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
