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Behavioral Dynamics Exam 2 > Anxiety and Stress Disorders > Flashcards

Anxiety and Stress Disorders Flashcards

1
Q

Anxiety - what is it?

A

● Anxiety is a normal emotion and common
reaction to the stress of everyday life.
● Diffuse, unpleasant, vague sense of
apprehension
● Becomes pathologic when functioning is impaired

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2
Q

Generalized Anxiety Disorder (GAD)

A

Generalized anxiety disorder (GAD) is characterized by excessive and persistent
worrying that is hard to control, causes significant distress or impairment, and
occurs on more days than not, for at least six months

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3
Q

Most common mental health disorder

A

GAD

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4
Q

Biological etiology of GAD

A

○ Norepinephrine, serotonin, and vanillylmandelic acid
are increased in patients with GAD
○ decreased postsynaptic alpha-2 adrenergic receptor
sensitivity

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5
Q

Medical conditions associated with GAD

A

○ Hyperthyroid
○ Cardiac arrhythmia
○ Asthma
○ Premenstrual Dysphoric disorder

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6
Q

GAD caused by medication side effects

A

○ Caffeine
○ Decongestants
○ Stimulants
○ Benzodiazepines

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7
Q

Review GAD DSM criteria in slides

A

slides 10-11

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8
Q

GAD- Clinical Presentation

A

● Restlessness or feeling keyed-up or on edge
● Being easily fatigued
● Difficulty concentrating or mind going blank
● Irritability
● Muscle tension
● Sleep disturbance

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9
Q

GAD - Screening tools

A

● GAD 7
● Hamilton Anxiety Scale
(HAM-A)

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10
Q

Complications & Risk Factors of GAD

A

● Associated with increased rates of substance abuse
● Common in patients presenting with medically unexplained Chronic pain
● Female sex
● Poverty
● Recent adverse life events
● Chronic physical illness (respiratory, cardiovascular, metabolic, cognitive),
● Chronic mental disorder (depression, phobia and past GAD)
● Parental loss or separation
● Low affective support during childhood
● History of mental problems in parents

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11
Q

GAD - Treatment

A

● Psychopharmacology
● Psychotherapy
● Other treatments

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12
Q

1st line treatment for Anxiety disorders is

A

● Psychotherapy
● SSRI
● Or both

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13
Q

Other Anxiolytics outside of SSRIs and SNRIs

A

○ Benzodiazepines
○ Buspirone
○ Hydroxyzine
○ Gabapentin

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14
Q

Benzodiazepine Mechanism of Action

A

● Target of action is the GABA receptor
● Gaba is the major inhibitory
neurotransmitter in CNS
● Binding of GABA to its receptor triggers opening of ION channel allowing Chloride ion influx
● Influx of chloride ion causes
hyperpolarization of the neuron and
decreases neurotransmission by inhibiting the formation of action potential
● Benzos increase frequency of channel
openings produced by GABA

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15
Q

Benzodiazepines

A

● Alprazolam (xanax)
● Clonazepam (klonopin)
● Diazepam (valium)
● Lorazepam (ativan)
● Temazepam (restoril)
● Chlordiazepoxide (librium)

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16
Q

Advantages of Benzodiazepines

A

● Work quickly
● Effective short term

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17
Q

Benzodiazepines Side effects

A

● Respiratory depression
● Daytime sedation
● Disinhibition
● Amnesia
● Physical and psychological
dependence

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18
Q

GAD - Psychotherapy

A

● CBT ( Cognitive Behavioral Therapy)
● Computerized CBT ( Fearfighter)
● Exercise
● Mindfulness
● Meditation

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19
Q

Panic Disorder- ___

A

characterized by recurrent, unexpected panic attacks that occur abruptly and are accompanied by debilitating fear of having additional attacks

20
Q

Klein & colleagues postulate panic attacks are misperception of
_____

A

suffocation

21
Q

Panic disorder Symptoms usually climb to maximum severity within _____ but
can reach peak in a few seconds

A

10 minutes

22
Q

Minimum of ___ symptoms must be present to meet diagnosis of panic attack

A

4

23
Q

Panic Disorder - Management

A

Choice of pharmacotherapy & psychosocial treatment
(typically CBT) based on patient preference &
willingness to participate in psychosocial treatment

24
Q

Panic Disorder - Agoraphobia

A

A severe form of panic disorder

25
Q

Agoraphobia is characterized by a marked fear or anxiety about two (or more) of the following situations:

A

○ Using public transportation
○ Being in open spaces
○ Being in enclosed spaces (e.g., shops, theaters, cinemas)
○ Standing in line or being in a crowd
○ Being outside the home alone.

26
Q

Acute stress disorder (ASD)

A

characterized by acute stress reactions that may occur in the initial month after a person is exposed to a traumatic event (threatened death, serious injury, or sexual violation). The disorder includes symptoms of intrusion, dissociation, negative mood, avoidance, and arousal.

27
Q

Acute Stress Disorder - Risk factors

A

● History of a pre trauma psychiatric disorder
● History of traumatic exposures prior to recent exposure
● Female gender
● Trauma severity
● Neuroticism
● Avoidant coping

28
Q

Acute stress disorder presents with similar symptoms as PTSD, but for ____

A

< 1month ≥ 3 days

29
Q

Adjustment Disorder

A

● Emotional or behavioral changes within first 3 months after known
stressor
● Distress out of proportion to stressor or impairment in functioning
● Stops by 6 months after end of stressor
NOT due to another mental health condition or normal bereavement
Examples of stressors: Lost job, end of relationship, major illness or
injury, natural disaster, getting married, having a child

30
Q

Adjustment Disorder - Treatment

A

● Brief Therapy
● Reassurance
● Screening for Suicide
● Treat insomnia, anxiety, or panic attacks as needed (Ex.
Hydroxyzine)
● FMLA or short term disability if helpful

31
Q

Post Traumatic Stress Disorder

A

PTSD is characterized by intrusive thoughts, nightmares and flashbacks of past traumatic events, avoidance of reminders of trauma, hypervigilance, and sleep disturbance, all of
which lead to considerable social, occupational, and interpersonal dysfunction.

32
Q

PTSD Exposure criteria

A
  1. Directly Experiencing
  2. Witnessing (in person)
  3. Learning of event occurring to family/friend
  4. Repeated or extreme exposure to details*
33
Q

PTSD - Management

A

● Cognitive behavioral therapy
● SSRI/ SNRI
● Second generation antipsychotics
● Alpha-adrenergic receptor blockers - Prazosin
● EMDR-Eye movement desensitization & reprocessing

34
Q

EMDR

A

EMDR is a technique that was unintentionally discovered. It was noticed that focusing visual attention on the wave movements of tree leaves in
the wind provided relief from rumination.

● Somewhat controversial
● Repetitive lateral eye movement technique that facilitates processing of trauma related thoughts.

35
Q

Obsessive Compulsive Disorder

A

● Recurrent, intrusive, and distressing thoughts, images, or impulses (ie, obsessions) and
● Repetitive mental or behavioral acts that the individual feels driven to perform (ie, compulsions) to prevent or reduce distress according to rules that
he or she believes must be applied rigidly or to achieve a sense of “completeness.”

36
Q

_____: repetitive or persistent thoughts
that are intrusive, unwanted, & cause distress or
anxiety

A

Obsessions

37
Q

Most common obsession themes in adults

A

○ Fear of contamination
○ Thoughts/ fear of causing harm to self or others
○ Violent or horrific scenes or urges
○ Fear of taboo thoughts or images

38
Q

_____ : repetitive behaviors or mental acts, not intrinsically
pleasurable & are performed in response to an obsession

A

Compulsions (rituals):

39
Q

Common Compulsions:

A

○ Reordering objects or repeating actions multiple times
○ Repetitive washing/cleaning
○ Repetitive checking- doors, locks,
○ Mental acts:
■ Checking one’s memory
■ Asking for forgiveness or excessive praying
■ Counting/repeating words

40
Q

Obsessive Compulsive Disorder - Management

A

Treatment ranges from stress reduction to Neurosurgery
● Pharmacology
○ SSRI
○ Clomipramine
○ Venlafaxine
● Psychotherapy
○ Exposure-&-response-prevention (form of CBT)
○ Low-intensity CBT alone for mild impairment
● combination medication plus psychotherapy for patients
unresponsive to either monotherapy

41
Q

1st line treatment for OCD

A

SSRI
○ No single SSRI has been found to be more efficacious for OCD
○ All SSRIʼs have FDA indication except for citalopram, escitalopram
○ Improvement in 40-60% of patients
○ Higher doses tend to be more effective

42
Q

Deep brain stimulation for OCD

A

● Neurosurgical technique that involves implantation of electrodes into the brain
● American Psychiatric Association (APA) recommends considering ablative neurosurgery or deep brain
stimulation only for very treatment-refractory, severe OCD & only at appropriate sites with expertise
● Patients should have a Y-BOCS score of at least 28
● Significant side effect of hypomania- 50-67% of cases

43
Q

Specific Phobic Disorder - common phobic fears:

A

● Animals
● Insects
● Heights
● water
● enclosed places
● driving
● flying
● seeing blood
● getting an injection
● choking or vomiting

44
Q

____ are the most effective
treatment for specific phobia

A

Exposure therapies

45
Q

______ is a common type of Phobia.

A

Social Anxiety Disorder

Behavioral Dynamics Exam 2 (5 decks)

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