Anxiety

-sedating antihistamine hydroxyzine can be used short-term for situational

anxiety in children (eg, preoperative anxiety)
Acute intermittent porphyria can result in autonomic arousal (eg, tachycardia,
hypertension, sweating) as well as anxiety, but these symptoms tend to occur
in acute attacks accompanied by neuropathy (eg, weakness, numbness) and
severe abdominal pain.
GAD in children can manifest as a need for perfectionism and order; when
these are not attainable, coping difficulty is also seen (eg, this patient's
emotional outburst after being criticized at school). Other manifestations
include somatic symptoms (eg, stomachache, school refusal).
Although the diagnosis of GAD in adults requires uncontrollable worry
accompanied by ≥3 additional symptoms (eg, restlessness, fatigue, irritability),
only 1 additional symptom is required in children and adolescents.
Kleptomania can be treated with psychotherapy and medications.
Psychotherapy involves a cognitive-behavioral therapy orientation, focusing
on techniques to resist and manage urges and anxiety.
Intradermal corticosteroid injections are indicated for alopecia areata, which
causes discrete patches of hair loss rather than generalized hair thinning.
Topical minoxidil therapy has been used to treat male pattern hair loss as well
as female pattern hair loss, which classically causes frontal scalp or scalp
vertex hair loss. Neither would explain this patient's low BMI and fear of weight
gain. Her hair loss should improve with AN management and weight
restoration.
normal stress response. His symptoms are mild rather than excessive given
the nature of the stressor; he does not meet the full criteria for any disorder;
and he is not markedly distressed (eg, does not himself bring the subject up
with the physician). Most importantly, the patient exhibits no impairment of
social and occupational functioning, a key feature of psychiatric illness.
The hypothetical association of beta blockers with depression has not
been substantiated by rigorous studies, and there is no evidence that beta
blockers exacerbate symptoms of PTSD. In addition, beta blockers provide
known survival benefit following acute MI; therefore, discontinuing metoprolol is
not indicated.
fear of separation with excessive concern that something bad will happen
and reluctance to leave her mother are suggestive of separation anxiety
disorder. It is more common in children under age 12 but can occur at any
age.
management programs in which parents are trained to reward prosocial
behavior and use brief, nonaversive consequences for misbehavior. Individual
or group psychotherapy focusing on anger management, problem-solving, and
social skills is also beneficial.

Dialectical behavior therapy focuses on treating emotional dysregulation and

self-harm behaviors in borderline personality disorder (eg, unstable
relationships, impulsivity). It has no demonstrated efficacy for OCD.
Benzodiazepines are also effective but are considered second-line for
GAD treatments
due to the risks of abuse, dependence, tolerance, and potential for
withdrawal syndromes and rebound effects with abrupt discontinuation

Benzodiazepines can be used when antidepressants are ineffective or

poorly tolerated, but they should be,They can also be used as an adjunct to
manage acute anxiety while waiting for SSRIs or SNRIs to take effect.
Buspirone, an FDA-approved non-benzodiazepine anxiolytic, has also been
used to treat GAD in patients without comorbid depression or panic symptoms.
Although it has a slower onset of action and weaker anxiolytic effects than
benzodiazepines, it can be helpful in patients with a high risk of
benzodiazepine abuse.

prazosin, an alpha-1 adrenergic receptor antagonist, is effective for

treatment of PTSD-related nightmares and is particularly helpful as an adjunct
to SSRI or SNRI treatment. Prazosin is thought to reduce nightmare
frequency by decreasing the adrenergic hyperactivity found in many patients
with PTSD. Prazosin is administered at bedtime and requires titration to reduce
the risk of effects on blood pressure (eg, orthostasis).
requires ≥4 characteristics related to problematic gambling behavior. This
patient exhibits the following 4: preoccupation with gambling, frequent return
to gambling to attempt to recover past losses, tendency to damage
relationships or jeopardize employment, and reliance on others to make up for
financial losses. Additional criteria listed in DSM-5 include: gambling when
distressed, depressed, or anxious; increased gambling to achieve the desired
excitement; irritability/distress when trying to cut back on gambling; and
repeated, unsuccessful attempts to cut back on and conceal the extent of the
behaviors.