2- Anxiety Disorders Flashcards by Colleen Cahill

Collectively, what is the most common of all mental disorders?

Anxiety disorders

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What is the difference b/w fear vs. anxiety?

Fear: emotional response to REAL or perceived ACUTE threats (fight or flight)

Anxiety: Anticipation of a future threat (“what ifs”, avoidant behavior)

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What can cause an anxiety disorder?

Hereditary components (brain/NT)
Environment (triggered event)
Temperament (neuroticism)

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Excessive worrying is caused by:

constantly SCANNING for threats
worrying used to COPE w/ problems
used to AVOID the fear
INTOLERANT of uncertainty
worry about CONSEQUENCES of worrying

What psychotherapy is an effective tx?

CBT

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What part of the brain responds to fear?

Amygdala

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The following are consequences of what?

Autonomic hyperactivity
Hormonal/metabolic imbalances
GI disturbances
HTN/tachycardia/Hyperlipidemia
Poor sleep

Anxiety (constant cortisol)

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When dx anxiety disorder what you first want to determine?

Duration: Acute vs chronic
Sensory triggers
Behavioral responses

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What must you r/o when dx someone w/ an anxiety disorder?

Medication or substances abuse as the cause

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In what anxiety disorder do you worry about many aspects of life?

Generalized anxiety disorder (GAD)

2:1 F
Co-occurs w/ other mental disorders and somatic complaints

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Is full remission common in pts w/ GAD?

Uncommon

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What is the DSM-5 criteria for GAD? (6)

6 mos of prominent tension, worry, apprehension
Diffculty controlling sx
3+ of the following sx: restlessness, easy fatiguability, poor concentration, irritability, muscle tension, sleep disturbance
Does not meet criteria for another disorder
Causes clinically significant impairment
Not due to GMC

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What screening instrument is used for GAD?

GAD-7

looks at sx over the past 2 wks
Scale: 0-21 (21 = high anxiety)

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What is the tx for pt w/ mild GAD?

CBT

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What is the goal of CBT in mild GAD?

ID negative thoughts/behaviors

- Replace w/ positive ones

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How many sessions are required for CBT in pts w/ mild GAD?

10-15, 60 min sessions

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What is the tx for pt w/ moderate/severe GAD?

CBT + pharmacotherapy

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What is 1st line med therapy for moderate/severe GAD?

Antidepressants: SSRI/SNRI

TCA if others fail

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What is the med therapy for moderate/severe GAD if concerned about substance abuse?

Buspirone or hydroxyzine

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What is the other med therapy can be given for pt w/ moderate/severe GAD?

Benzos (short course)

Quietapine (atypical antidepressant)

What anxiety disorder is marked by persistent fear of social or performance situation where the pt is exposed to unfamiliar people or to possible SCRUTINY by others and may develop due to a previous negative experience/trauma?

Social anxiety disorder (SAD)

Very common and functionally impairing
Onset late in childhood to early adolescence

What does a pt w/ social anxiety disorder fear?

He/she will act in a way that will be humiliating or embarrassing

What is the DSM5 criteria for SAD? (8)

Marked/persistent fear of 1+ social/performance situations, w/ possible scrutiny by others
Fear of showing anxiety sx that will be negatively evaluated
Social situation ALWAYS provokes fear or anxiety
Situations are avoided or enduring w/ intense fear
Fear is out of proportion to event
Persistent for 6+ month
Causes distress/impairment
Not due substance, GMC, or other mental disorder

The DSM 5 requires what is specified for a DX of SAD?

Specify if fear is restricted to speaking or performing

What is first line tx for SAD?

CBT

+/- SSRI/SNRI

What 2 additional txs are added for pt w/ performance SAD?

BB | Short term BZ

What anxiety disorder is characterized by panic attacks and maladaptive behaviors?

Panic disorder - 2:1 F to M - Onset early/mid 20s - Genetic (Fhx, NA) and environmental factors (triggers, unpredictable life stressors)

What is the DSM5 criteria for panic disorder? (3)

1. Discrete period of intense fear or discomfort in 4+ of the following that develops abruptly and reaches a peak w/in 10 mins - Palpitations, chest pain, sweating, shaking, SOB, sensation of chocking, N/abd distress, faint/dizzy, derealization or depersonalization, fear of losing control/going crazy, fear of dying, paresthesias, chills/hot flashes 2. Followed by 1+ month of the following: - Persistent concern about additional panic attacks or worry about effects of attack - Significant maladaptive change in behavior 3. No due substance, GMC, or other mental disorder

What are the goals of tx for panic disorder? (4)

Reduce intensity, frequency, duration Reduce avoidance behaviors Limit over-reliance on safety cues Improve functional capacity

T or F: Panic disorders are associated w/ a high rate of relapse?

TRUE!

What is the tx for panic disorders?

CBT + SSRI/SNRI | BZ Prn

What is a specific phobia?

Cued by presence or anticipation of a specific object or situation EX: Animals, needles, heights, nature...

Is a needle/bood-injection-injury phobia more common in med or women?

Men

What is the avg. age of onset for phobia disorders?

7-10 yo

What is the DSM5 criteria for specific phobias? (7)

1. Marked/persistent excessive/unreasonable fear of presence or anticipation of specific object/situation 2. Exposure provokes immediate anxiety response 3. Avoided or endured w/ intense anxiety/distress 4. Fear/anxiety is OOP to stimulus 5. ≥ 6 mos 6. Causes functional impairments 7. Not explained by substance, GMC, other anxiety d/o

What is the tx for specific phobias?

CBT (short term intervals, improvement w/in 1-5 session) + SSRI/SNRI BZ Prn

What disorder will onset early in life, progressively increase w/ age and is often comorbid w/ mood or anxiety disorders?

OCD

What is the DSM5 criteria for OCD? (3)

1. Obsession, compulsion or both 2. O/C are time consuming (>1 hr/day) or cause impairment 3. Not explained by substance, GMC, other mental d/o

How does the DSM5 define obsessions? (2)

1. Recurrent & persistent intrusive and inappropriate thoughts, impulses, or images experiences that cause marked anxiety or distress 2. Attempts to ignore or suppress the thoughts or to neutralize them w/ other thoughts/actions (by performing compulsion)

How does the DSM5 define compulsions? (2)

1. Repetitive behaviors or mental action performed in response to obsession or according to rigid rules 2. Aimed at reducing/preventing distress in an unrealistic way or that is clearly excessive

What is the DSM 5 criteria for hoarding d/o (w/in OCD)? (5)

1. Persistent difficulty discarding objects regardless of value 2. Perception to save items and distress would occur w/ discarding them 3. Accumulation results in clutter and compromised use of active living areas 4. Hoarding causes distress or impairment 5. Not due to GMC or other mental d/o

50% of those w/ hoarding d/o have what? (2)

1. 50% have hereditary influence | 2. 50% have SI

What is the tx for all OCDs?

CBT w/ exposure and response prevention (ERP) | SSRI/SNRI or TCA (Clompramine)

What disorder is a psychological response to an identifiable stressor(s) resulting in clinically significant emotional or behavioral sx?

Adjustment D/o

What are the DSM5 criteria for adjustment d/o? (5)

1. Sx develop w/in 3 months of stressor 2. Distress is OOP to event resulting in impairment 3. Not due to other m/o, bereavement 4. Must resolve w/in 6 months following stressor

What is the tx for adjustment d/o?

Psychotherapy + group therapy Meds only for associated sx (insomnia, anxiety, depression)