anxiety Flashcards
what are the physical symptoms of anxiety?
sympathetic activation. diaphoresis, mydriasis, tachycardia, tremor. GI/GU inc. diarrhea and urinary frequency. hyperventilation: dizziness and syncope. numbness and tingling in the extremities and around mouth. restlessness, irritability, trouble concentrating, worrisome
what are the different types of disorders?
GAD, panic disorder (with or without agoraphobia), specific phobia or social anxiety disorder, OCD, acute stress and PTSD.
diagnosis
must occur for >6 months. interfere with normal functioning, significant distress.
GAD general (pop, demographics, etc.)
common 3-5% pop. women more than men, half begin prior to adulthood. tends to get worse over time.
GAD
excessive worry, occurring more days than not for at least 6months. at least one event per activity. find it difficult not to worry. associated with at least three of the symptoms.
symptoms of GAD
restlessness, easily fatigued, difficult to concentrate, irritable, muscle tension, sleep disturbance.
panic attack (within the panic disorder)
an abrupt surge of intense fear or discomfort peaks within min that is unexpected. at least four of the symptoms.
symptoms of panic attack.
palpitations/pounding heart/accelerated rate, sweating, shaking, trembling, sensation of shortness of breath, choking feeling, chest pain/discomfort, nausea, dizziness/lightheadedness, chills or heat, parenthesis, derealization, fear of losing control, fear of dying.
panic disorder itself
recurrent unexpected attacks. at least one attack then one month with concern about additional attacks or consequences, with a significant maladaptive change in behavior related to the attacks.
PD with agoraphobia
fear or anxiety about at least 2 of the following: public transportation, open spaces, enclosed spaces, standing in a crowd, outside (home alone). fear of not be able to leave a situation, situation almost always produces fear and anxiety, at least 6months. fear and anxiety must be out of proportion of the actual threat.
treatment for PD
cognitive behavioral therapy with systematic desensitization or flooding. psychodynamics.
medication for PD
for emergency use benzo. for long term use SSRI, SNRI, immediately or long-acting benzo.
phobia
at least 6 months, signif. impairment. fear or anxiety about situation or object. that thing always produces fear. fear/anxiety is out of proportion.
social anxiety disorder
phobia. at least 6 months, sig impair, fear or anxiety about social situations in which one may be negatively scrutinized. social situation provokes fear. avoidance, out of proportion.
first line treatment for phobia?
flooding/systematic desensitization. psychodynamics.
treat for SAD
CBT, assertiveness training, group therapy.
medication for SAD
ssri, snri, MAOi
how do we treat performance anxiety?
use beta blockers such as propanolol
OCD
presence of obsessions and compulsions. time consuming and cause sign distress. are not substance related.
obession?
recurrent thoughts, images, urges. they are intrusive and unwanted and cause the person distress. the person will try to ignore or neutralize by performing some act (this is an ego defense mechanism). this is also the compulsion.
compulsion
repetitive behavior that the person performs in response to an obsession. they are usually a set of rules that the person must follow. this typically undoes or reduces anxiety
what happens if you stop the compulsion?
causes great anxiety and distress.
comorbidities?
33% also have MDD. 66% of people with tourettes will have OCD. suicide is high.
treatment for OCD
CBT. exposure and response prevention.
pharma for OCD?
SSRI, TCA, antipsychotics.
do benzos work for OCD?
no they do not work.
what other diseases look like OCD?
tourettes, temporal lobe epilepsy, obessive compulsive personality disorder.
PTSD
exposure to actual or threatened traumatic event. death, serious injury, sexual violence. symptoms must be present for 1 month.
does the person have to be directly affected by the event to get PTSD?
no. can be direct, but also indirect through witnessing, learning of a family member, directly experiencing related or horrific details of the event.
intrusion syndrome?
secondary criterion for PTSD. reliving of events. digressing memories, dreams, flashbacks. psychological distress that symbolizes or resembles an aspect of the traumatic event.
other associations with PTSD?
avoidance. if the patient avoids things that resemble, r causes memories.
negative features of PTSD
if the patient loses cognition over the event. for example dissociative amnesia, exaggerated beliefs, expectations, paranoid stances, distortion of thoughts, memories. negative emotional states such as depression or irritability. feeling of detachment from others. inability to experience positive emotions.
alterations of arousal and behavior in PTSD
irritable or angry outburst verbal or physical aggression toward others or objects. reckless and self-destructive behavior. hyper vigilance. exaggerated startle response. problems with concentration. sleep disturbances.
acute stress disorder
same exact as PTSD only 3 days to one month after event.
comorbid wirth PTSD/ASD
depressive disordes, substance, other anxiety disorders, bipolar, personality
treatment for PTSD
crisis intervention. support/grounding, validation of feelings. CBT, etc.
medications for PTSD
SSRI, TCA, MAOi, anticonvulsant, clonidine.
