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Chapter 57. Anxiety Disorders

A 27-year-old woman complains of excessive worrying, poor concentration, back and neck pain, and difficulty sleeping through the night. She constantly worries about losing her job as a data analyst despite the fact that she recently received a promotion. These symptoms have progressively worsened in the past 7 months and have negatively affected her relationship with her friends.

The psychiatrist is seeking a recommendation for this new diagnosis of generalized anxiety disorder. Which medication has an FDA indication for this disorder?

a. Levomilnacipran

b. Amitriptyline

c. Bupropion

d. Buspirone

e. Fluvoxamine

Answer d is correct. Buspirone has an FDA indication for generalized anxiety disorder.

Answer a is incorrect. Levomilnacipram is only indicated for major depression.

Answer b is incorrect. Amitriptyline is only indicated for depression.

Answer c is incorrect. Bupropion is only indicated for depression, depression associated with seasonal affective disorder and smoking cessation.

Answer e is incorrect. Fluvoxamine is only indicated for obsessive compulsive disorder.

A 27-year-old woman complains of excessive worrying, poor concentration, back and neck pain, and difficulty sleeping through the night. She constantly worries about losing her job as a data analyst despite the fact that she recently received a promotion. These symptoms have progressively worsened in the past 7 months and have negatively affected her relationship with her friends.

The mechanism of action of buspirone is:

a. Dopamine 2A partial agonist

b. Selective serotonin reuptake inhibitor

c. Serotonin and norepinephrine reuptake inhibitor

d. Serotonin 1A partial agonist

e. Serotonin and dopamine antagonist

Answer d is correct. Buspirone works primarily by acting as a serotonin 1A partial agonist.

Answers a, b, c, and e are incorrect. Buspirone has no action at dopamine or norepinephrine receptors and does not selectively inhibit the reuptake of serotonin.

Which of the following benzodiazepines has the longest duration of action at steady state?

a. Alprazolam

b. Oxazepam

c. Diazepam

d. Triazolam

e. Lorazepam

Answer c is correct. Diazepam has multiple metabolites which extends the half-life when administered in multiple doses.

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