Anxiety (13 & 14) Flashcards
Name some physical manifestations of anxiety?
Sympathetic NS (diaphoresis, mydriasis, tachycardia, tremor)
GI/GU symptoms (diarrhea, increase urine frequency)
Hyperventilation (dizziness, syncope, parasthesia)
Numbness and tingling
Name the main classes of anxiety disorders?
Generalized anxiety disorder
Panic disorder (w/ or w/o agoraphobia)
Phobia/ Social Anxiety Disorder
OCD
Acute stress disorder
PTSD
When diagnosing anxiety…symptoms must:
1- Be persistent (generally >6mo)
2- Interfere with normal functioning
3- Cause significant distress
What are the neurobiological changes/ factors associated with anxiety?
Decreased serotonin and GABA
Increased NE and Glutamate
What are some psychosocial factors associated with anxiety?
Traumatic events/ extreme stressors
Maladaptive coping skills/ personality traits
Learned?
What is the gender bias of anxiety?
Women > Men
What is the DSM-V criteria for Generalized Anxiety Disorder (GAD)?
Excessive anxiety/worry, occurring more days than not for 6 months about at least one event
It is difficult to control the worry.
At least 3 additional symptoms
Causes significant impairment
What are the additional symptoms of GAD?
Restlessness, easy fatigue, difficulty concentrating, irritability muscle tension, sleep disturbance
Prognosis of GAD?
Gets worse without treatment
What are the main treatments for GAD?
1- CBT
2- Antidepressants (SSRI, SNRI)
3- Buspirone (5HT1 angonist)
4- Benzo
What is the DSM-V criteria for panic attacks?
An abrupt, surge of intense fear of discomfort, peaks within minutes, that is unexpected
Must have 4 or more of the following symptoms:
Palpitations, pounding/racing heart, sweating, shaking, SOB, choking feeling, Nausea, dizziness, chills/heat, parasthesias, derealization, fear of losing control/ death
What is the DSM-V criteria for Panic Disorder?
1- recurrent unexpected panic attacks
2- 1 or more attacks followed by 1 (more more) month of at least one of the following–> concern about additional panic attacks/ consequences OR significant maladaptive change in behavior related to attacks
What are the DSM-V criteria for Agoraphobia?
1- Fear/ anxiety about 2 or more: using public transit, being in open spaces being in enclosed spaces, standing in line or a crowd, being outside home
2- fear of not being able to escape
3- Situation almost always produces anxiety
4- avoids situations
5- Fear/ anxiety out of proportion to acutal danger
6- >6 mo
7- causes signifcant impairment
Prognosis with panic disorder?
Chronic and recurring
Increased risk of depression and suicide
Treatment for panic disorder?
1- CBT
2- systematic desensitization
3- Fast acting benzo (emergency)
4- SSRI/ SNRI (1st line for long term)
DSM-V criteria for phobia diagnosis?
1- >6mo
2- Causes significant impairment
3- marked fear for a specific object/ situation
4- object/ situation ALWAYS produces the fear
5- actively avoids the situation/ object
6- Fear is out of proportion
What are the criteria for social anxiety disorder diagnosis?
1- >6mo
2- causes significant impairment
3- marked fear when exposed to social situation w/ possible scrutiny with others
4- fear of acting in ways that will be negatively scrutinized
5- social situation provokes fear
6- Fear out of proportion
What is performance only social anxiety disorder?
Fear is restricted to public speaking or performing and does not generalize to other social aspects of life
Treatment for specific phobias?
1- Flooding
2- Systematic desnsitization
3- CBT
4- Benzos?
What is the treatment for social phobia?
1- CBT
2- Assertiveness training/ Group therapy
3- SSRI/ SNRI
4- MAOI
Treatments for performance anxiety?
Beta Blockers (propronolol)
What are the criteria for OCD diagnosis?
Criteria A: The presence of Obsessions and Compulsions
Criteria B: The obsession and compulsions must be either time consuming or cause significant distress
What is an obsession?
Recurrent/ persistent thoughts urges and/ or images
They are intrusive and unwanted
What is a compulsion?
Repetitive behavior or activity that the patient performs in response to an obsession or as a set of rules that must be strictly adhered to
T/F: A compulsion typically undoes or reduces anxiety
True
Is OCD more common in women or men?
Same in each
What is the prognosis of OCD?
Long and variable course
1/3 are cured, and a large amount have moderate improvement while 20-40% remain ill or worsen
What illness is usually seen with OCD?
Tourette’s Syndrome
What type of psychotherapy is used to treat OCD?
CBT
ERP (Exposure and Response Prevention)
ACT (Acceptance and Commitment Therapy)
What Rx are used to treat OCD?
1st Line: SSRI
2nd Line: Clomipramine (a TCA)
3rd Line: antipsychotics, other antidepressants
What needs to be on the differential diagnosis for OCD?
1- Tourette’s Syndrome
2- Temporal Lobe Epilepsy
3- Obsessive Compulsive Personality Disorder
What is the most common thing that could cause PTSD?
Death of a loved one
What is most likely thing to cause PTSD?
Assault
What are the greatest variables associated with PTSD? (4)
Proximity, harm by another human, severity, repititino
What is criterion A for PTSD diagnosis?
Exposure to actual or threatened traumatic even (death, serious injury, sexual violence)
How long must symptoms be present for PTSD diagnosis?
More than 1 month
What are some modes of exposure in PTSD?
1- Directly experiencing events
2- Witnessing events as occur to others
3- Learning that a family member/ friend experienced such an event
4- Directly experiencing repeated/ extreme exposure to horrific details of an event
What is criterion B for PTSD diagnosis?
> 1 “intrusion Symptom” associated with an event:
Distressing memories, distressing dreams/ nightmares, psychological distress from exposure to clues that symbolize the event, psychological reactions to exposure to external cues
What is criterion C for PTSD diagnosis?
Avoidance of stimuli associated with traumatic events
What is criteria D for PTSD diagnosis?
Negative changes in cognition and mood with the associated event. Need 2 or more of the following:
- dissociative amnesia or repression
- exaggerated beliefs
- blame
- negative emotional state
- inability to experience positive emotions
What is criterion E for PTSD diagnosis?
Alterations in arousal/ reactivity (>2 of the following):
- Irritable behavior/ angry outbursts
- Reakless/ self-destructive behavior
- Hypervigilance
- Exaggerated startle response
- Problems with concentration
- Sleep dusturbance
What is the criteria for acute stress disorder?
Same criteria for PTSD, just persists for 3 days - 1 month
When is the best time to treat PTSD/ ASD?
The earlier the treatment begins, the better
What are some co-morbidities seen with PTSD and ASD?
Depressive disorders
Substance related disorders
Other anxiety disorders
Bipolar disorders
Personality disorders`
How is PTSD and ASD treated with psychotherapy?
CBT, Eye-Movement Desensitization and Reprocessing (EMDR), Support groups/ Family therapy
What are some Rx used to treat PTSD and ASD?
1st line: SSRI
2nd line: TCAs, atypical antipsychotics
3rd line: MAOi, Trazodone, propranolol
What can prazosin treat?
Nightmares
