19. Anxiety Disorders Flashcards
what are the 3 major anxiety disorders?
panic d/o, generalized anxiety d/o, OCD
given that anxiety is a normal response to threat, when does anxiety become maladaptive?
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
a few key features of a panic attack?
partially a sympathetic reaction: palpitations, sweating, trembling/shaking, SOB, choking, chest pain/pressure, N/D, dizziness
what is the Yerkes-Dodson Law about arousal and performance?
at medium arousal level you will perform your best: too much or too little stress and you will underperform
what is psychotic vs neurotic ways of being?
psychotic: disorganized, not integrated
neurotic: rigidly organized, overcontrolled
what is the difference between a panic disorder and a panic attack?
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
panic disorder, specific phobias, social anx disorder, agoraphobia: what characterizes all these?
fear and avoidance (as opposed to distress)
specific phobias: what cues them?
presence of a specific object or situation (flying, heights, animals, blood)
define social anxiety disorder
fear of embarrassment, scrutiny
define agoraphobia
fear of spaces that cannot be escaped from
example of a safety behavior?
in agoraphobia, “safety person”. someone who pt can leave the house with
evolutionary basis for specific phobias?
ex: blood phobia is adaptive because it slows down HR (we faint, stop pumping blood as fast)
what sustains fear and avoidance disorders?
operant conditioning: positive and negative feedback
with operant conditioning, what is negative reinforcement?
increases the behavior by removal or prevention of the negative experience
GAD: what is the primary feature?
WORRY. made worse by uncertainty, ambiguity
what does it mean for GAD to be ego syntonic?
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.
GAD stereotype? what can go wrong?
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.
what can be a positive feature of worry?
it can distract from difficult emotional content.
common comorbid conditions with GAD?
GI symptoms, aches and pains
GAD: psychotic or neurotic end of the spectrum?
neurotic
OCD: overall prevalance greatest in what populations?
boys and adult women
4 common symptoms of compulsions?
- symmetry/ordering
- hoarding
- contamination
- obsessions/checking
insight in OCD?
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
pt suffers anxiety every day for much of life: dx?
GAD
pt experiences symptoms intensely/abruptly for no apparent reason: dx?
panic d/o
pt has anxiety in presence of specific stimulus or environment: dx?
specific phobia, agoraphobia, social anxiety
pt has sx when reminded of a specific event: dx?
PTSD
pt has compulsive rituals that have become the source of anxiety: Dx?
OCD
sense of impending doom: dx?
panic disorder
what is one bad result from panic disorder?
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
tx for panic disorder?
-CBT (cognitive restructuring, exposure therapy) -pharmacotherapy (SSRIs most commonly used)
how does GAD compare to panic?
generally less severe but more continuous. worried/tense rather than terrified
tx for GAD?
multimodal: CBT, meditation and SSRIs/SNRIs
somatic experiences in phobic disorders such as social phobia and specific phobias?
tachycardia, sweating, flushing
tx for phobic disorders?
- make sure not secondary to panic, depression, schiz
- CBT (exposure, cog restructuring). propanolol.
cardinal sx of OCD?
intrusive thought and ritual which the pt experiences as alien but is powerless to control.
tx for OCD?
CBT, clomipramine (tricyclic), SSRIs (fluoxetine, fluvoxamine). usually behavioral and pharm tx used together.
describe exposure therapy?
repeated and prolonged exposure to feared stimuli resulting in reduced anxiety
describe cognitive restructuring (type of CBT)?
challenging mis-interpretations/over-assumptions
de-catastrophizing
front line pharm for anxiety?
SSRIs, SNRIs
CBT vs pharm tx: what is most effective?
meds + CBT more effective than either solo
