GAD Exam 32 Questions with Verified Answers,100% CORRECT, Exams of Nursing

Download GAD Exam 32 Questions with Verified Answers,100% CORRECT and more Exams Nursing in PDF only on Docsity! GAD Exam 32 Questions with Verified Answers GAD DSM 5 - CORRECT ANSWER -Excessive anxiety and worry lasting for at least 6 months and difficulty in controlling the worry -Presence of 3 of following 1. feeling keyed up or on edge: restlessness 2. becoming easily fatigued 3. Mind going blank; difficulty concentrating 4. Irritability 5. Muscle tension 6. Sleep disturbance, usually insomnia -Focus of the anxiety and worry are not caused by another anxiety or psychiatric disorder -Significant distress or functional impairment b/c of anxiety symptoms -Symptoms are not caused by a substance or a general medical condition (e.g. pheochromocytoma) GAD Psychological and Cognitive Signs and Symptoms - CORRECT ANSWER Excessive anxiety Worries that are difficult to control Feeling keyed up or on edge Poor concentration or mind going blank Restlessness Irritability GAD Physical Symptoms Signs and Symptoms - CORRECT ANSWER Fatigue Muscle tension Sleep disturbance GAD Impairment Signs and Symptoms - CORRECT ANSWER Social Occupational or other important functional areas Poor coping skills Generalized Anxiety Disorder Assessment-7 GAD-7 - CORRECT ANSWER 7 item scale self rated brief (5 mins) screens for GAD and assesses severity 5-mild 10-moderate 15- severe anxiety if score 10, further eval. Hamilton Anxiety Scale (HAM-A) - CORRECT ANSWER 14 item scale clinician rated assesses severity of anx sx requires trained rater (10-15 mins) 0-17 mild 18-24 mild to moderate 25-30 moderate to severe Remission 70% better or score < 7 Improved 50% better Partial response 25-49% better Non-response < 25% Beck Anxiety Inventory (BAI) - CORRECT ANSWER 21 item scale self rated brief (5- 10 mins) measures severity and distinguishes anx from depression 0-7 minimal 8-15 mild 16-25 moderate 26-63 severe Penn State Worry Questionnaire (PSWQ) - CORRECT ANSWER 16 item scale self rated brief (5-10 mins) used for screening, eval of path worry < 40, non-anxious 40-60, non-GAD > 60, GAD Zung Self-Rated Anxiety Scale (SAS) - CORRECT ANSWER 20 item scale brief (5-10 mins) 3rd Line Treatment Augmentation with SGA: risp, olanz Other Treatment Mirtazapine Bupropion citalopram nafazodone fluoxetine International Psychopharmacology Algorithm Project (IPAP) 2010 - CORRECT ANSWER First Line Treatment CBT or relaxation therapy SSRI: escitalopram, paroxetine, sertraline SNRI: venlafaxine, duloxetine 2nd Line Treatment BZD (short-term use) Buspirone Imipramine Trazodone Hydroxyzine 3rd Line Treatment Augmentation of antidepressant with BZD, hydroxyzine, buspirone, or tiagabine Other Treatment: Mirtazapine Citalopram Trazodone National Institute for Health and Clinical Excellence (NICE) 2011 - CORRECT ANSWER First Line Treatment CBT or applied relaxation SSRI: sertraline BZD: short-term use (2-4weeks) for crisis 2nd Line Treatment Alternative SSRI or SNRI 3rd Line Treatment Pregabalin World Federation of Societies of Biological Psychiatry-First Revision 2008 - CORRECT ANSWER First Line Treatment SSRI: escitalopram, paroxetine, sertraline SNRI: venlafaxine, duloxetine Pregabalin Quetiapine 2nd Line Treatment Imipramine BZD(only without hx of dependency):diaz,loraz Hydroxyzine 3rd Line Treatment Buspirone (inconsistent evidence) Augmentation with SGA: risp, olanz CBT Cognitive Behavioral Therapy - CORRECT ANSWER -most effective psychological therapy underused secondary to cost, time and limited therapists -Comparable efficacy to medication in acute tx sustained reductions in anx over 6-12 months -identifies negative thought patterns that provoke or worsen anx and changes these thoughts to be more positive SSRIs - CORRECT ANSWER Paroxetine and escitalopram-FDA approved escitalopram 10mg was superior to parox 20mg in fixed-dosed study Parox and Sertraline were found to be similarly effective in short term tx of GAD Citalopram not approved but used in elderly max dose 20mg/day sertraline max dose in elderly 50-100mg/day --onset of action of antidepressants 4-12 weeks SRNIs - CORRECT ANSWER -Venlafaxine XR FDA approved for GAD 8 week double blind study compared escitalopram 10-20mg/day vs venlafaxine XR (75-225mg) vs placebo. both effective, escital better tolerated Venal similar to pregabalin in one RCT but less effective in another Venlafaxine has benefit for psychic sx, eg ruminative worry -Duloxetine FDA approved efficacy demon in short term and long term studies decrease in relapse with doses of 60-120mg -onset of action of antidepressants 4-12 weeks Benzodiazepines, (BZDs) Efficacy - CORRECT ANSWER -Efficacy: effective in acute tx of GAD, provide rapid relief of anxiety sx long term use not rec. w/drawal sx up to 44% for as few as 4-6 wks 2nd line agents should only be used for 2-3 weeks until antidep begins to work -MOA binding to GABAa receptor causes allosteric modification of receptor that increases GABA2 receptor activity Benzodiazepines, (BZDs) MOA - CORRECT ANSWER -MOA binding to GABAa receptor causes allosteric modification of receptor that increases GABA2 receptor activity Benzodiazepines, (BZDs) Contraindications/Warnings/Precautions - CORRECT ANSWER -Contraindications 1. Hypersensivity to BZDs 2. Substance abuse hx 3. Myasthenia gravis 4. Respiratory disorders 5. Significant hepatic dz 6. Acute narrow angle glaucoma 7. Pregnancy/Labor/lactation -Warnings and Precautions 1, Dependence and w/drawal rx, including seizures 2. Inter-dose sx 3. Risks associated with dose reduction