Anxiety Flashcards
Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least three of the following:
separation anxiety disorder
emotional response to real or perceived imminent threat
Surges of autonomic symptoms (fight or flight)
fear
anticipation of future threat
Diffuse, unpleasant, vague symptoms of apprehension
Muscle tension, hypervigilance, and cautious/avoidant behaviors
anxiety
Fear/anxiety about a specific object/thing
Which provokes immediate fear/anxiety
Phobic object is avoided or endured with intense fear/anxiety
Fear/anxiety is out of proportion to (OOPT) actual danger posed
Fear/anxiety is persistent (6 months)
Clinically significant distress or impairment
Not better explained by something else
specific phobia
Key feature is a phobic stimulus with
active avoidance
Suicide risk up to 60% more likely to attempt, possibly due to comorbidity of other anxiety DO or Personality DO
specific phobia
Behavioral tx:
Desensitization
Frequently used with medications
specific phobia
first line psychotherapy for specific phobia?
CBT… can use with pharmacology (better than monotherapy but NOT requried)
May be treated with SSRIs or SNRIs
Great in long term management
Decreased risk of tolerance or dependence
Consider typical IRBA and length of time for resolution with these medications
specific phobia
(propanolol for areas like performance anxiety)
(miscellaneous = gabapentin)
Fear/anxiety about a social situation where one is exposed to scrutiny by others
Fear of expressing anxiety symptoms that will be negatively evaluated
Social situations always provoke these feelings
Social situations are avoided or endured with anxiety
Fear/anxiety is OOPT actual threat posed by social situation
Symptoms are persistent
If comorbidity present, they are clearly unrelated or is excessive
Social Anxiety Disorder
Key feature is fear of a social situation where one may be scrutinized by others
social anxiety disorder
These individuals may inadequately assertive, submissive, or occasionally highly controlling
Non-pharmacologic for SAD?
same as specific phobia
Behavioral = Desensitization, Frequently used with medications
Psychological = Cognitive behavioral therapy (First-line psychotherapy; Combo of this and medications are better than monotherapy.This does not imply that both MUST be used together )
Medication for SAD?
same as specific phobia
May be treated with SSRIs or SNRIs
Great in long term management
Decreased risk of tolerance or dependence
Consider typical IRBA and length of time for resolution with these medications
Miscellaneous = Gabapentin; Propranolol for performance or test anxiety
Unexpected panic attack with at least 4 associated symptoms that are not culturally normal
Panic attack
(4 associated symptoms that are not culturally normal might include palpitations, sweating, trembling/shaking, SOB, feelings of choking, chest pn/discomfort, nausea/abd stress, dizziness/lightheaded/faint, paresthesias, derealization/depersonalization, fear of losing control, feeling of going crazy, fear of dying
A panic disorder attack is followed by at least one of these
Worrying about more panic attacks
Maladaptive change in behavior because of the panic attacks
Key feature is recurrent unexpected panic attacks
Panic Disorder
Abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four or more of a list of 13 physical and cognitive symptoms occur
No obvious cause or trigger
Expected or unexpected
Nocturnal panic attacks
Relaxation training
Desensitization
Can work as well as medication
Non-pharmacologic/Behavioral Treatment for panic disorder
psychological tx for panic disorder?
CBT
First-line psychotherapy
Combo of this and medications are better than monotherapy
This does not imply that both MUST be used together
Appear to respond as well to cognitive behavioral therapy as it does to medications
First line meds for panic disorder?
ADs (SSRIs, SNRIs, TCA)
great in long term mgmt, decreased risk of tolerance/dependence)
consider typical IRBA and length of time for these meds
Other med options or panic disorder?
Benzodiazepines
Much faster efficacy; beneficial in acute management
Much higher risk of dependence and withdrawal symptoms
Miscellaneous
Propranolol
improve the peripheral symptoms of anxiety without significantly affecting motor and cognitive performance
i.e. palpitations, tremors, etc…
Marked anxiety in at least 2 of 5 situations
Avoids these situations because escape will be difficult or help will be limited
Agoraphobic situations always evoke anxiety and actively avoided, endured, or require a companion
OOPT actual danger
Persistent
Clinically significant or clearly excessive if another medical condition is present
Not better explained
agoraphobia
“2 of 5 situations for agoraphobia” includes?
public trans
Being in open spaces (parking lots, marketplaces, etc.)
ENclosed spaces (shops, theaters, etc)
Standing in lines/crowds
Being otuside of the home alone
Associated with considerable disability
More than 1/3 of these individuals live alone
Agoraphobia
Requiring fears from two or more of the agoraphobic situations is a robust means for differentiating agoraphobia from specific phobias, particularly the situational subtype
check
Non-pharmacologic
Peer support groups have been found to be helpful
Agoraphobia
Meds for agoraphobia?
SSRIs
SNRIs
Gabapentin
Excessive worry about multiple things, more days than not, for at least 6 months
Difficult to control the worry
At least 3 of 6 symptoms
Clinically significant
Generalized Anxiety Disorder
At least 3 of 6 symptoms for GAD include?
restlessness/feeling on edge
being easily fatigued
difficulty concentrating/mind going blank
Irritability
muscle tension
sleep disturbances
Key feature is the excessive worry about multiple things
The intensity, duration, or frequency of the anxiety and worry is out of proportion to the actual likelihood or impact of the anticipated event
generalized anxiety disorder
Non-pharmacologic generalized anxiety disorder
Behavioral
Relaxation and desensitization techniques
Frequently used with medications
Psychological
Cognitive behavioral therapy
First-line psychotherapy
Combo of this and medications are better than monotherapy
This does not imply that both MUST be used together
Antidepressants are first line medications (SSRI, SNRI, TCA)
Great in long term management
Can be anxiogenic
Decreased risk of tolerance or dependence
Consider typical IRBA and length of time for resolution with these medications
Generalized Anxiety Disorder
Much faster efficacy; beneficial in acute management
Much higher risk of dependence and withdrawal symptoms
BZDs for GAD
Misc meds for GAD include = Buspirone, Gabapentin, Propranolol
Tx for MILD GAD?
barely meets criteria, self-contorlled, not adversely affecting life, etc.
Behaviroal health, non-medication mgmt
follow up as needed, meds if needed… try to avoid BZDs
Tx for mdoerate GAD…
mre than meets critera, mostly NOT self-controlled, may/may not affect lfie…
Start as low as possible….
Behavioral health always… consider meds at this poitn (try to avoid abortive meds if possible)
Consider work restriction suggestions
Reassess/readjust at f/u
Severe GAD tx?
more than meets criteria, severe ssx, adversely affected lfie
Start low (behavioral referral always)
Work w/ subspecialist if possible
Consider daily meds/breakthrough, abortive med
GAD and depression are similar… but?
someone with depression has to tell you they feel depressed…
Endorse depression
