Anxiety + Adjustment Disorders Flashcards
Adjustment disorder
Develops 3 mo after nontraumatic event
- Distress in excess after stressful life event OR
- significant impairment in function
Sx resolve in 6 mo after stressor terminated
Stressful event is not divorce, death, loss of job. In PTSD it is.
2x more common in females
Tx adjustment disorder
Supportive psychotherapy most effective
Group therapy
Pharm for associated sx (insomnia, anxiety, depression)
Most common association with panic disorder
Depression
Social anxiety disorder (social phobia)
Anxiety about >=1 social situations for > 6 mo
Fear of scrutiny by others, humiliation, embarrassment
Social situations avoided or endured w/ intense distress
Marked impairment (social, academic, occupational)
Generalized vs performance only social anxiety disorder
Tx?
Generalized = meeting new ppl, initiating convos, being observed by others
Performance only = public speaking or presentations
Tx:
- Generalized = SSRI/SNRI, CBT
- Performance = Benzo or propanolol 30-60min before situation, CBT
Specific phobia
Marked anxiety about specific object or situation for > 6mo (need to be > 6 mo if less than 18 yo)
Types: Flying, heights, animals, injections, blood
Avoidance behavior
Common 10% population
Usually develops in childhood; can develop after traumatic event
Person recognizes fear is excessive
Tx specific phobia
Behavior therapy #1
Short acting benzos acutely
DDx of anxiety disorders
Social anxiety DO - fear of scrutiny
Panic DO - unexpected panic attacks
Specific phobia - anxiety with specific object
GAD - Chronic multiple worries
Neurotransmitter associations with anxiety
Increased norepi
Decreased GABA and serotonin
Medical causes of anxiety disorders
Hyperthyroidism Vit B12 defificency Hypoxia Neuro DO - epilepsy, brain tumors, MS, CVD CV dz Anemia Pheo Hypoglycemia
Panic attack criteria
PANICS
Palps Ab distress Numbness, nausea Intense fear of death Choking, chills, chest pain Sweating, shaking, SOB
Panic attack association
MItral valve prolapse Asthma PE Angina Anaphylaxis
Panic disorder criteria
Panic attacks followed by at least 1 mo of the following:
Persistent concern about having additional attacks
Worry about impolications of attack
Sig change in behavior to try and avoid attacks
ALWAYS SAY IF PANIC DO WITH or WITHOUT AGORAPHOBIA
Tx panic disorder
- SSRIs: paroxetine, sertraline
- –> need 2-4 weeks for effective, need higher doses than for depression
- imipramine
- TCAs, benzos, MAOIs
Tx should last for 8-12 mo at least as relapse common
Agoraphobia
Fear of being alone in public places
Ppl will avoid place or situations from which escape or help might be difficult
- can be 2/2 to panic attack apprehension
If 2/2 panic DO, once panic DO treated, agoraphobia usually resolves
Which one is dx more? Social vs. specific phobia
Specific phobia
Women 2x more likely to have specific phobia than men
Social phobia equal prevalence men and women
Tx specific phobia
Pharm NOT effetive
Best: Behavior therapy
- systemic desensitization is common = gradual exposure of pt to feared object or situation
SSRI/SNRI - if freq exposure to stimulus + CBT not available
Benzo - if not frequent exposure to stimulus + CBT not available
Tx social phobia
CBT or SSRI/SNRI (paroxetine) if generalized (frequent) form
Benzo or beta blocker if infrequent occurrence
Shy vs social phobia
Social phobia complete avoidance of scrutiny and exaggerated fears in day to day life causing significant distress and/or disability
OCD diagnosis
Either obsessions or compulsions as defined below:
- obsessions
- -> lots of intrusive thoughts or impulses with more anxiety
- -> person wants to SUPPRESS thoughts
- -> person has insight - compulsions
- -> repetitive behaviors person feels needs to do in response to obsession
- -> behaviors aimed at dec distress but no real link to do this
Person has insight
Obsession have lots of distress, time consuming, significantly interfere w/ daily functioning
Increased activity in caudate nucleus
Defense mechanism: UNDOING
Rate of COD is higher in pts with…
first degree relatives for have TOURETTE
Tx OCD
Behavioral tx + Meds
- Exposure and response prevention (ERP)
SSRIs (need higher doses than in depression)
- fluoxetine
- fluvoxamine**
- paroxetine
- sertraline
TCAs
- Clomipramine
Can use amitriptyline if have corresponding pain sydnrome
ECT is last resort
Exposure and response prevention
prolonged exposure to ritual eliciting stimulus and prevention of the relieving compulsion
Dx PTSD
witness traumatic event
persistent avoidance
hyperarousal
Reexeriencing traumatic event
ALL FOR MORE THAN 1 MONTH
