Alternative treatments for anxiety US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Alternative treatments for anxiety. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Alternative treatments for anxiety US Medical PG Question 1: A 75-year-old female patient comes to the emergency department with altered mental status. She is brought in by her daughter with whom the patient lives. The patient’s daughter said they were watching TV when her mother became unresponsive. On exam the patient withdraws to pain but does not open her eyes or speak. An emergent head CT is done and shows an intracranial bleed. The patient is moved to the ICU and intubated. Further history is obtained from the daughter. The patient has a past medical history of diabetes and a previous stroke. Her medications are metformin and warfarin. The patient is compliant with all of her medications. The daughter says that the patient changed her diet about 1 month ago in response to a diet she saw on a talk show. Which of the following foods is most likely to cause the pathology seen in this patient?
- A. Grapefruit juice (Correct Answer)
- B. St. John’s wort
- C. Green tea
- D. Chili peppers
- E. Spinach
Alternative treatments for anxiety Explanation: ***Grapefruit juice***
- **Grapefruit juice** is a potent inhibitor of **cytochrome P450 3A4 (CYP3A4)**, which is involved in the metabolism of **warfarin**.
- Inhibition of warfarin metabolism leads to increased warfarin levels, subsequently potentiating its **anticoagulant effect** and significantly increasing the risk of **bleeding**, including dangerous **intracranial hemorrhage**.
*St. John’s wort*
- **St. John's wort** is a known **CYP3A4 inducer**, meaning it increases the metabolism of drugs like warfarin.
- This typically leads to **decreased warfarin efficacy** and thus an increased risk of **thrombosis**, not bleeding.
*Green tea*
- **Green tea** contains **vitamin K**, which can **antagonize the effects of warfarin**.
- Ingesting large amounts of green tea could potentially *reduce* warfarin's anticoagulant effect, increasing the risk of clotting, rather than bleeding.
*Chili peppers*
- **Chili peppers** do not have a well-documented significant interaction with **warfarin** that would lead to increased bleeding risk.
- Their primary effects relate to gastric irritation or altered sensation, not anticoagulant modulation.
*Spinach*
- **Spinach** is high in **vitamin K**, which is a crucial factor in blood clotting and is directly antagonized by **warfarin**.
- Increased intake of spinach would likely **decrease the efficacy of warfarin**, leading to a higher risk of **clotting**, not bleeding.
Alternative treatments for anxiety US Medical PG Question 2: A professional golfer tees off on the first day of a tournament. On the first hole, his drive slices to the right and drops in the water. He yells at his caddy, then takes his driver and throws it at his feet, blaming it for his poor swing. Notably, the golfer had had a long fight with his wife last night over problems with family finances. The golfer's actions on the course represent which type of defense mechanism?
- A. Isolation of affect
- B. Repression
- C. Displacement (Correct Answer)
- D. Sublimation
- E. Rationalization
Alternative treatments for anxiety Explanation: ***Displacement***
- **Displacement** is a defense mechanism where a person redirects strong emotions, often anger, from the original source to a less threatening target. The golfer's anger regarding family finances is redirected from his wife to his caddy and golf club.
- The anger stemming from his domestic dispute is **displaced** onto unrelated targets (caddy, golf club) during the golf game.
*Isolation of affect*
- **Isolation of affect** involves experiencing an event without the associated emotion. The individual intellectually understands the situation but does not feel the emotional impact.
- In this scenario, the golfer is clearly expressing strong emotions (anger, yelling), which is contrary to the concept of isolating affect.
*Repression*
- **Repression** is an unconscious defense mechanism where unacceptable thoughts, feelings, or memories are buried in the unconscious mind to avoid distress.
- The golfer is actively expressing his anger and frustration, indicating that these emotions are not being repressed but rather expressed in an inappropriate manner.
*Sublimation*
- **Sublimation** is a mature defense mechanism where unacceptable impulses or feelings are transformed into socially acceptable behaviors or achievements.
- The golfer's aggressive and destructive behavior (throwing the club, yelling) is not a constructive or socially acceptable transformation of his impulses.
*Rationalization*
- **Rationalization** involves creating logical or socially acceptable explanations for behaviors or feelings that are actually driven by unacceptable impulses.
- While blaming the club may seem like an attempt to rationalize his poor swing, the primary mechanism at play is the redirection of underlying anger from his conflict with his wife, which is characteristic of displacement.
Alternative treatments for anxiety US Medical PG Question 3: Please refer to the summary above to answer this question
Which of the following is the most appropriate pharmacotherapy?
Patient Information
Age: 30 years
Gender: F, self-identified
Ethnicity: unspecified
Site of Care: office
History
Reason for Visit/Chief Concern: "I'm so anxious about work."
History of Present Illness:
7-month history of sensation that her heart is racing whenever she gives oral presentations at work
she has also had moderate axillary sweating during these presentations and feels more anxious and embarrassed when this happens
feels otherwise fine when she is interacting with her colleagues more casually around the workplace
Past Medical History:
alcohol use disorder, now abstinent for the past 2 years
acute appendicitis, treated with appendectomy 5 years ago
verrucae planae
Medications:
disulfiram, folic acid, topical salicylic acid
Allergies:
no known drug allergies
Psychosocial History:
does not smoke, drink alcohol, or use illicit drugs
Physical Examination
Temp Pulse Resp BP O2 Sat Ht Wt BMI
36.7°C
(98°F)
82/min 18/min 115/72 mm Hg –
171 cm
(5 ft 7 in)
58 kg
(128 lb)
20 kg/m2
Appearance: no acute distress
Pulmonary: clear to auscultation
Cardiac: regular rate and rhythm; normal S1 and S2; no murmurs
Abdominal: has well-healed laparotomy port scars; no tenderness, guarding, masses, bruits, or hepatosplenomegaly
Extremities: no tenderness to palpation, stiffness, or swelling of the joints; no edema
Skin: warm and dry; there are several skin-colored, flat-topped papules on the dorsal bilateral hands
Neurologic: alert and oriented; cranial nerves grossly intact; no focal neurologic deficits
Psychiatric: describes her mood as "okay"; speech has a rapid rate but normal rhythm; thought process is organized
- A. Clonazepam
- B. Olanzapine
- C. Sertraline
- D. Venlafaxine
- E. Propranolol (Correct Answer)
Alternative treatments for anxiety Explanation: ***Propranolol***
- This patient presents with symptoms consistent with **performance anxiety** (situational anxiety triggered by public speaking) characterized by a racing heart and sweating. **Propranolol**, a non-selective beta-blocker, is effective in reducing the peripheral physical symptoms of anxiety by blocking adrenergic receptors.
- It works by blunting the **physical manifestations of sympathetic nervous system** activation (e.g., palpitations, tremors, sweating), which can be particularly distressing during performance situations.
*Clonazepam*
- **Clonazepam** is a long-acting benzodiazepine that can be used for anxiety but carries a significant risk of **dependence, tolerance, and withdrawal symptoms**, especially given the patient's history of alcohol use disorder.
- While effective for acute anxiety, its use in performance anxiety should be cautious due to side effects like **sedation** and potential for abuse, making it less appropriate as a first-line treatment in this specific context.
*Olanzapine*
- **Olanzapine** is an atypical antipsychotic primarily used for **schizophrenia** and **bipolar disorder**, or as an augmentation strategy for severe, refractory mood or anxiety disorders.
- Its side effect profile, which includes **metabolic issues** and sedation, makes it an inappropriate choice for treating isolated performance anxiety.
*Sertraline*
- **Sertraline** is an **SSRI** (selective serotonin reuptake inhibitor) often used for generalized anxiety disorder, panic disorder, or social anxiety disorder when symptoms are pervasive and persistent.
- However, for **situational performance anxiety**, which is intermittent and triggered by specific events, SSRIs typically require several weeks to achieve therapeutic effects and are not ideal for immediate symptom relief.
*Venlafaxine*
- **Venlafaxine** is an **SNRI** (serotonin-norepinephrine reuptake inhibitor) indicated for various anxiety disorders, including generalized anxiety disorder and social anxiety disorder.
- Similar to SSRIs, SNRIs take time to become effective and are generally reserved for more **chronic and widespread anxiety**, rather than acute, situational symptoms that can be effectively managed by a beta-blocker.
Alternative treatments for anxiety US Medical PG Question 4: A 24-year-old male comes into the psychiatric clinic complaining of consistent sadness. He endorses feelings of worthlessness, anxiety, and anhedonia for the past couple months but denies feeling suicidal. He further denies any past episodes of feeling overly energetic with racing thoughts. Confident of the diagnosis, you recommend frequent talk therapy along with a long-term prescription of a known first-line medication for this disorder. What is the drug and what are some of the most frequently encountered side effects?
- A. Selective serotonin reuptake inhibitor; hypomania, suicidal thoughts
- B. Tricyclic antidepressants; hypomania, suicidal thoughts
- C. Selective serotonin reuptake inhibitor; anorgasmia, insomnia (Correct Answer)
- D. Monoamine oxidase inhibitors; Orthostatic hypotension, weight gain
- E. Tricyclic antidepressants; Orthostatic hypotension, anticholinergic effects
Alternative treatments for anxiety Explanation: ***Selective serotonin reuptake inhibitor; anorgasmia, insomnia***
- The patient presents with classic symptoms of **major depressive disorder**, including persistent sadness, worthlessness, anxiety, and anhedonia, without any history of manic or hypomanic episodes. **SSRIs** are considered first-line pharmacotherapy for this condition.
- Common side effects of SSRIs include **sexual dysfunction** (e.g., anorgasmia, decreased libido) and **insomnia** or agitation, especially during the initial weeks of treatment.
*Selective serotonin reuptake inhibitor; hypomania, suicidal thoughts*
- While SSRIs are the correct drug class, **hypomania** is not a frequent side effect in patients without bipolar disorder. For patients with bipolar disorder, antidepressant monotherapy can induce hypomania or mania, but this patient denies such episodes.
- **Suicidal thoughts** can occur, particularly in young adults, during the initial phase of antidepressant treatment, but it is less common to frame it as a *frequently encountered side effect* in the general population compared to sexual dysfunction or sleep disturbances.
*Tricyclic antidepressants; hypomania, suicidal thoughts*
- **Tricyclic antidepressants (TCAs)** are generally not first-line due to their less favorable side effect profile compared to SSRIs, including significant anticholinergic effects and cardiovascular risks.
- As with SSRIs, **hypomania** is not a typical frequent side effect in unipolar depression, and while **suicidal thoughts** are a concern with antidepressants, TCAs carry a higher risk of lethality in overdose, making them less preferred initially.
*Monoamine oxidase inhibitors; Orthostatic hypotension, weight gain*
- **Monoamine oxidase inhibitors (MAOIs)** are effective but are typically reserved for **refractory depression** due to their significant drug and food interactions (e.g., tyramine-induced hypertensive crisis).
- While **orthostatic hypotension** and **weight gain** are known side effects of MAOIs, this class is not considered a first-line treatment for major depressive disorder.
*Tricyclic antidepressants; Orthostatic hypotension, anticholinergic effects*
- **TCAs** are indeed associated with side effects such as **orthostatic hypotension** and prominent **anticholinergic effects** (e.g., dry mouth, constipation, blurred vision, urinary retention).
- However, because of these more burdensome side effects and higher toxicity in overdose, TCAs are not generally considered the first-line medication choice, especially when SSRIs are available and safer.
Alternative treatments for anxiety US Medical PG Question 5: A 26-year-old woman presents with an 8-month history of insomnia and anxiety. She says that she has difficulty sleeping and has feelings of impending doom linked to her difficult financial situation. No significant family history and no current medications. The patient was prescribed an 8-week supply of medication. She follows up 4 weeks later saying that she has increased anxiety and needs a refill. She says that over the past month, due to increasing anxiety levels, she started taking extra doses of her medication to achieve an anxiolytic effect. Which of the following medications was most likely prescribed to this patient?
- A. Triazolam (Correct Answer)
- B. Hydroxyzine
- C. Zolpidem
- D. Buspirone
- E. Propranolol
Alternative treatments for anxiety Explanation: ***Triazolam***
- Triazolam is a **short-acting benzodiazepine** commonly prescribed for insomnia, but its rapid onset and short duration can lead to **rebound anxiety** and dependence with chronic use, as seen with the patient's increased anxiety and need for a refill.
- The patient's need to take "extra doses...to achieve an anxiolytic effect" suggests the development of **tolerance** and dependence, which is characteristic of benzodiazepine misuse.
*Hydroxyzine*
- Hydroxyzine is a **first-generation antihistamine** with sedative and anxiolytic properties, often used for anxiety and insomnia due to its relatively low abuse potential.
- It does not typically cause the **rapid tolerance** and withdrawal symptoms (like increased anxiety needing extra doses) seen with benzodiazepines.
*Zolpidem*
- Zolpidem is a **non-benzodiazepine hypnotic** (Z-drug) that acts on GABA-A receptors and is commonly prescribed for insomnia.
- While it has **lower dependence potential** than benzodiazepines, the patient's presentation with rapid tolerance development and dose escalation for anxiolytic effect is more characteristic of **benzodiazepine use** rather than zolpidem, which primarily provides sedation without strong anxiolytic effects.
*Buspirone*
- Buspirone is an **anxiolytic** that works on serotonin receptors and is used for generalized anxiety disorder, but it has a **delayed onset of action** (weeks) and lacks the immediate anxiolytic effect that would lead to acute dose escalation.
- It has a **low potential for abuse** or dependence, making it an unlikely choice for a patient rapidly escalating doses for an immediate effect.
*Propranolol*
- Propranolol is a **beta-blocker** used to manage the physical symptoms of anxiety (e.g., tremors, palpitations), but it does not directly treat the psychological symptoms of anxiety or insomnia.
- It is not associated with **tolerance, dependence**, or the need for dose escalation to achieve an anxiolytic effect.
Alternative treatments for anxiety US Medical PG Question 6: A 35-year-old man comes to the Veterans Affairs hospital because of a 2-month history of anxiety. He recently returned from his third deployment to Iraq, where he served as a combat medic. He has had difficulty readjusting to civilian life. He works as a taxi driver but had to take a leave of absence because of difficulties with driving. Last week, he hit a stop sign because he swerved out of the way of a grocery bag that was in the street. He has difficulty sleeping because of nightmares about the deaths of some of the other soldiers in his unit and states, “it's my fault, I could have saved them. Please help me.” Mental status examination shows a depressed mood and a restricted affect. There is no evidence of suicidal ideation. Which of the following is the most appropriate initial step in treatment?
- A. Dialectical behavioral therapy
- B. Venlafaxine therapy
- C. Cognitive behavioral therapy (Correct Answer)
- D. Motivational interviewing
- E. Prazosin therapy
Alternative treatments for anxiety Explanation: ***Cognitive behavioral therapy***
- **Cognitive Behavioral Therapy (CBT)** is considered a first-line psychological treatment for **Post-Traumatic Stress Disorder (PTSD)**, which the patient's symptoms (deployments, intrusive thoughts, nightmares, avoidance, guilt) strongly suggest.
- CBT helps individuals identify and challenge **maladaptive thought patterns** and behaviors related to the trauma, fostering new coping mechanisms.
*Dialectical behavioral therapy*
- **Dialectical Behavioral Therapy (DBT)** is primarily used for individuals with **Borderline Personality Disorder** or severe emotional dysregulation.
- While it can help with emotional regulation, it is not the **first-line therapy** specifically targeting trauma-related cognitive distortions and avoidance behaviors seen in PTSD.
*Venlafaxine therapy*
- **Venlafaxine**, an SNRI, is an antidepressant that can be effective for PTSD symptoms. However, current guidelines recommend **psychotherapy (like CBT)** as the initial step, especially when feasible.
- While pharmacotherapy can be used, it's typically considered **adjunctive** or for cases where psychotherapy alone is insufficient or not preferred.
*Motivational interviewing*
- **Motivational interviewing** is a patient-centered counseling style used to address ambivalence and enhance a person's **intrinsic motivation** for change.
- It is often utilized in substance abuse treatment or when patients are resistant to treatment, but it is not a primary, standalone treatment for the core symptoms of PTSD.
*Prazosin therapy*
- **Prazosin** is an alpha-1 antagonist used off-label to treat **PTSD-related nightmares** and sleep disturbances.
- While it can be helpful for a specific symptom, it does not address the broader spectrum of PTSD symptoms, such as intrusive thoughts, avoidance, or negative cognitions.
Alternative treatments for anxiety US Medical PG Question 7: A 33-year-old man visits his psychiatrist with feelings of sadness on most days of the week for the past 4 weeks. He says that he is unable to participate in his daily activities and finds it hard to get out of bed on most days. If he has nothing scheduled for the day, he sometimes sleeps for 10–12 hours at a stretch. He has also noticed that on certain days, his legs feel heavy and he finds it difficult to walk, as though there are bricks tied to his feet. However, he is still able to attend social events and also enjoys playing with his children when he comes home from work. Other than these simple pleasures, he has lost interest in most of the activities he previously enjoyed. Another troubling fact is that he had gained weight over the past month, mainly because he eats so much when overcome by these feelings of depression. His is prescribed a medication to treat his symptoms. Which of the following is the mechanism of action of the drug he was most likely prescribed?
- A. Activates the γ-aminobutyric acid receptors
- B. Inhibit the uptake of serotonin and norepinephrine at the presynaptic cleft (Correct Answer)
- C. Works as an antagonist at the dopamine and serotonin receptors
- D. Non-selectively inhibits monoamine oxidase A and B
- E. Stimulates the release of norepinephrine and dopamine in the presynaptic cleft
Alternative treatments for anxiety Explanation: ***Inhibit the uptake of serotonin and norepinephrine at the presynaptic cleft***
- The patient presents with symptoms characteristic of **atypical depression**, including increased sleep (**hypersomnia**), increased appetite leading to weight gain, **leaden paralysis** (heavy feelings in the limbs), and **mood reactivity** (enjoying social events/playing with children).
- For initial treatment of atypical depression, **SSRIs** (e.g., fluoxetine, sertraline) and **SNRIs** (e.g., venlafaxine, duloxetine) are considered **first-line therapies** due to their favorable safety profile and efficacy.
- **SNRIs** address both serotonin and norepinephrine imbalances and are effective for atypical depression, particularly when there is significant fatigue or pain.
*Activates the γ-aminobutyric acid receptors*
- This mechanism describes **benzodiazepines** or other GABAergic drugs, which are typically used for anxiety, insomnia, or acute agitation.
- While they can provide symptomatic relief for anxiety associated with depression, they do not target the core depressive symptoms, lack antidepressant efficacy, and carry risk of dependence.
*Works as an antagonist at the dopamine and serotonin receptors*
- This mechanism describes **second-generation antipsychotics** (e.g., quetiapine, aripiprazole), which are primarily used to treat psychotic disorders or as adjuncts in severe depression with psychotic features or treatment-resistant depression.
- The patient's symptoms do not suggest psychotic features, and antipsychotics are not first-line treatment for uncomplicated atypical depression.
*Non-selectively inhibits monoamine oxidase A and B*
- This describes **non-selective MAOIs** (e.g., phenelzine, tranylcypromine), which are considered the **most effective** antidepressants for atypical depression based on clinical trials.
- However, MAOIs are typically reserved for **treatment-resistant depression** due to their significant side effect profile, dietary restrictions (tyramine-free diet to prevent **hypertensive crisis**), and drug interaction risks.
- Given this is an initial presentation without treatment failure, MAOIs would not be the first-line choice despite their superior efficacy.
*Stimulates the release of norepinephrine and dopamine in the presynaptic cleft*
- This mechanism could describe **amphetamines** or certain **wake-promoting agents**, which are not standard antidepressant treatments.
- **Bupropion** (an antidepressant) inhibits reuptake of norepinephrine and dopamine but does not directly stimulate their release.
- Stimulants are occasionally used as adjuncts for treatment-resistant depression but are not first-line monotherapy due to abuse potential and limited evidence for long-term efficacy in depression.
Alternative treatments for anxiety US Medical PG Question 8: A 65-year-old woman presents with memory problems for the past few weeks. Patient vividly describes how she forgot where she put her car keys this morning and did not remember to wish her grandson a happy birthday last week. Patient denies any cognitive problems, bowel/bladder incontinence, tremors, gait problems, or focal neurologic signs. Patient mentions she wants to take Ginkgo because her friend told her that it can help improve her brain function and prevent memory loss. Past medical history is significant for an acute cardiac event several years ago. Current medications are aspirin, carvedilol, and captopril. Patient denies any history of smoking, alcohol or recreational drug use. Patient is a widow, lives alone, and is able to perform all activities of daily living (ADLs) easily. No significant family history. Patient is afebrile and vital signs are within normal limits. Physical examination is unremarkable. Which of the following would be the most appropriate response to this patient’s request to take Ginkgo?
- A. "Yes, ginkgo is widely used for improving brain function and memory."
- B. “No, you have Alzheimer's disease and need to start donepezil.”
- C. “No, herbal preparations are unsafe because they are not regulated by the FDA.”
- D. "No, taking ginkgo will increase your risk for bleeding." (Correct Answer)
- E. Yes, ginkgo may not help with your memory, but there is no risk of adverse events so it is safe to take.
Alternative treatments for anxiety Explanation: ***"No, taking ginkgo will increase your risk for bleeding."***
- **Ginkgo biloba** has known antithrombotic effects due to its inhibition of platelet-activating factor, which can increase the risk of **bleeding**, especially when combined with other antithrombotic agents like **aspirin**, which this patient is taking.
- Given her history of a cardiac event and current aspirin use, adding ginkgo would significantly raise her risk of hemorrhagic complications.
*"Yes, ginkgo is widely used for improving brain function and memory."*
- While ginkgo is popularly marketed for cognitive enhancement, there is **insufficient scientific evidence** to support its effectiveness in improving memory or preventing cognitive decline.
- Recommending it based solely on popular belief disregards evidence-based medicine and potential patient risks.
*"No, you have Alzheimer's disease and need to start donepezil.”*
- This is an inappropriate response as a diagnosis of **Alzheimer's disease** cannot be made based solely on the patient's self-reported memory issues; a comprehensive workup is required.
- Additionally, immediately prescribing **donepezil** without a confirmed diagnosis and without discussing potential risks or alternatives is premature and goes against diagnostic protocols.
*"No, herbal preparations are unsafe because they are not regulated by the FDA."*
- While it's true that **herbal preparations** are not regulated by the FDA in the same way as prescription drugs, labeling all such preparations as "unsafe" is an **overgeneralization**.
- The primary concern here is not just the lack of FDA regulation, but the specific **pharmacological interaction** of ginkgo with her current medications.
*"Yes, ginkgo may not help with your memory, but there is no risk of adverse events so it is safe to take."*
- This statement is incorrect because, as explained, ginkgo carries a significant **risk of adverse events**, particularly **increased bleeding risk**, especially in this patient due to her concomitant aspirin use.
- It is critical to acknowledge and address potential drug interactions and side effects, rather than dismissing them.
Alternative treatments for anxiety US Medical PG Question 9: A 42-year-old female complains of feeling anxious and worrying about nearly every aspect of her daily life. She cannot identify a specific cause for these symptoms and admits that this tension is accompanied by tiredness and difficulty falling asleep. To treat this problem, the patient is prescribed sertraline. She endorses a mild improvement with this medication, and over the next several months, her dose is increased to the maximum allowed dose with modest improvement. Her psychiatrist adds an adjunctive treatment, a medication which notably lacks any anticonvulsant or muscle relaxant properties. This drug most likely acts at which of the following receptors?
- A. Beta adrenergic receptor
- B. 5HT-1A receptor (Correct Answer)
- C. GABA receptor
- D. Alpha adrenergic receptor
- E. Glycine receptor
Alternative treatments for anxiety Explanation: ***5HT-1A receptor***
- The patient's presentation of generalized anxiety disorder, treated with an SSRI (sertraline) and an adjunctive medication that lacks anticonvulsant or muscle relaxant properties, points to **buspirone**.
- **Buspirone** is a 5HT-1A partial agonist, commonly used as an augmenting agent in anxiety disorders, which explains the mechanism of action.
*Beta adrenergic receptor*
- Medications acting on **beta-adrenergic receptors** (e.g., propranolol) are typically used for situational anxiety or performance anxiety, not generalized anxiety disorder, and they primarily reduce physical symptoms like palpitations and tremors.
- While beta-blockers lack anticonvulsant or muscle relaxant properties, they are not typically considered a first-line adjunctive therapy for generalized anxiety after an SSRI failure.
*GABA receptor*
- Drugs acting on **GABA receptors** (e.g., benzodiazepines) are known for their anxiolytic, sedative, anticonvulsant, and muscle relaxant properties.
- The question explicitly states that the adjunctive medication "notably lacks any anticonvulsant or muscle relaxant properties," ruling out GABAergic drugs.
*Alpha adrenergic receptor*
- Medications targeting **alpha-adrenergic receptors** (e.g., clonidine) are sometimes used for anxiety associated with opiate withdrawal or PTSD, but are not a common adjunctive treatment for generalized anxiety disorder in this context.
- While they may lack anticonvulsant or muscle relaxant properties, their primary mechanism involves regulating sympathetic outflow rather than the specific mood and cognitive symptoms of GAD.
*Glycine receptor*
- The **glycine receptor** is an inhibitory ion channel, primarily found in the spinal cord and brainstem, involved in motor control and pain processing.
- Agonists of this receptor are not commonly used to treat anxiety disorders, and the described clinical scenario does not align with its therapeutic applications.
Alternative treatments for anxiety US Medical PG Question 10: A goalkeeper of a famous soccer team gives an interview with a health agency regarding his childhood. He describes how when he was a child, he would constantly clear his throat in class and the teachers would write a note to his mother with advice to go see an ENT doctor. He complained of being restless, fidgety, and sometimes hyperactive in class, disrupting the environment and causing him many social problems. He would blurt out the answer at times and keep repeating it without any control, leading to some embarrassing timeouts. But he was always nice to his teachers, so he calls it a “benign frustration” rather than aggressively causing distress. He also talked about how his symptoms were dramatically improved with medication. Which of the following is an FDA approved drug for this patient’s most likely condition?
- A. Lithium
- B. Clonazepam
- C. Haloperidol (Correct Answer)
- D. Clonidine
- E. Guanfacine
Alternative treatments for anxiety Explanation: ***Haloperidol***
- The patient's presentation of constant throat clearing (**motor tics**), blurting out answers and repeating words (**vocal tics**), along with restlessness and hyperactivity, is highly suggestive of **Tourette syndrome**.
- **Haloperidol** is one of the **FDA-approved medications** specifically for Tourette syndrome, along with pimozide and aripiprazole.
- It is a **typical antipsychotic** that effectively treats severe tics through **dopamine D2 receptor blockade**, particularly in the nigrostriatal pathway.
- It remains a gold standard treatment despite potential extrapyramidal side effects.
*Lithium*
- **Lithium** is a **mood stabilizer** used primarily for **bipolar disorder** through its effects on intracellular signaling pathways.
- It has no role in treating Tourette syndrome or tic disorders and is not FDA-approved for this indication.
*Clonazepam*
- **Clonazepam** is a **benzodiazepine** with **GABAergic effects** used for **anxiety disorders**, **panic disorder**, and certain seizure disorders.
- While it may help with comorbid anxiety, it is not a primary treatment for tics and is **not FDA-approved** for Tourette syndrome.
*Clonidine*
- **Clonidine** is an **alpha-2 adrenergic agonist** that can reduce tics, particularly in children with mild to moderate symptoms or comorbid ADHD.
- However, it is **off-label** for Tourette syndrome and not FDA-approved for this indication, though commonly used as a second-line agent.
*Guanfacine*
- **Guanfacine** is also an **alpha-2 adrenergic agonist** similar to clonidine, used primarily for ADHD.
- It may help with tics in an **off-label capacity**, especially when ADHD is comorbid, but it is **not FDA-approved** specifically for Tourette syndrome.
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