19. Anxiety Disorders

Question 1

what are the 3 major anxiety disorders?

Answer 1

panic d/o, generalized anxiety d/o, OCD

Question 2

given that anxiety is a normal response to threat, when does anxiety become maladaptive?

Answer 2

when the level is too high, when it is uncontrolled (do not abate in reasonable amt of time), when it is inappropriate to the situation

Question 3

a few key features of a panic attack?

Answer 3

partially a sympathetic reaction: palpitations, sweating, trembling/shaking, SOB, choking, chest pain/pressure, N/D, dizziness

Question 4

what is the Yerkes-Dodson Law about arousal and performance?

Answer 4

at medium arousal level you will perform your best: too much or too little stress and you will underperform

Question 5

what is psychotic vs neurotic ways of being?

Answer 5

psychotic: disorganized, not integrated
neurotic: rigidly organized, overcontrolled

Question 6

what is the difference between a panic disorder and a panic attack?

Answer 6

attacks are cued, usually have a specific stimulus. could be a phobia.
panic disorder is fear of the attacks themselves and the internal sensations that accompany the attacks. uncued, unpredictable

Question 7

panic disorder, specific phobias, social anx disorder, agoraphobia: what characterizes all these?

Answer 7

fear and avoidance (as opposed to distress)

Question 8

specific phobias: what cues them?

Answer 8

presence of a specific object or situation (flying, heights, animals, blood)

Question 9

define social anxiety disorder

Answer 9

fear of embarrassment, scrutiny

Question 10

define agoraphobia

Answer 10

fear of spaces that cannot be escaped from

Question 11

example of a safety behavior?

Answer 11

in agoraphobia, “safety person”. someone who pt can leave the house with

Question 12

evolutionary basis for specific phobias?

Answer 12

ex: blood phobia is adaptive because it slows down HR (we faint, stop pumping blood as fast)

Question 13

what sustains fear and avoidance disorders?

Answer 13

operant conditioning: positive and negative feedback

Question 14

with operant conditioning, what is negative reinforcement?

Answer 14

increases the behavior by removal or prevention of the negative experience

Question 15

GAD: what is the primary feature?

Answer 15

WORRY. made worse by uncertainty, ambiguity

Question 16

what does it mean for GAD to be ego syntonic?

Answer 16

worry is about things that are in harmony with or acceptable to the needs/goals of the ego. pt may have decided that worry is part of their personality.

Question 17

GAD stereotype? what can go wrong?

Answer 17

high achievers, planful. problems when an event throws off the plan and they can’t adapt. may worry even about things that are relatively mundane.

Question 18

what can be a positive feature of worry?

Answer 18

it can distract from difficult emotional content.

Question 19

common comorbid conditions with GAD?

Answer 19

GI symptoms, aches and pains

Question 20

GAD: psychotic or neurotic end of the spectrum?

Answer 20

neurotic

Question 21

OCD: overall prevalance greatest in what populations?

Answer 21

boys and adult women

Question 22

4 common symptoms of compulsions?

Answer 22

• symmetry/ordering
• hoarding
• contamination
• obsessions/checking

Question 23

insight in OCD?

Answer 23

most people with OCD have insight that allows them to not be delusional: they know that their thoughts are abnormal, yet still have to comply with the checking in order to feel at ease/be able to relax

Question 24

pt suffers anxiety every day for much of life: dx?

Answer 24

GAD

Question 25

pt experiences symptoms intensely/abruptly for no apparent reason: dx?

Answer 25

panic d/o

Question 26

pt has anxiety in presence of specific stimulus or environment: dx?

Answer 26

specific phobia, agoraphobia, social anxiety

Question 27

pt has sx when reminded of a specific event: dx?

Answer 27

PTSD

Question 28

pt has compulsive rituals that have become the source of anxiety: Dx?

Answer 28

OCD

Question 29

sense of impending doom: dx?

Answer 29

panic disorder

Question 30

what is one bad result from panic disorder?

Answer 30

patient’s lifestyle may become restricted because of need to avoid situations where panic has occurred, or may require that locations have easy escape routes. may coexist with agoraphobia

Question 31

tx for panic disorder?

Answer 31

-CBT (cognitive restructuring, exposure therapy) -pharmacotherapy (SSRIs most commonly used)

Question 32

how does GAD compare to panic?

Answer 32

generally less severe but more continuous. worried/tense rather than terrified

Question 33

tx for GAD?

Answer 33

multimodal: CBT, meditation and SSRIs/SNRIs

Question 34

somatic experiences in phobic disorders such as social phobia and specific phobias?

Answer 34

tachycardia, sweating, flushing

Question 35

tx for phobic disorders?

Answer 35

• make sure not secondary to panic, depression, schiz

- CBT (exposure, cog restructuring). propanolol.

Question 36

cardinal sx of OCD?

Answer 36

intrusive thought and ritual which the pt experiences as alien but is powerless to control.

Question 37

tx for OCD?

Answer 37

CBT, clomipramine (tricyclic), SSRIs (fluoxetine, fluvoxamine). usually behavioral and pharm tx used together.

Question 38

describe exposure therapy?

Answer 38

repeated and prolonged exposure to feared stimuli resulting in reduced anxiety

Question 39

describe cognitive restructuring (type of CBT)?

Answer 39

challenging mis-interpretations/over-assumptions

de-catastrophizing

Question 40

front line pharm for anxiety?

Answer 40

SSRIs, SNRIs

Question 41

CBT vs pharm tx: what is most effective?

Answer 41

meds + CBT more effective than either solo