Anxiety Flashcards
Differentiate between “normal anxiety” and “diagnosable anxiety.”
In diagnosing anxiety, symptoms must be PERSISTENT (6+ months), INTERFERE WITH NORMAL FUNCTIONING, cause SIGNIFICANT DISTRESS.
What are etiological theories for anxiety in terms of psychosocial, biologic, neurobiologic?
Psychosocial: Traumatic events, extreme stress, Maladaptive coping skills, personality traits, learned. Biologic: Genetics (~30%), women > men (except OCD). Neurobiologics: v 5HT, GABA / ^ NE, Glutamate.
Diagnose General Anxiety Disorder. Usually onsets when? What is the prognosis w/o tx?
Excessive anxiety/worry for 6+ months on more days than not. Difficult to control worries. Causing significant impairment. W/o other explanation. Associated w/ 3+ of the following: Restlessness, Easily Fatigued, Difficulty concentrating, Irritability, Muscle tension, Sleep disturbance. Usually onsets before adulthood. Worsens over time w/o tx.
Best tx for GAD is? What medications can be used?
Best is CBT (psychodynamic can also be used). Meds: Antidepressants (SSRIs, SNRIs), Busipirone (5HT1a rec agonist), Benzodiazepines (2nd line). B-blockers can be used for symptomatic relief (not indicated for GAD alone).
Diagnose Panic Disorder.
An abrupt and unexpected surge of intense fear or discomfort, peaking within minutes, with 4+ of the following: Palpitations, sweating, shaking/trembling, sensation of SOB, choking feeling, chest pain, N, dizziness, chills/heat, paresthesias, derealization, fear of losing control, fear of dying. Recurrent attacks (1+ attack followed by 1 month of: concerns about additional attacks or consequences and/or maladaptive behavioral change related to attacks).
What is agoraphobia?
For 6+ months, fear/anxiety of 2+ of the following: Public transportation, open spaces, enclosed spaces, crowds or lines, being outside the home alone. + Fear of not being able to escape situation. Situation produces fear/anxiety that is out of proportion to actual danger. Avoids situation. Significant impairment. No other explanation.
What is the tx for panic disorder?
CBT: Systemmatic desensitization or flooding. Psychodynamic therapy. Medication: (in an emergency) fast-acting benzodiazepines, SSRI/SNRI (1st line for long-term), intermediate/long-acting benzodiazepines (2nd line). Combination tx.
Diagnose specific phobia. What is social anxiety/social phobia? What is “performance only” phobia?
6+ months. Significant impairment. No other explanation. Marked fear/anxiety of object/situation out of proportion to actual danger. Object/situation provokes fear/anxiety. Avoids object/situation. Social anxiety disorder is phobia in relation to social situations (with same criteria as above). Performance only phobia is restricted to public speaking or performing, and does not generalize to other social aspects of life.
What is tx for specific phobias? What about social anxiety/social phobia? Performance only phobia?
Specific phobia: 1st line is CBT: flooding, systemmatic desensitization. Benzodiazepines may or may not be useful. For social phobia: CBT, Assertiveness training, Group therapy is useful. Medication can be used as well: SSRI/SNRI (1st line), MAOIs, Beta Blockers (for performance only!)
Diagnose Obsessive Compulsive Disorder (OCD). What exactly are obsessions? What about compulsions?
The presence of obsessions & compulsions that are time consuming, cause significant distress, are not substance-induced, and are not better explained by another disorder. An obsession is a “recurrent/persistent thought, urge, &/or image that is intrusive and unwanted, causes a person anxiety/distress…The person will try to ignore/suppress them or neutralize them through action (undoing ego defense mechanism).” A compulsion is a repetitive behavior performed in response to an obsession, used to undo or reduce anxiety, and the stopping of which dramatically increases anxiety.”
What sex is affected more with OCD? When does this onset? Usually after____? What is the prognosis?
Men & women are equally effected. Onsets in late teens/early 20s, usually after a stressful event. Long & variable course but this is “likely the hardest anxiety to treat.”
What is front-line treatment of OCD? What drugs can be used? What definitely does not work as treatment?
Front-line: CBT (as effective as pharmacotherapy, with longer-lasting effects, especially Exposure and Response Prevention (ERP) [a specific treatment for OCD], Acceptance & Commitment Therapy (ACT). Pharmacotherapy: SSRIs (1st) – need higher dose and duration than other disorders (MDD). Clomipramine (TCA) (2nd). Antipsychotics, other Antidepressants (3rd line). Benzodiazepines DO NOT work.
What might OCD be confused as?
Tourette’s, Temporal Lobe Epilepsy. Obsessive Compulsive Personality Disorder (pts with OCD have insight into their behavior, whereas pts with OCPD do not and do not have repetitive discrete behaviors to undo anxiety).
What is the most common thing that could cause PTSD? What is the likely cause of PTSD? What is the risk of PTSD after a bone fracture in a car accident? What are the greatest variable associated with the development of PTSD?
Death of a loved one. Assault. 15%. Proximity, harm by another human, severity, repetition.
What are the modes of exposure in PTSD?
Directly experience. Witness. Learn that a family member/close friend experienced. Experience repeated/extreme details of an event.
