Anxiety Flashcards
- starting new job
- “worry-wart” from outside peers
- – losing friends, appearance, family
- constant muscle tension
- irritable
- not sleeping well: affecting work and friends comment
- OCD about work
- aware about her “worrying”
Generalized anxiety disorder (GAD)
- worries about family, finances, house
- interferes w/ enjoying life
- feels restlessness
- muscle tension
- cannot take on more jobs because he is too worried
- afraid of failure
- cannot sleep well: sleeping pills
- panic attack
- incident triggered
Generalized anxiety disorder (GAD)
Normal worry vs uncontrollable worry?
pt feels:
- people tell me I worry too much
- worrying when everything is ok
- keep myself busy and distracted
- hard to STOP worrying
Anxiety disorder?
prominent
persistent
disruptive in daily life
more common than depression
Types of anxiety disorder?
panic disorder agoraphobia social anxiety disorder/social phobia generalized anxiety specific phobia
Triad of anxiety disorder?
emotional (fear, nervousness)-what you feel
physical (muscular tension, tachycardia, dizziness, insomnia)
cognitive (worry, sense of doom, derealization)-what you think about
Anxiety-etiology?
biologic - GABA receptors, neurotransmitters, adrenergic system
psychological stressors
maladaptive cognitions - overestimate danger, underestimate coping
environmentally conditioned: ie) driving + stress + fear = fear of driving
driving + stress + fear?
environmentally condition anxiety
Anxiety - RF?
female younger age single/divorced low socioeconomic poor social support low education white stressful life event childhood maltreatment modeling genetics
Anxiety- comorbidities?
other anxiety disorders
personality disorders
substance use
physical disorders (CV, respiratory, arthritis, migraines)
Generalized Anxiety Disorder GAD?
has ALL triad
involves multiple domains of worry (school, work, relationship, travel, health)
AT LEAST 6mo
20-30yo
GAD tx?
SSRI
SNRI
Benzo for ACUTE management - orally (Diazapam 5-10mg) NOT IV
- severe palpitations, shakes when meeting people/presentation
- anxious w/ people
- he is aware
- avoiding travel
- otherwise, everything else is unremarkable
- worrying about job
- worrying about how people view him
social anxiety disorder
Social anxiety disorder?
fear of social and performance situations –> avoids the situations
fear of doing or saying something to result in embarrassment or humiliation
Social anxiety disorder - PE?
blush profuse sweating trembling nausea difficulty talking
Social anxiety disorder - hx?
situations are avoided or endured
present in adolescence or before
Social anxiety disorder - duration?
continuous and lifelong
shyness vs social anxiety disorder?
**
Social anxiety disorder - tx?
short acting benzodiaezpines (alprazolam - 0.25-.5mg)
Cognitive behavioral therapy
SSRI/SNRI (sertraline, paroxetine, venlafaxine)
Beta blocker (usually used just before)
- extreme heart palpitation; cannot find trigger
- nausea, sweating, tingling in arm, hot flashes
Panic disorder
Panic disorder?
foundation is panic attack
recurrent, uncued panic attacks:
-worry about future attacks
-avoidance or behavior changes to avoid attacks
-pervasive phobic avoidance (agoraphobia): trying to prevent panic attacks by avoiding situations
Panic attack?
has a beginning and end
has abrupt cognitive and somatic sx
INTENSE FEAR
less than 30 min
Panic disorder - cognitive sx in panic attack?
racing thoughts
preoccupation w/health
catastrophic misinterpretation of somatic sx
believing one is going insane
Panic disorder - sx?
very much like a "heart attack" somatic sx -choking sensation -jelly legs -feeling detached or unreal -chest pain
What makes panic disorder worse?
MVP
meniere’s
migraines
sleep apnea
Avoiding driving on bridges b/c of previous panic attacks?
agoraphobia
Higher risk for suicide?
- panic disorder and depression
- panic disorder and anxiety/depression
Agoraphobia-dx?
anxiety about 2 or more:
- using public transportation
- being in open spaces
- being in enclosed spaces
- standing in line/crowds
- being outside of home alone
Panic disorder - tx?
low dose SSRI and titrate (paroxetine 10mg) - NO TCA
MAOI
SSRI (4-6wks for clinical effect; 12-16wks for optimal relief)
cognitive behavioral therapy
adjunct benzo or other anti-anxiety
Specific phobias-dx?
least disabling
episodic, marked fear or anxiety about a specific object or situation
-predictable-always or nearly always provoked
-actively avoided or endured: with significant fear or anxiety
-fear/anxiety out of proportion to actual danger
-persistent over 6mo or more
Specific phobias - sx?
heart racing
tremors
SOB
vasovagal (ie blood injection injury)
Specific phobia - tx?
cognitive behavioral therapy
pharmacology not established
short acting benzo prior to exposure if no performance requirements
Illness anxiety disorder?
pt complains: no one has worked up thoroughly and is not worried about POSSIBILITY not illness
absence of significant sx
unlikely alleviated by neg testing and ressurance
Illness anxiety disorder-timeline?
at least 6 mo
Illness anxiety disorder - tx?
early referral to psych- NOT substitute for medical care
+/- SSRI
schedule PE so pt feels that she is being taken seriously
AVOID invasive tests
