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MSII - Behavioral Science > Anxiety > Flashcards

Anxiety Flashcards

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1
Q

what are physical manifestations of anxiety?

A
  1. symapthetic: diaphoresis, mydriasis, tachycardia, tremor
  2. GI/GU symptoms (diarrhea, more urine)
  3. hyperventilation –> dizziness and syncope, parasthesia
  4. numbness and tingling in extremities and around the mouth
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2
Q

what are psychological manifestations of anxiety?

A

restlessness, irritability, trouble concentrating, worry

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3
Q

what is the time frame of anxiety?

A

disorder depdendent

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4
Q

what are organic (medical) causes for anxiety?

A
  • caffeine
  • substance abuse (cocaine, amphetamines)
  • withdrawal (alcohol, benzos, opiates)
  • hyperthyroidism
  • arrhythmia
  • B12 deficiency
  • hypoglycemia
  • pheochromocytoma
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5
Q

what are often seen in ED setting presenting as anxiety?

A

acute MI, PE, COPD, asthma
-regardless of setting, must take history about medical and psych components, perform physical, and send labs as needed to rule out medical causes

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6
Q

what are psychiatric disorders associated with anxiety?

A
  • depression
  • schizophrenia
  • eating disorders
  • personality disorders
  • substance dependence
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7
Q

how do you diagnose anxiety?

A

symptoms must:

  1. be persistent (>6 mo, shorter in children)
  2. interfere with normal functioning (work, job, marriage)
  3. cause significant distress

otherwise, we declare normal anxiety and fear responses as pathological

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8
Q

what are psychosocial factors of anxiety?

A
  • traumatic events or extreme stressors (PTSD, panic attack) may help create anxiety disorder (Freudian Signal Anxiety)
  • maladaptive coping skills/personality traits make people vulnerable to increase stress levels (GAD, phobias)
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9
Q

what are biologic factors of anxiety?

A
  • greater prevalence in populations of family members with anxiety disorders
  • -genetics may play role (30% as opposed to 50% schizophrenia, 7-80% ADHD/bipolar)
  • gender bias (disorder dependent) in that women > men (equal in OCD)
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10
Q

what are neurobiological factors of anxiety?

A
  • decreased serotonin and GABA activity

- increased NE and glutamate activity

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11
Q

what is diagnostic criteria for general anxiety disorder?

A
  1. excessive anxiety/worry occurring more days than not for >6 mo, regarding >1 event/activity
  2. difficult to control worry
  3. associated with >3 of following:
    - restlessness
    - easily fatigued
    - difficulty concentrating
    - irritability
    - muscle tension
    - sleep disturbance
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12
Q

what is the occurrence of GAD?

A
  1. 3-5% in general population
  2. women > men
  3. 50% begin prior to adulthood
  4. parents may be GAD
  5. may self-medicate with alcohol
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13
Q

prognosis of GAD?

A

without treatment, tends to worsen over time (especially if stressful)

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14
Q

explain the treatment for all anxiety, and how they work?

A
  1. therapy (cognitive behavioral therapy or psychodynamic)
  2. medication
    - antidepressants (SSRI, SNRI) increase SR or NE, or both (downregulate/desensitize receptors)
    - Buspirone (slow-acting 5HT1a receptor agonist that initially lowers 5-HT activity, then increases output)
    - -only used for GAD
    - benzodiazepine (fast-acting GABA-A receptor positive allosteric modulator allows more Cl- channels to open)
    - -second line due to risk of addiction, falls, and apnea
    - beta-blockers (off-label use; for symtomatic relief of performance anxiety from sympathetic system - NOT GAD)
    - combinations
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15
Q

what is the diagnostic criteria for panic disorder?

A
  1. recurrent unexpected panic attacks
  2. > 1 attack followed by > 1 month of > 1 of the following:
    - concern about additional panic attacks or consequences
    - significant maladaptive change in behavior related to attacks
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16
Q

what are symptoms associated with panic disorder?

A

> 4 of the following physical and psychological components

  • palpitations, pounding heart, accelerated HR
  • sweating
  • shaking/trembling
  • sensation of SOB or smothering
  • choking feeling
  • chest pain/discomfort
  • nausea
  • dizziness, lightheadedness, or fainting
  • chills/heat
  • paresthesias
  • derealization (out of body experience)
  • fear of losing control
  • fear of dying
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17
Q

what is agoraphobia?

A
  1. fear/anxiety of >2 of the following, for >6 mo:
    - using public transportation
    - being in open/enclosed spaces
    - standing in line or a crowd
    - being outside the home alone
  2. fear of not being able to escape situation
    - situation almost always produces fear/anxiety, to the point of avoiding it
  3. fear/anxiety out of proportion to actual danger
  4. causes significant impairment, with no other explanations
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18
Q

occurrence and prognosis of panic disorder

A
  1. 5 to 3.5% prevalence in general population, women > men
    - chronic and recurring
    - increased risk of depression and suicide
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19
Q

what is treatment of panic disorder?

A
  1. therapy
    - cognitive behavioral therapy via systemic desensitization or flooding
    - psychodynamic therapy
  2. medication
    - emergency treatment: fast acting benzos
    - long term 1st line: SSRI/SNRI
    - intermediate or long-term 2nd line: benzos (addiction potential)
  3. combination treatment
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20
Q

what are diagnostic criteria for phobia?

A
  1. > 6 mo of marked fear/anxiety about a specific object/situation
  2. object/situation almost always provokes fear/anxiety
    - actively avoids object/situation
    - fear/anxiety is out of proportion to actual danger
  3. no other explanation for symptoms
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21
Q

what is coulrophobia?

A

fear of clowns

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22
Q

what is ophidiophobia?

A

fear of snakes

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23
Q

what is aerophobia?

A

fear of airplanes

24
Q

what is aerophidiophobia?

A

fear of snakes on a plane

25
Q

what is peladophobia?

A

fear of bald people

26
Q

what is iatrophobia?

A

fear of going to the doctor or of doctors

27
Q

how do you diagnose social anxiety disorder?

A
  1. social phobia for > 6 mo that causes significant impairment
  2. marked fear/anxiety when exposed to social situation with possible scrutiny by others
  3. fear of acting in ways that will be negatively scrutinized
  4. social situation provokes fear
    - avoids social situation
    - fear/anxiety is out of proportion to actual threat
28
Q

what is performance anxiety?

A

subset of social anxiety disorder (social phobia) restricted to public speaking or performing, and doesn’t generalize to other social aspects of life

29
Q

what is the occurrence and co-morbidities for phobia?

A

up to 5% of men, 10% of women

  • if social phobia, women > men is questionable
  • co-morbidities with other anxiety disorders and depression
30
Q

what is treatment for specific phobias?

A
  1. therapy (first line): flooding, systemic desensitization (CBT)
    - psychodynamics for signal anxiety
  2. medication: sedatives depending
31
Q

what is treatment for social anxiety disorder?

A
  1. therapy: CBT, asseriveness training, group therapy
  2. medication: first line SSRI, then MAOi
    - beta-blockers are first line for performance-only variant, as it will stop the physical symptoms to prevent downhill spiral
32
Q

what is the definition of OCD?

A

criterion A: presence of obsessions and compulsions
criterion B: obsessions and compulsions must be either:
-time consuming (>1hr/day) or
-cause clinically significant distress

33
Q

what is an obsession?

A
  • recurrent/persistent thoughts, urges, and/or images
  • intrusive and unwated
  • -sometimes called ego dystonic
  • -cause person anxiety and distress
  • patient tries to ignore or suppress them, or try to neurtalize with thought or action
  • -undoing ego defense mechanism
34
Q

what is a compulsion?

A
  • repetitive behavior or activity that patient performs in response to obsession or as a set of rules that must be strictly adhered to
  • typically undoes or reduces anxiety (typically an obsession)
  • stopping compulsion often dramatically increases anxiety
35
Q

what is the occurrence of OCD?

A
  • lifetime prevalence = 2-3%
  • men and women equally affected
  • 50-70% have onset after a stressful event
  • mean onset for men is 19 yo, women is 22 yo
36
Q

what is the prognosis of OCD?

A
  • long, but variable course
  • 20-30% have significant improvement
  • 40-50% have moderate improvement
  • 20-40% remain ill, or wosen
  • hardest anxiety to treat
37
Q

what are comorbidities with OCD?

A

1/3 have MDD, and up to 2/3 of Tourette’s patients have OCD

-suicide risk is high

38
Q

what is treatment for OCD? what definitely doesn’t work?

A
  1. psychotherapy
    - CBT (as effective as Rx, with longer-lasting effects)
    - -ERP (exposure and response prevention0 is specific for OCD
    - supportive and dynamic psychotherapy
  2. pharmacotherapy (best results when combined with psychotherapy)
    - 1st line: SSRIs, higher dosage and duration than MDD
    - 2nd line: TCA (clomipramine approved for OCD)
    - 3rd line: antipsychotics, other antidepressants
    - benzos DON’T WORK
39
Q

what are the different diagnoses for OCD?

A
  1. Tourette’s disorder (vocal and/or motor tics)
  2. temporal lobe epilepsy (both may have repetitive motor movements, which may look like compulsion)
  3. OC personality disorder
    - unlike OCD patients, they do not have insight into behavior; they are rigid, moralistic, work-a-holics, list-oriented, but don’t have repetitive discrete behaviors to undo anxiety
40
Q

what is the most common thing that can cause PTSD?

A

death of a loved one

41
Q

what is the most likely thing to cause PTSD?

A

assault

42
Q

what is the likelihood of getting PTSD after a car crash?

A

15%

43
Q

what are the greatest variables associated with PTSD?

A
  • proximity
  • harm by another human
  • severity repetition
44
Q

what are the criteria for PTSD via DSM-V?

A
  1. exposure to an actual or threatened traumatic event
    - death, serious injury, sexual violence
  2. 1+ intrusion symptom associated with event
    - reliving event via distressing memories, dreams/nightmares, or dissociative reactions
  3. avoidance of stimuli associated with traumatic events
  4. negative changes in cognition and mood associated with event (2+)
  5. alterations in arousal/reactivity
45
Q

how long to symptoms need to present for it to be PTSD?

A

> 1 month

  • must cause distress/impairment
  • must not be result of substance or other medical condition
46
Q

what are the modes of exposure in PTSD?

A

exposure to death, serious injury, or sexual violence must have occured via:

  • directly experiencing event
  • witnessing events that occur to others
  • learning that a family member/friend experienced an event
  • directly experiencing repeated/extreme exposure to horrific details of an event
47
Q

what does “intrusion symptom” mean for PTSD?

A

1+ for PTSD definition: reliving of events

  • distressing memories, dreams/nightmares, or dissociative reactions (flashbacks)
  • -during falshbacks, they are unaware of surroundings
  • psycholocial distress from exposure to internal or external cues that symbolize/resemble an aspect of the traumatic event(s)
  • distinct psycholocial reactions to exposure to external cues
48
Q

how do people avoid stimuli associated with PTSD?

A

avoid:

  • memories/thoughts/feelings about or associated with the event
  • external reminders (people/places/situations) that may arouse memories, thoughts, or feelings
  • interpersonal connectivity (estrangement, lack of commitment, unwilling to settle down, reclusiveness
49
Q

what are negative changes in cognition/ood related to PTSD

A

2+ of the following:

  • inability to remember an important part of the event due to dissociative amnesia or repression
  • persistent, exaggerated beliefs/expectations of oneself, others, or the world (paranoid stance)
  • distortion of thoughts/memories of the event, causing individual to blame themselves/others
  • persistently negative emotional setate (depression, irritability)
  • decreased interest in participating in daily activities
  • feeling of detachment from others
  • inability to experience positive emotions
50
Q

what are alterations in arousal/activity in PTSD?

A
  • irritable behavior/angry outbursts expressed as verbal or physical aggression towards other people/objects
  • reckless/self-destructive behavior
  • hypervigilance
  • exaggerated startle response
  • problems with concentration
  • sleep disturbances
51
Q

what is acute stress disorder (ASD)

A

PTSD, except for 3 days to 1 month after exposure (as opposed to >1 mo)
-best time to treat is early, to decrease risk of full PTSD onset

52
Q

occurrence of PTSD and ASD?

A

PTSD: 8%
ASD: 5-15%
women > men

53
Q

prognosis of PTSD and ASD?

A

variable
-better if: rapid onset of symptoms, good pre-morbid functioning, no other psychiatric co-morbidities

untreated

  • 30% recover completely, 60% continue having mild/moderate symptoms, and 10% have worsening symptoms
  • by 1 year, 50% will have recovered
54
Q

co-morbidities with PTSD/ASD?

A
  • depressive disorders
  • substance-related disorders
  • other anxiety disorders
  • bipolar disorders
  • personality disorders (esp. borderline personality disorder)
55
Q

treatment for PTSD/ASD?

A

psychotherapy

  • follow model of crisis intervention
  • -initial support, grounding, validation of feelings
  • -relive event VS seal over and move on
  • –CBT, eye-movement desensitization and reprocessing (EMDR), psychodynamic psychotherapy, support groups, family therapy

pharmacotherapy

  • 1st line: SSRIs
  • 2nd line: TCAs, atypical antipsychotics
  • 3rd line: MAOi, trazodone, anticonvulsants, clonidine, propanolol
56
Q

what is a very effective nightmare treatment?

A

prazosin (a1 inhibitor)

MSII - Behavioral Science (18 decks)

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