4. Anxiety & OCD Flashcards
What are the 2 things that make a diagnosis?
1) Clinical significance
2) Affects on daily life
What are the short-term responses to stress?
1) Increased HR
2) Increase BP
3) Liver converts glycogen to glucose and releases glucose to blood
4) Dilation of bronchioles
5) Changes in blood flow patterns leading to decreased digestive system activity and reduced urine output
6) Increased metabolic rate
What are the prolonged responses to stress (mineral corticoids)? (2)
1) Retention of sodium and water by kidneys
2) Increased blood volume and BP
What are the prolonged responses to stress (glucocorticoids)? (3)
1) Proteins and fats converted to glucose or broken down for energy
2) Increased blood glucose
3) Suppression of immune system
What is allostasis?
Process by which the body responds to stressors in order to gain homeostasis
Why should we care about anxiety disorder?
Life-time prevalence, women 60% more likely to experience
T/F: It is rare for someone to just have anxiety disorder, may be with one or more other component.
True!
How is anxiety disorder different than everyday anxiety? (5)
1) Constant and unsubstantial worry that causes significant distress and interferes with daily life
2) Avoiding social situations for fear of judgement and embarrassment
3) Seemingly out-of-the-blue panic attacks and fear of having another one
4) Irrational fear or avoidance of things
5) Recurring nightmares, flashbacks, or emotional numbing related to traumatic event that occurred several months or years before
What are some DSM-V defined disorders?
1) Separation anxiety
2) Selective mutism
3) Specific phobia
4) Social anxiety disorder
5) Agoraphobia
6) Panic disorder
7) Generalized anxiety disorder (GAD)
8) Substance/medicine induced
9) Due to medical condition
10) Other
11) Unspecified
Characteristics of separation anxiety disorder
1) Developmentally inappropriate and excessive fear or anxiety of separation from attached individuals
2) Persistent – 4 weeks (kids), 6 months (adults)
3) Prevalence – 4.1% (kids), 6.6% (adults)
Separation anxiety criteria: 3 of 8 (persistent)
1) Recurrent excessive distress when anticipating or experiencing separation from figure
2) Worry about experiencing event that causes separation
3) Worry over losing attachment figure or harm to them
4) Reluctance/refusal to leave figure
5) Fear of being left alone
6) Refusal to sleep away from/go to sleep without figure
7) Nightmares about separation
8) Somatic complaints when separated
Characteristics of selective mutism
1) Consistent failure to speak in situations where speaking is expected (regular speech otherwise)
2) Interferes with educational, occupational, or social communication
3) At least 1 month duration
4) Failure to speak not lack of language or knowledge
What are some specific phobias?
Animal Natural environment Blood-injection injury Situational Other
Characteristics of specific phobias
1) Fear/anxiety about a specific object or situation
2) Provokes immediate fear or anxiety
3) Actively avoided or endured with intense fear
4) Disproportionate fear to actual danger present
5) Fear, anxiety, or avoidance last 6+ months
At what age does specific phobias start?
About 7 years old
Characteristics of social anxiety disorder
1) Similar to specific phobias, but in social setting
2) Fear that actions will be negatively evaluated
3) Not attributed to other medical condition/substance use
4) Specify if performance only (restricted to speaking or performing in public)
What is panic disorder?
Recurrent, unexpected panic attacks (abrupt sense of intense fear/discomfort, peaks in minutes)
Panic disorder criteria (must have 4 of 13)
1) Palpitations/accelerated HR
2) Diaphoresis
3) Trembling/shaking
4) Sensation of SOB/smothering
5) Feelings of choking
6) Chest pain or discomfort
7) Nausea or abdominal distress
8) Dizzy, light-headed, faint
9) Chills/heat sensations
10) Paresthesias
11) Derealization/depersonalization
12) Fear of losing control/going “crazy”
13) Fear of dying
T/F: Panic attack is followed for 1 month by persistent concern or worry about additional attacks or their consequences
TRUE!
T/F: In regards to panic disorder, significant maladaptive change in behavior is related to the panic attacks
True! People stop doing things altogether for fear of having another panic attack
T/F: Agoraphobia is a fear or anxiety of about 2+ (of 5) situations
True! The 5 situations include: public trans, open spaces, enclosed spaces, standing in line or being in a crowd, outside of home alone
T/F: Agoraphobia affects those ages 30-59 the most
True
Characteristics of agoraphobia (6)
1) Avoids situations due to fear of inability to escape or developing panic attack or other embarrassing/incapacitating symptoms
2) Situations always provoke fear or anxiety
3) Actively avoided or require companion
4) Fear disproportionate to danger posed
5) Persistent (6 months+)
6) If medical condition present, reaction excessive
What is generalized anxiety disorder (GAD)?
Excessive anxiety/worry over numerous events for at least 6 months; difficult to control
GAD criteria: 3+ (of 6) for past 6 months
1) Restlessness or keyed up
2) Easily fatigued
3) Difficulty concentrating or mind blank
4) Irritability
5) Muscle tension
6) Sleep disturbance
What is a criteria for substance/medication-induced anxiety disorder?
Same criteria as depressive disorder (panic attacks or anxiety predominate)
What are the specifiers (onset) of substance/medication-induced anxiety disorder? (3)
1) Intoxication
2) Withdrawal
3) After med use
T/F: Anxiety disorder due to another medical condition has the same criteria as for depressive disorder
True; plug in anxiety (lock and key)
What are some examples of anxiety disorder due to another medical condition? (5)
- Endocrine dz
- CV (CHF)
- Respiratory (asthma, pneumo)
- Metabolic (B12, porphyria)
- Neurologic (neoplasm, seizures)
Other specified anxiety disorders: khyal cap (wind attacks)
Cambodia, Vietnam
Other specified anxiety disorders: ataque de nervios (“Puerto Rican Syndrome)
- Caribbean
- Stressful event
- Sense of impending loss of control
- Negative affect (fear/anger)
Anxiogenic wind (khyal)
- Air-like substance (also blood “tubes” – sasai)
- Blockages lead to distress (slap day slap ceung = “death of the arms and legs” like stroke)
- Abdominal (“inner wind” moves upward into body – khyal theau laeung leu)
- “Wind overload” (sensations felt upon standing – khyal ko)
Unspecified anxiety disorder
Used in ER when they don’t have time to do an interview to figure out if they have some sort of anxiety disorder
Taijin Kyofusho (Japan)
Fear of offending or harming people
Shubo-kyofu
fear of body deformity (BDD-like)
Jikoshu-kyofu
offensive body odor/olfactory reference syndrome
Sekimen-kyofu
fear of blushing
Jikoshisen-kyofu
fear of eye contact
Dhat syndrome (vital fluid)
India: fear premature ejaculation or impotence; passing semen in urine or vaginal discharge
China: Shenkui (kidney [reservoir of vital essence] deficiency
Ufufuyane (Kenya, Zulu, Bantu)
Anxiety state attributed to the effects of magical potions (given to them by rejected lovers) or spiritual possession; sobbing, repeated neologisms, paralysis, trance-like staes
Koro
Fear that penis (vulva/nipples) will recede into body causing death – Africa, Asia, Europe
USA – genital retraction syndrome
China – shook yang
Susto (“fright”)
latinos (US), mexico, central/south america
- distress and misfortune explanation
2. frightening event –> soul leaves body (unhappiness/sickness)
Hwa-byung (China)
- “Fire illness”
- Build-up of unresolved anger (“haan” = everlasting woe)
- psychosomatic component: heavy mass pushed up from abdomen
Pa-leng (China, SE Asia)
- Pathological fear of cold (frigophobia) and wind (anemophobia)
- Believed to produce fatigue, impotence, death
- Dress in heavy or excessive clothing
Latah
- Malaysia and Indonesia: exaggerated startle reaction, involuntary imitative behavior (echopraxia, echolalia
- Mali mali (Philippines)
Hikikomori
- Withdrawal neurosis/taikyaku shinkeishou
- School refusal syndrome
- M > F (80%/20%)
- Mixed bag (GAD, dysthymia, OCD, schizo, PDD)
- Cultural factors
What is OCD?
Presence of obsessions, compulsions, or both
Obsession
- Recurrent and persistent thoughts, urges, or images experienced, causing marked anxiety or stress (intrusive and unwanted
- Attempt to neutralize by other thought/action (compulsion)
Compulsion
- Repetitive behaviors (responses to obsession), rigid rules
- Aim to reduce stress/anxiety; not realistic
Characteristics of OCD
- Time consuming (1+ hr)
2. Specifiers: good or fair insight, poor insight, absent insight/delusional beliefs, tic-related
Body dysmorphic disorder
- Preoccupation w/ 1 or more perceived body defects not seen by others
- Repetitive behaviors
- Not explained by eating d/o
- Specifiers: muscle dysmorphia, insight
Hoarding disorder
- Difficulty discarding/parting with possessions regardless of value
- Perceived need to save
- Distress with discarding
- Congest/clutter house
- Etiology: traumatic event, genetic
Trichotillomania
- Recurrent hair pulling (hair loss)
- Repeated attempts to stop
- Not other med issue
- Can eat –> trichotillophagia
Excoriation disorder
- Dermatillomania psychogenic.neurotic excoriation
- Recurrent skin picking (lesions)
- Repeated attempts to stop
- Not substance/medically induced
What drugs are related to substance/medication-induced obsessive compulsive and related disorder
Amphetamines, cocaine, methamphetamine
PANDAS
- Obsessive-compulsive and related disorder due to another medical condition
- Gas (Syndenham’s chorea)
- Specifiers: hoarding, hair-pulling, skin-picking, OCD-like, appearance preoccupations
Other specified obsessive-compulsive and related disorders
- Body dysmorphic-like disorder w/actual flaws
- Body dysmorphic-like disorder w/o repetitive behaviors
- Body-focused repetitive behavior disorder (nail/lip biting, cheek chewing
- Obsessional jealousy (non-delusional preoccupation w/partner’s perceived infidelity)