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.
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.
5. Which medications have been FDA approved to treat PTSD?
6. Why is good history taking information necessary when considering benzos?
7. Explain why cognitive/behaviorally based treatments AND pharmacology are helpful in treating most forms
of anxiety.
8. Discuss the role of sleep medications and why patients need to be aware of their potential abuses.
9. Discuss how elevated cortisol and adrenaline levels may lead to health concerns.
10. Explain how atypical antipsychotic medications are used in cases of severe OCD with racing thoughts at
bedtime. Which is best?
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 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 5% of the population suffers from OCD.
11. Typical withdrawal from benzos takes about three weeks.
12. There were four phases of the chloride ion channel presented in the text.
13. Panic can be triggered in Panic Disorder patients by injecting CCK.
14. SSRIs and 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. Sonata
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?
3. When is it appropriate to consider using atypical antipsychotics with anxiety patients?
4. Have students present a brief lecture on the etiology of anxiety disorders. Be sure to have them explain the
three phases of chloride ion channels.
5. Explain what the authors mean by the “four Bs” in the treatment of anxiety conditions.
6. Explain how propranolol has been used as a “prophylactic” in cases of trauma.
7. Which medication currently used to treat severe OCD in children?
Read the Case Vignette in this chapter and answer the following questions:
Case Vignette Discussion Questions:
1. What is the major pathology or diagnosis presented in the case?
2. Is there another disorder that may apply or should be ruled-out?
3. Do you agree with the medication suggestions made in this case?
4. Any other medications that might be considered…what is the rationale?
5. If you were asked to follow-up on this case as the treating therapist, would you offer any additional
suggestions or approaches?
Chapter Seven
Answer Key
True/False Questions:
Multiple Choice Questions: