Pharmacotherapy for anxiety disorders US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Pharmacotherapy for anxiety disorders. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Pharmacotherapy for anxiety disorders US Medical PG Question 1: A 42-year-old man comes to the emergency department complaining of chest pain. He states that he was at the grocery store when he developed severe, burning chest pain along with palpitations and nausea. He screamed for someone to call an ambulance. He says this has happened before, including at least 4 episodes in the past month that were all in different locations including once at home. He is worried that it could happen at work and affect his employment status. He has no significant past medical history, and reports that he does not like taking medications. He has had trouble in the past with compliance due to side effects. The patient’s temperature is 98.9°F (37.2°C), blood pressure is 133/74 mmHg, pulse is 110/min, and respirations are 20/min with an oxygen saturation of 99% on room air. On physical examination, the patient is tremulous and diaphoretic. He continually asks to be put on oxygen and something for his pain. An electrocardiogram is obtained that shows tachycardia. Initial troponin level is negative. A urine drug screen is negative. Thyroid stimulating hormone and free T4 levels are normal. Which of the following is first line therapy for the patient for long-term management?
- A. Cognitive behavioral therapy (Correct Answer)
- B. Alprazolam
- C. Imipramine
- D. Fluoxetine
- E. Buspirone
Pharmacotherapy for anxiety disorders Explanation: ***Cognitive behavioral therapy***
- This patient's symptoms are highly suggestive of **panic disorder**, characterized by recurrent, unexpected panic attacks and persistent worry about future attacks. **Cognitive behavioral therapy (CBT)** is considered **first-line treatment** for panic disorder, especially for long-term management, as it addresses the underlying thought patterns and behaviors.
- CBT, particularly exposure therapy, helps patients **reframe their catastrophic thoughts** and directly confront situations that trigger anxiety, leading to a significant reduction in panic attack frequency and severity. It is a good choice for this patient since he has had problems with medication compliance.
*Alprazolam*
- **Alprazolam** is a **benzodiazepine** that provides rapid symptom relief during acute panic attacks but is generally not recommended as first-line for long-term management due to its **potential for dependence**, tolerance, and withdrawal symptoms.
- Its short half-life can lead to rebound anxiety, and it does not address the underlying cognitive distortions common in panic disorder.
*Imipramine*
- **Imipramine** is a **tricyclic antidepressant (TCA)** that can be effective for panic disorder, but it is **not generally a first-line pharmacotherapy** due to its more significant side effect profile (e.g., anticholinergic effects, cardiac toxicity in overdose) compared to SSRIs.
- The patient's history of medication non-compliance due to side effects makes this a less suitable long-term option compared to CBT.
*Fluoxetine*
- **Fluoxetine** is a **selective serotonin reuptake inhibitor (SSRI)**, which is often considered first-line pharmacotherapy for panic disorder due to its efficacy and generally favorable side effect profile. However, given the patient's strong preference against medication and history of non-compliance, CBT would be the preferred initial long-term strategy.
- While effective, SSRIs generally take several weeks to reach full therapeutic effect, and the patient may still experience initial side effects, further contributing to potential non-compliance.
*Buspirone*
- **Buspirone** is an **anxiolytic** that is effective for generalized anxiety disorder but is **not considered first-line for panic disorder**.
- It has a slower onset of action and is typically less effective in treating the acute, intense symptoms of panic attacks compared to other agents.
Pharmacotherapy for anxiety disorders US Medical PG Question 2: A 27-year-old woman presents to the psychiatrist due to feelings of sadness for the past 3 weeks. She was let go from her job 1 month ago, and she feels as though her whole life is coming to an end. She is unable to sleep well at night and also finds herself crying at times during the day. She has not been able to eat well and has been losing weight as a result. She has no will to go out and meet with her friends, who have been extremely supportive during this time. Her doctor gives her an antidepressant which blocks the reuptake of both serotonin and norepinephrine to help with these symptoms. One week later, she is brought to the emergency room by her friends who say that she was found to be in a state of euphoria. They mention bizarre behavior, one of which is booking a plane ticket to New York, even though she has 3 interviews lined up the same week. Her words cannot be understood as she is speaking very fast, and she is unable to sit in one place for the examination. Which of the following was most likely prescribed by her psychiatrist?
- A. Bupropion
- B. Venlafaxine (Correct Answer)
- C. Sertraline
- D. Fluvoxamine
- E. Lithium
Pharmacotherapy for anxiety disorders Explanation: ***Venlafaxine***
- The patient's presentation of depression followed by a rapid shift to **euphoria**, **bizarre behavior**, **rapid speech**, and **psychomotor agitation** after starting an antidepressant strongly suggests **antidepressant-induced mania**.
- This response is characteristic of an underlying **bipolar disorder** unmasked by an antidepressant, particularly a **serotonin-norepinephrine reuptake inhibitor (SNRI)** like venlafaxine.
*Bupropion*
- Bupropion is a **norepinephrine-dopamine reuptake inhibitor (NDRI)**, not an SNRI, and is less commonly associated with inducing mania compared to SNRIs or SSRIs in vulnerable individuals.
- While it can be activating, its specific mechanism primarily targets dopamine and norepinephrine, with less direct serotonin reuptake blockade.
*Sertraline*
- Sertraline is a **selective serotonin reuptake inhibitor (SSRI)**, which primarily blocks serotonin reuptake.
- While SSRIs can induce mania in patients with undiagnosed bipolar disorder, the question specifically states the doctor prescribed an antidepressant that blocks the reuptake of **both serotonin and norepinephrine**.
*Fluvoxamine*
- Fluvoxamine is also a **selective serotonin reuptake inhibitor (SSRI)**, primarily targeting serotonin, not both serotonin and norepinephrine.
- As with other SSRIs, it can induce manic episodes in vulnerable individuals, but it does not fit the description of the prescribed drug's mechanism of action.
*Lithium*
- Lithium is a **mood stabilizer** primarily used for the treatment of bipolar disorder and prevention of manic/depressive episodes, not an antidepressant.
- It would be contraindicated as a first-line treatment for what initially presented as unipolar depression and is used to *treat* rather than *induce* mania.
Pharmacotherapy for anxiety disorders US Medical PG Question 3: An 8-year-old boy is brought to the emergency department by his parents 30 minutes after losing consciousness. He was at a water park with his family when he fell to the ground and started to have jerking movements of the arms and legs. On arrival, he continues to have generalized, violent muscle contractions and is unresponsive to verbal and painful stimuli. The emergency department physician administers lorazepam. The expected beneficial effect of this drug is most likely caused by which of the following mechanisms?
- A. Increased affinity of GABAA receptors for GABAB agonists
- B. Noncompetitive NMDA receptor antagonism
- C. Increased duration of chloride channel opening
- D. Allosteric activation of GABAA receptors (Correct Answer)
- E. Inhibition of GABA transaminase
Pharmacotherapy for anxiety disorders Explanation: ***Allosteric activation of GABAA receptors***
- **Lorazepam** is a **benzodiazepine** that acts as a positive allosteric modulator of the **GABAA receptor**.
- This binding enhances the effect of **GABA**, leading to increased frequency of **chloride channel opening** and neuronal hyperpolarization, which ultimately suppresses seizure activity.
*Increased affinity of GABAA receptors for GABAB agonists*
- This statement is incorrect because lorazepam acts on **GABAA receptors** and does not increase the affinity for **GABAB agonists**.
- **GABAB agonists** like baclofen act on a different receptor subtype and have a distinct mechanism of action.
*Noncompetitive NMDA receptor antagonism*
- This mechanism describes drugs like **ketamine** or **phencyclidine (PCP)**, which block the **NMDA receptor** to produce anesthetic or dissociative effects.
- Lorazepam's primary action is on the **GABAA receptor**, not the **NMDA receptor**.
*Increased duration of chloride channel opening*
- While benzodiazepines increase chloride influx, they primarily do so by increasing the **frequency** of **chloride channel opening**, not the duration.
- **Barbiturates**, such as phenobarbital, are known to increase the **duration** of chloride channel opening.
*Inhibition of GABA transaminase*
- **GABA transaminase** is an enzyme responsible for GABA metabolism. Its inhibition would lead to increased GABA levels in the synapse.
- **Valproic acid** is an example of an antiepileptic drug that inhibits **GABA transaminase**, but this is not the mechanism of action for lorazepam.
Pharmacotherapy for anxiety disorders US Medical PG Question 4: 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)
Pharmacotherapy for anxiety disorders 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.
Pharmacotherapy for anxiety disorders US Medical PG Question 5: A 33-year-old woman presents with lethargy and neck pain. She says that, for the past 6 months, she has been feeling tired all the time and has noticed a lot of muscle tension around the base of her neck. She also says she finds herself constantly worrying about everything, such as if her registered mail would reach family and friends in time for the holidays or if the children got their nightly bath while she was away over the weekend. She says that this worrying has prevented her from sleeping at night and has made her more irritable and edgy with her family and friends. Which of the following is the best course of treatment for this patient?
- A. Support groups
- B. A vacation
- C. Diazepam
- D. Family therapy
- E. Buspirone (Correct Answer)
Pharmacotherapy for anxiety disorders Explanation: ***Buspirone***
- **Buspirone** is a non-benzodiazepine anxiolytic agent. It is often preferred for long-term management of **generalized anxiety disorder (GAD)** due to its favorable side effect profile and lack of dependence potential, addressing the patient's chronic symptoms effectively.
- Unlike benzodiazepines, buspirone does not cause sedation or withdrawal symptoms, making it suitable for a patient experiencing prolonged anxiety, sleep disturbances, and irritability.
*Support groups*
- While **support groups** can provide emotional support and coping strategies, they are typically used as an adjunct to pharmacotherapy or psychotherapy, not as a primary standalone treatment for moderate to severe GAD.
- This patient's symptoms (lethargy, significant muscle tension, chronic worrying, sleep disturbance) suggest a need for a more direct pharmacological intervention to alleviate her symptoms.
*A vacation*
- A vacation might offer temporary relief from stress but will not address the underlying physiological and psychological components of her **generalized anxiety disorder**.
- Her chronic and pervasive worrying, along with physical symptoms, indicates a need for sustained medical management.
*Diazepam*
- **Diazepam** is a benzodiazepine that provides rapid, short-term relief from anxiety, but it is generally not recommended for long-term management due to the risks of **dependence, tolerance, and withdrawal symptoms**, especially in a patient with chronic symptoms.
- Given the patient's 6-month history of symptoms, a medication with a better long-term safety profile is preferred.
*Family therapy*
- **Family therapy** could be beneficial if family dynamics are a significant contributor to her stress or if her symptoms are impacting family relationships negatively. However, it does not directly address the primary diagnosis of generalized anxiety disorder with its constellation of chronic symptoms.
- While it may provide some support, it is not the initial best course of treatment for the patient's core anxiety symptoms.
Pharmacotherapy for anxiety disorders US Medical PG Question 6: A 45-year-old man has a history of smoking 1 pack per day and drinking a six-pack of beer daily over the last ten years. He is admitted to the medical floor after undergoing a cholecystectomy. One day after the surgery, the patient states that he feels anxious and that his hands are shaking. While being checked for a clean surgical site, the patient starts shaking vigorously and loses consciousness. The patient groans and falls to the floor. His arms and legs begin to jerk rapidly and rhythmically. This episode lasts for almost five minutes, and the patient's airway, breathing, and circulation are stabilized per seizure protocol. What is the best next step for this patient?
- A. Antibiotics
- B. Morphine
- C. Chest radiograph
- D. Urinalysis
- E. Lorazepam (Correct Answer)
Pharmacotherapy for anxiety disorders Explanation: ***Lorazepam***
- The patient exhibits classic signs of **alcohol withdrawal syndrome**, including anxiety, tremors, and a generalized tonic-clonic seizure, which is a medical emergency.
- **Benzodiazepines** like lorazepam are the first-line treatment for alcohol withdrawal seizures due to their ability to potentiate **GABA** (gamma-aminobutyric acid) and stabilize neuronal hyperactivity.
*Antibiotics*
- There is no clinical indication for infection in this patient's presentation; the symptoms are clearly related to **alcohol withdrawal**.
- Administering antibiotics without evidence of infection contributes to **antibiotic resistance** and potential side effects.
*Morphine*
- **Opioids** like morphine can depress the respiratory system and do not address the underlying pathophysiology of alcohol withdrawal seizures.
- Administering morphine could worsen the patient's condition by masking symptoms or increasing the risk of respiratory compromise.
*Chest radiograph*
- A chest radiograph is primarily used to evaluate **pulmonary pathology** like pneumonia or aspiration, which are not the immediate concerns given the seizure and alcohol history.
- While aspiration is a risk during seizures, the immediate priority is to stop the ongoing seizure and address the underlying cause.
*Urinalysis*
- A urinalysis is used to detect urinary tract infections, kidney disease, or metabolic abnormalities, none of which are suggested by the patient's acute presentation of seizures and withdrawal symptoms.
- While it may be part of a broader workup, it is not the most urgent next step for an ongoing or recent seizure due to alcohol withdrawal.
Pharmacotherapy for anxiety disorders US Medical PG Question 7: A 30-year-old woman presents to her family doctor requesting sleeping pills. She is a graduate student and confesses that she is a “worry-a-holic,” which has been getting worse for the last 6 months as the due date for her final paper is approaching. During this time, she feels more on edge, irritable, and is having difficulty sleeping. She has already tried employing good sleep hygiene practices, including a switch to non-caffeinated coffee. Her past medical history is significant for depression in the past that was managed medically. No current medications. The patient’s family history is significant for her mother who has a panic disorder. Her vital signs are within normal limits. Physical examination reveals a mildly anxious patient but is otherwise normal. Which of the following is the most effective treatment for this patient’s condition?
- A. Buspirone (Correct Answer)
- B. Diazepam
- C. Desensitization therapy
- D. Relaxation training
- E. Bupropion
Pharmacotherapy for anxiety disorders Explanation: ***Buspirone***
- This patient's symptoms of **generalized anxiety** (excessive worry, difficulty sleeping, irritability, on edge for 6 months) without panic attacks or phobias, and a history of depression, make buspirone a suitable choice.
- **Buspirone** is a non-benzodiazepine anxiolytic that is effective for **generalized anxiety disorder** and has a lower risk of dependence compared to benzodiazepines, making it a good option for chronic use.
*Diazepam*
- **Diazepam** is a benzodiazepine, primarily used for acute anxiety or short-term management due to its **rapid onset of action**.
- Its potential for **dependence and withdrawal symptoms** makes it less ideal for chronic anxiety management, especially in a patient with a predisposition to depression and requesting "sleeping pills".
*Desensitization therapy*
- **Desensitization therapy** (a form of exposure therapy) is primarily used for **phobias** and **post-traumatic stress disorder**, where specific triggers are identified.
- The patient's presentation of generalized, pervasive worry, rather than a fear of specific situations, suggests this would not be the most effective initial treatment.
*Relaxation training*
- While beneficial as an adjunct, **relaxation training** alone is generally not sufficient as the **most effective monotherapy** for generalized anxiety disorder, especially given the severity and duration of the patient's symptoms.
- The patient has already tried **sleep hygiene practices**, indicating that behavioral interventions alone might not be enough to manage her anxiety.
*Bupropion*
- **Bupropion** is an antidepressant primarily used for **major depressive disorder** and **smoking cessation**.
- It is generally **not efficacious for anxiety disorders** and can sometimes exacerbate anxiety due to its stimulating effects.
Pharmacotherapy for anxiety disorders US Medical PG Question 8: A 28-year-old medical student presents to the student health center with the complaint being unable to sleep. Although he is a very successful student, over the past few months he has become increasingly preoccupied with failing. The patient states that he wakes up 10-15 times per night to check his textbooks for factual recall. He has tried unsuccessfully to suppress these thoughts and actions, and he has become extremely anxious and sleep-deprived. He has no past medical history and family history is significant for a parent with Tourette's syndrome. He is started on cognitive behavioral therapy. He is also started on a first-line medication for his disorder, but after eight weeks of use, it is still ineffective. What drug, if added to his current regimen, may help improve his symptoms?
- A. Risperidone (Correct Answer)
- B. Sertraline
- C. Propranolol
- D. Methylphenidate
- E. Phenelzine
Pharmacotherapy for anxiety disorders Explanation: ***Risperidone***
- The patient presents with classic symptoms of **Obsessive-Compulsive Disorder (OCD)**, including intrusive thoughts (preoccupation with failing) and compulsive behaviors (checking textbooks). When a first-line SSRI is ineffective after an adequate trial (8-12 weeks), **augmentation with an atypical antipsychotic** is the evidence-based next step.
- **Risperidone** (along with aripiprazole) has the strongest evidence for augmenting SSRIs in treatment-resistant OCD. It helps reduce the severity of **obsessive thoughts** and **compulsive actions** by modulating dopamine and serotonin pathways.
- The family history of **Tourette's syndrome** further supports this choice, as both conditions share genetic links and respond to dopamine modulation.
*Sertraline*
- **Sertraline** is a **first-line selective serotonin reuptake inhibitor (SSRI)** for OCD. The patient in the vignette has already been on a first-line medication for eight weeks, implying an initial SSRI was ineffective.
- Adding another SSRI like sertraline when one has already failed is generally not the next step in managing refractory OCD; augmentation with a different class of medication (atypical antipsychotic) is the preferred strategy.
*Propranolol*
- **Propranolol** is a **beta-blocker** primarily used to manage symptoms of anxiety such as **tremors**, **palpitations**, and **social anxiety** by reducing peripheral adrenergic effects.
- It does not directly address the core obsessive thoughts or compulsive behaviors characteristic of OCD and is not considered a primary treatment or augmentation strategy for this disorder.
*Methylphenidate*
- **Methylphenidate** is a **stimulant** medication primarily used to treat **Attention-Deficit/Hyperactivity Disorder (ADHD)** and **narcolepsy**.
- It is not indicated for the treatment of OCD and could potentially exacerbate anxiety or sleep disturbances in this patient.
*Phenelzine*
- **Phenelzine** is a **monoamine oxidase inhibitor (MAOI)**, an older class of antidepressants. While MAOIs can be effective for some anxiety disorders, they are not first-line for OCD due to their significant side effect profile and dietary restrictions (**tyramine-free diet**).
- MAOIs are generally reserved for highly refractory cases of depression or anxiety and are not a standard augmentation strategy when an SSRI has failed for OCD, especially before trying atypical antipsychotics.
Pharmacotherapy for anxiety disorders US Medical PG Question 9: A 35-year-old woman presents to clinic in emotional distress. She states she has been unhappy for the past couple of months and is having problems with her sleep and appetite. Additionally, she reports significant anxiety regarding thoughts of dirtiness around the house. She states that she cleans all of the doorknobs 5-10 times per day and that, despite her actions, the stress related to cleaning is becoming worse. What is this patient's diagnosis?
- A. Panic Disorder (PD)
- B. Generalized anxiety disorder (GAD)
- C. Obsessive compulsive personality disorder (OCPD)
- D. Obsessive compulsive disorder (OCD) (Correct Answer)
- E. Tic disorder
Pharmacotherapy for anxiety disorders Explanation: ***Obsessive compulsive disorder (OCD)***
- The patient's **recurrent distressing thoughts** about dirtiness (obsessions) and **repetitive cleaning behaviors** (compulsions) designed to reduce anxiety are hallmark symptoms of OCD.
- The significant **emotional distress**, impact on daily life, and worsening stress despite the compulsions further support this diagnosis.
*Panic Disorder (PD)*
- Characterized by **recurrent, unexpected panic attacks** and persistent worry about additional attacks or their consequences.
- While anxiety is present, the patient's primary distress is driven by specific obsessions and compulsions, not sudden episodes of intense fear.
*Generalized anxiety disorder (GAD)*
- Involves **excessive, uncontrollable worry** about a variety of events or activities for at least 6 months.
- The anxiety symptoms are general, not focused on specific obsessions leading to compulsive behaviors as seen in this case.
*Obsessive compulsive personality disorder (OCPD)*
- Marked by pervasive patterns of **perfectionism, orderliness, and control** at the expense of flexibility and efficiency.
- While there may be a preoccupation with rules, OCPD does not typically involve intrusive, ego-dystonic obsessions or ritualistic compulsions like repetitive cleaning to reduce anxiety.
*Tic disorder*
- Characterized by **sudden, rapid, recurrent, non-rhythmic motor movements or vocalizations**.
- Tics are distinct from the complex, goal-directed, and anxiety-driven compulsive behaviors described by the patient.
Pharmacotherapy for anxiety disorders US Medical PG Question 10: An 8-year-old girl is brought to the physician by her parents because of difficulty sleeping. One to two times per week for the past 2 months, she has woken up frightened in the middle of the night, yelling and crying. She has not seemed confused after waking up, and she is consolable and able to fall back asleep in her parents' bed. The following day, she seems more tired than usual at school. She recalls that she had a bad dream and looks for ways to delay bedtime in the evenings. She has met all her developmental milestones to date. Physical examination shows no abnormalities. Which of the following is the most likely diagnosis?
- A. Normal development
- B. Sleep terror disorder
- C. Nightmare disorder (Correct Answer)
- D. Post-traumatic stress disorder
- E. Separation anxiety disorder
Pharmacotherapy for anxiety disorders Explanation: ***Nightmare disorder***
- The key features supporting **nightmare disorder** are vivid, frightening dreams that lead to waking up, the ability to recall the dream content, being easily consolable, and attempts to avoid bedtime.
- Sleep disturbances, daytime fatigue, and negative emotional responses centered around sleep are characteristic of this disorder.
*Normal development*
- While occasional bad dreams are part of normal development, a frequency of one to two times per week over 2 months, leading to daytime tiredness and bedtime avoidance, suggests a **clinical disorder** exceeding typical developmental experiences.
- The distress caused and impact on daily functioning (tiredness at school) differentiate it from normal, transient nightmares.
*Sleep terror disorder*
- **Sleep terrors** typically involve abrupt awakening with intense fear, screaming, and autonomic arousal, but the individual is usually disoriented, inconsolable, and has no recall of the event upon waking or the next day.
- In this case, the child is consolable and *recalls* having a bad dream, distinguishing it from sleep terrors.
*Post-traumatic stress disorder*
- **PTSD** requires exposure to a traumatic event, which is not mentioned in the vignette.
- While nightmares can be a symptom of PTSD, they are usually accompanied by other symptoms like flashbacks, avoidance behavior, negative alterations in cognition/mood, and hypervigilance related to the trauma.
*Separation anxiety disorder*
- **Separation anxiety disorder** is characterized by excessive fear or anxiety concerning separation from attachment figures.
- Although the child sleeps in her parents' bed, the primary issue is frightening dreams and difficulty sleeping, not anxiety specifically related to separation from her parents.
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