s anxiety.
4. Discuss the steps involved in treating Panic Disorder.
Possible True/False Questions:
1. Stimulants such as nicotine and caffeine can worsen one’s anxiety states.
2. SSRIs such as Prozac and Luvox are used in the treatment of OCD.
3. Buspar is typically used in the treatment of Panic Disorder.
4. Atypical antipsychotics or mood stabilizers may be necessary for agitated PTSD patients.
5. Thyroid conditions may worsen one’s anxiety.
6. Most patients with Panic Disorder are helped by talk therapy alone.
7. Alcohol also binds at the chloride ion channel.
8. Clonazepam has a longer half life than alprazolam and typically is abused less often.
9. Alpha and beta blockers may be used in the treatment of Social Anxiety Disorder.
10. Approximately 3% of the population suffers from OCD.
11. Typical withdrawal from benzos takes about three weeks.
12. There were five phases of the chloride ion channel presented in the text.
13. Panic can be triggered in Panic Disorder patients by injecting CCK.
14. SSRIs or MAOIs offer the best results for patients with social fears.
15. Sleep aids should generally not be used for more than two–three weeks.
Possible Multiple Choice Questions:
1. Which of the following is approved primarily for Generalized Anxiety Disorder?
a. Buspar
b. Ativan
c. Xanax
d. None of these
2. In treating Social Anxiety Disorder, the best results are achieved with:
a. TCAs
b. Atypical Antipsychotics
c. SSRIs or MAOIs
d. None of these
3. For spot treating specific social phobias like public speaking, one may consider:
a. Buspar
b. Klonopin
c. Prozac
d. Inderol
4. When treating OCD, we typically consider ________ doses of SSRIs.
a. Lower
b. Same as depression
c. Higher
d. Not used in OCD
5. All of the following EXCEPT ______ are typically used to treat PTSD symptoms.
a. SSRIs
b. Effexor
c. Mood stabilizers
d. Stimulants
6. Which longer acting benzo is less likely to be abused by clients with anxiety?
a. Ativan
b. Xanax
c. Klonopin
d. Tranxene
7. The four “Bs” in treating anxiety disorders stand for:
a. benzos, booze, Buspar and bupropion.
b. Bipolars, benzos, barbiturates and bennies.
c. benzos, barbiturates, Buspar and Beta-blockers.
d. benzos, booze, babes, and Bipolars.
8. For patients with mild and occasional insomnia, who prefer a quick “home remedy,” which of the following
could be used safely?
a. Klonopin
b. Buspar
c. barbiturates
d. benadryl
9. For OCD patients with severe agitation or racing thoughts _______ may be added to their other medications
(SSRIs).
a. Antipsychotics
b. MAOIs
c. Another SSRI
d. None of these
10. A panic patient feels relaxed when the chloride ion channels ________.
a. Hypopolarize
b. Dipolarize
c. Hyperpolarize
d. All of the above
11. Which of the following sleep medications has not been shown to be habit-forming?
a. Ambien
b. Belsomra
c. Restoril
d. Rozerem
12. All of the following except _______ would be appropriate for a patient with GAD symptoms.
a. Effexor
b. Pristiq
c. Buspar
d. Wellbutrin
Alternative Class Assignments and Essay Questions:
1. Role-play a session with an anxious patient. Have the students decide when a prescribing professional might
use one medication over another and why.
2. Compare and contrast the various medications used in the treatment of anxiety disorders. What are the
advantages of some with the various types of patients?
Case 1 and 2 Vignette Discussion Questions:
1. What is the major pathology or diagnosis presented in each case?
2. Is there another disorder that may apply or should be ruled-out?
Answer Key to Possible True/False and Multiple Choice Questions Chapter Seven
Possible True/False Questions:
Multiple Choice Questions: