Anxiety Flashcards
What are some of the sympathetic manifestations of anxiety?
diaphoresis, mydriasis, tachycardia and tremor
What are the GI/GU symptoms associated with anxiety?
diarrhea and increased urinary frequency
What are some of the other symptoms of anxiety?
dizziness, syncope, hyperventilation, numbness and tingling in the extremities
What are some of the psychological manifestations of anxiety?
restlessness, irritability, trouble concentrating and worry
What are the 6 classifications of anxiety disorders?
GAD, panic disorder, OCD, simple phobia, PTSD, mixed anxiety and depressive disorder
What are some of the organic causes of anxiety-like symptoms?
caffeine, substance abuse, withdrawal, hyperthyroid, hypoglycemia
What are some of the psychiatric disorders that are associated with anxiety?
depression schizophrenia eating disorders personality disorders substance dependence
What are the 3 main criteria for a diagnosis of anxiety?
Symptoms persistent (>6 months) Interfere with normal functioning Cause significant distress
What are some of the psychosocial factors in the etiology os anxiety disorders?
traumatic disorders
maladaptive coping skills
learned anxiety? (worrying parents)
In which 2 populations is there a higher a prevalence of anxiety disorders?
- those with family members with anxiety disorders
- women more affected than men
Which neurotransmitters are hypothesized to be involved in the pathology of anxiety disorders?
decreased serotonin and GABA
increased NE and glutamate
What are the diagnostic criteria for generalized anxiety disorder?
- excessive worry >6 months about >1 thing
- difficulty controlling worry
- > 3 of : restlessness, fatigue, diff. concentrating, irritability, muscle tension and sleep disturbance
- causes significant impairment
What is the prognosis like for GAD?
worsens over time without treatment
What types of therapies and medications are used to treat GAD?
- therapy: CBT or psychodynamic
- medications: antidepressants, buspirone, benzodiazepenes (2nd line), Beta blockers
What is a panic attack?
abrupt surge of intense fear or discomfort that is unexpected (not precipitated by a trigger)
What are the diagnostic criteria for panic disorder?
- recurrent, unexpected panic attacks
- > 1 attack followed by >1 month of >1 of: concern about more attacks, changes in behavior related to attacks
- no other explanation for symptoms
What is agoraphobia?
- Fear/anxiety about >2 of: public transportation, open spaces, enclosed spaces, in line or in a crowd, and being outside the home alone
- fear of not being able to escape a situation
- avoids situations
- fear out of proportion to actual danger
- > 6 months
- causes significant impairment
- no other explanation for symptoms
How is panic disorder treated?
CBT, psychodynamic therapy, SSRI, Benzos (emergency tx)
What is a phobia?
- > 6 months
- significant impairment
- fear/anxiety about a specific object/situation
- avoids object/situation
- fear/anxiety out of proportion to actual danger
- no other explanation
What is social anxiety disorder?
- > 6 months
- significant impairment
- fear/anxiety when exposed to social situation
- fear of acting in ways that will be negatively scrutinized
- avoids social situations
- fear/anxiety out of proportion to actual threat
- no other explanation for symptoms
What is performance only social anxiety?
fear is restricted to public speaking or performing and doesn’t generalize to other social aspects
How are specific phobias treated?
- therapy: flooding, systemic desensitization, psychodynamics
- meds: Benzos?
How is social anxiety treated?
- therapy: CBT, assertiveness training, group therapy
- meds: SSRI/SNRI, MAOI, Beta Blockers for performance only variant
What are the criteria for OCD?
A-presence of obsessions and compulsions
B-O & C must be time consuming, cause significant distress, not substance induced and not better explained as symptoms of another disorder
How is an obsession defined?
recurrent/persistent thoughts, urges and images
- intrusive and unwanted
- try to ignore/suppress them or neutralize (undoing-defense mechanism)
What is a compulsion?
- repetitive behavior in response to obsession (or set of rules)
- typically undoes anxiety
- stopping the compulsion increases anxiety
Who is more affected by OCD, men or women?
both are affected equally
Why types of disorders may be comordbid with OCD?
- MDD or tourettes
- suicide risk is high
What types of therapy are used for treatment of OCD?
CBT
ACT-acceptance and commitment therapy
Supportive Psychotherapy
What types of medications might be used for OCD?
SSRI at higher dose
Clomipramine (TCA)
Antipsychotics
Benzodiazepene
What are 3 other conditions considered in the differential for OCD?
- Tourettes
- Temporal lobe epilepsy
- Obsessive compulsive personality disorder
What is the most common thing that has the potential to cause PTSD?
death of a loved one
What is the most likely thing to cause PTSD?
assault
What variables are associated with the development of PTSD?
proximity to trauma
harm by another human
severity by repetition
What are the criteria for PTSD diagnosis?
-exposure to actual or threatened traumatic event
-Sx > 6 months
-Sx cause distress/impairment
->1 intrusion Sx: distressing memories and/or nightmares reliving event, dissociative rxn, flashbacks, psychological distress that resembles an aspect of the trauma, or psychological rxn to exposure to external cues
-avoidance of stimuli associated with event
-negative changes in cognition and mood associated with the event
alterations in arousal/reactivity
What are the criteria for acute stress disorder?
- PTSD except for 3 days-1 month
- Precursor to PTSD
- Best time to treat
What are the 5 categories of symptoms for ASD and PTSD?
1) re-experiencing event
2) avoidance
3) dissociate symptoms
4) negative mood
5) changes in arousal
Who is PTSD and ASD more common in, men or women?
women
Which factors make for a better prognosis?
- rapid onset of Sx
- No psychiatric co-morbidities
- Good premorbid functioning
Which psychiatric disorders make a patient more vulnerable to PTSD?
- depressive disorder
- substance related disorders
- anxiety disorders
- bipolar disorders
- personality disorders
Which type of psychotherapy is used for treatment of PTSD?
- cognitive
- behavioral
- eye movement desensitization and reprocessing
- psychodynamic
- family and group therapy
What types of medications are used in the treatment of PTSD?
SSRI
TCAs
MAOi
Prazosin- for nightmares
