Anxiety and PTSD

Question 1

What are the levels of anxiety

Answer 1

Mild:
- can be productive; learning possible

Moderate:
- attention = more selective; might see peripheral if someone points it out

Severe;
- tunnel vision; perceptual field = greatly reduced

Panic: perceptual field is reduced to detail which is elaborated by distortion or the focus is scattered

Question 2

What are the defining characteristics of a panic attack

Answer 2

• symptoms develop abruptly and peak within 10 mins of onset
• sx similar to heart attack: palpitations, sweating, trembling or shaking, SOB, feelings of choking, chest pain, dizziness, lightheaded or faint
• R/O heart attack
• get labs (troponin, BNP, CBC), ECG

Question 3

Define agoraphobia

Answer 3

anxiety about being in places or situations from which escape might be difficult or embarrassing or fear of having an unexpected panic attack without help being available

Question 4

What is the difference between specific phobia and social phobias

Answer 4

Specific:

• fear that is excessive or unreasonable cued by situations or objects
• causes panic attacks in adults, tantrums, freezing or clinging in children

Social:

• persistent fear of social or performance situations which embarrassment might occur
• person is exposed to unfamiliar people or scrutiny by others; provokes anxiety (children at birthday parties)

Question 5

What are the hallmark characteristics of GAD

Answer 5

• excessive anxiety and worry occurring more days than not for at least 6 months

Question 6

What are treatment options (meds vs therapy) for anxiety disorders

Answer 6

Therapy:
- CBT, behavioral or exposure (phobias)

Meds:

• adjunctive
• safety net or rescue meds (benzodiazepines; cannot be used long term because of addiction and withdrawal sx - always used for acute episodes)

Question 7

What is the difference between obsessions and compulsions

Answer 7

Obsessions:

• persistent thoughts, impulses, or images that are experienced as intrusive and inappropriate causing marked anxiety or distress
• they have insight

Compulsions:

• repetitive behaviors that the person feels driven to perform in response to obsession or according to rules that must be applied rigidly
• these give them anxiety

Question 8

What are the s/s of body dysmorphic disorder

Answer 8

• preoccupation with one or more perceived defects or flaws in physical appearance that either are not observable or slightly noticeable to others
• repeated behaviors or mental acts in response to their appearance concerns

Question 9

What is the treatment for body dysmorphic disorder

Answer 9

CBT = best therapy
- could also do cognitive restructuring, thought stopping

Meds:
- SSRIs and TCA antidepressants

Question 10

What is the difference between acute stress disorder and PTSD

Answer 10

Acute stress disorder:

• Sx for at least 3 days up to 1 month after the even exposure
• direct or indirect experience
• does not include e-media, tv, movies, or pics unless work related

PTSD:

• must have sx for at least 1 month
• direct or indirect, witnessed or confronted with an event involving actual or threatened death or serious injury, or threat to physical integrity of self or others

Question 11

What are characteristics and examples of avoidance (with acute stress disorder)

Answer 11

Characteristics:
- efforts made to distressing memories, thoughts or feelings or external reminders that are associate with the event

Examples:

• avoids thoughts, feelings, or conversations associated with trauma
• avoids activities, places or people that arouse recollection
• inability to recall important aspects of the trauma

Question 12

What are examples of reactivity

Answer 12

• difficulty falling or staying asleep
• irritability or anger outbursts
• hypervigilance
• exaggerated startle response