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Behavioral Health > Anxiety and Stress Disorders > Flashcards

Anxiety and Stress Disorders Flashcards

1
Q

Define the following:
Fear?
Anxiety?

A
  1. Fear: a response to a real or perceived immediate threat
  2. Anxiety: expectation of future threat, feeling of fear, worry, and uneasiness to an overreaction to a situation that is only subjectively seen as menacing
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2
Q
  1. When is anxiety normal?

2. When does it become a disorder?

A
  1. Necessary warning signal of danger

2. Becomes a disorder when symptoms interfere with a persons daily life or ability to function

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3
Q

Symptoms of Anxiety include what? 5

A
  1. Muscle tension
  2. Poor memory
  3. Sweaty hands
  4. Fear or confusion
  5. Constant worry
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4
Q

Causes of Anxiety? 3

Risk Factor? 3

A

Causes

  1. Heart disease
  2. Diabetes
  3. Thyroid problems

Risk Factors

  1. Being female
  2. Trauma
  3. Stress due to an illness
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5
Q

Experiencing anxiety has 2 components

2

A
  1. Awareness of physiological sensations (palpitations and sweating)
  2. Awareness of being nervous or frightened
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6
Q

Emotional symptoms of Anxiety? 4

Physical symptoms of Anxiety?
5

A

Emotional

  1. Excessive fear & worry
  2. Feelings of apprehension
  3. Trouble concentrating
  4. Feeling tense

Physical

  1. Pounding heart
  2. Sweating
  3. Stomach upset
  4. Frequent urination
  5. SOB
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7
Q

PP of Anxiety: 3 systems that affect this?

A
  1. Major neurotransmitters
  2. Autonomic nervous system
  3. Sympathetic nervous system
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8
Q

What are the major NT involved in anxiety? 4

A
  1. Norepinephrine
  2. Serotonin
  3. Dopamine
  4. GABA
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9
Q

Treatments for Anxiety: Therapy? 2

A
  1. Cognitive-Behavioral Therapy (CBT)

2. Exposure Therapy

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10
Q

Describe the three components of exposure therapy?

A
  1. Desensitization: Combines relaxation with a gradual exposure to whatever provokes the anxiety
  2. Flooding: Involves intense and prolonged exposure to the feared stimulus
  3. Modeling: Involves the witnessing of another handle a feared stimulus without anxiety
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11
Q

Treatment for Anxiety: Medications? 4

A
  1. Selective Serotonin Reuptake Inhibitors (SSRIs)
  2. Serotonin-Norepinephrine
    Reuptake Inhibitors (SNRIs)
  3. Benzodiazepines
  4. Tricyclic Antidepressants
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12
Q

Treatment for Anxiety: Alternative treatments? 5

A
  1. Stress and Relaxation Techniques
  2. Meditation
  3. Yoga
  4. Acupuncture
  5. Kava
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13
Q

In the DSM-5 what are the three categories of anxiety type disorders?

A
  1. Anxiety Disorders
  2. Obsessive-Compulsive Disorder
  3. Trauma and Stressor-Related Disorders
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14
Q

What are the specific disorders that are categorized in the following:
1. Anxiety Disorders

  1. Obsessive-Compulsive Disorder
  2. Trauma and Stressor-Related Disorders
A
  1. Separation anxiety disorder, selective mutism, specific phobia, social phobia, panic disorder, agoraphobia, and generalized anxiety disorder
  2. Obsessive-compulsive disorder, body dysmorphic disorder, hoarding disorder, trichotillomania, and excoriation disorder
  3. Reactive attachment disorder, disinhibited social engagement disorder, PTSD, acute stress disorder, and adjustment disorder
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15
Q

What are the Anxiety Disorders?

9

A
  1. Post-Traumatic Stress Disorder
  2. Acute Stress Disorder
  3. Generalized Anxiety Disorder
  4. Panic Disorder
  5. Agoraphobia
  6. Specific Phobia
  7. Social Phobia
  8. Obsessive Compulsive Disorder
  9. Anxiety Disorder Due to a General Medical Condition
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16
Q
  1. What is PTSD?
  2. What does this cause trouble with?
  3. Age?
A
  1. A debilitating condition that can occur in people who have experienced or witnessed a natural disaster, serious accident, terrorist incident, sudden death of a loved one, war, violent personal assault such as rape, or other life-threatening events
  2. Have trouble with relationships with family & friends
  3. Can occur at any age
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17
Q

PTSD: Signs and Symptoms

  1. Re-experiencing symptoms? 3
  2. Avoidance symptoms? 5
  3. Hyperarousal symptoms? 4
  4. Children? 4
A
  1. Re-experiencing symptoms
    - Flashbacks
    - Bad dreams
    - Frightening thoughts
  2. Avoidance symptoms
    - Staying away from events, places, objects
    - Feeling emotional numb
    - Feeling strong guilt, depression, worry
    - Losing interest in activities
    - Having trouble remembering the dangerous event
  3. Hyperarousal symptoms
    - Being easily startled
    - Feeling tense
    - Difficulty sleeping
    - Having angry outburst
  4. Children
    - Bedwetting
    - Forgetting how or being able to talk
    - Acting out event during playtime
    - Being unusually clingy
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18
Q 
Clinical Presentation (think TRAUMA!)
6
A 
Traumatic event
Re-experience
Avoidance
Unable to function
Month long or more duration of symptoms
Arousal is increased
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19
Q

PTSD diagnosis criteria?

4

A
  1. Symptoms usually begin within 3 months of incident and last more than a month

A person must have all the following for at least 1 month:

  1. At least one re-experiencing symptom
  2. At least three avoidance symptoms
  3. At least two hyperarousal symptoms
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20
Q

PTSD treatment

  1. Therapy? 1
  2. Medications? 2
A
  1. Psychotherapy (combo/mono 1st line)
    -6-12 weeks
    -Cognitive Behavioral Therapy
    (Exposure therapy, Cognitive restructuring, Stress inoculation training)
  2. Medications
    First line (combo/mono)
    -SSRI
    -SNRI
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21
Q
  1. An episode of Acute Stress Disorder must last for how loing?
  2. Must occur within the ___ weeks of the traumatic event?
  3. How would you think of this in regards to PTSD?
A
  1. An episode of ASD must last for a minimum of 3 days and a maximum of 4 weeks
  2. 4 weeks
  3. So think of PTSD on a short vacation!
    After 4 weeks it is diagnosed as PTSD
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22
Q

ASD Treatment?

2

A

Treatment
1. CBT
2. Benzodiazepines
Clonazepam 0.5-2mg/day

23
Q

Generalized Anxiety Disorder

  1. Applies to which kind of people?
  2. What things are they always expecting or thinking about? 2
  3. Average age of onset?
A
  1. Applies to people who are worried or anxious about almost everything
    • Think things will always go badly
    • The worrying causes impaired functioning
  3. Average age of onset is 31 y/o
24
Q

GAD

Signs and Symtpoms? 6

A
  1. Can’t relax
  2. Startle easily
  3. Have difficulty concentrating
  4. Trembling
  5. Irritability
  6. sweating
25
Q

GAD

Dx?

A

Worries excessively about a variety of everyday problems for at least 6 months

26
Q

GAD Treatment first line? 2

Alternative? 1

A

Combo/mono

  1. Psychotherapy (CBT)
    - Alone or with SSRI
  2. SSRI
    - Paroxetine, Sertraline, Citalopram
  3. SNRI
    - Alternative to First-Line
27
Q

Second line treatment for GAD? 2

A
  1. TCAs

2. Benzo’s

28
Q

Which TCA would you chose for GAD?

Which Benzos would use for GAD? 4

A
  1. Tricyclic antidepressants
    - Imipramine
2. Benzo’s
Short ½ life
-Alprazolam (11.2 hours)
-Lorazepam (12 hours)
Longer ½ life
-Diazepam (45-100 hours)
-Flurazepam (74-90 hours)
29
Q
  1. Panic disorder: What is it?
  2. What is it chracterized by?
  3. Why do these patients often feel ashamed and discouraged?
  4. Onset is usually when?
A
  1. People have sudden and repeated attacks of fear that last for several minutes
  2. “Panic Attacks” Characterized by a fear of disaster or of losing control even when there is no real danger
  3. Become discouraged and feel ashamed b/c they cannot carry out simple task
  4. Begins in late adolescence or early adulthood
30
Q

Panic disorder Signs and Symtpoms?

5

A
  1. Sudden and repeated attacks of fear
  2. Feeling of being out of control during a panic attack
    During attack:
  3. Pounding or racing heart
  4. Sweating
  5. Weakness or dizziness
31
Q

Panic disorder Dx? 3

A
  1. Attacks can occur at any time
  2. Attack will peak in 10 minutes
  3. One-third of people become housebound or are able to confront a feared situation only with a spouse or trusted person
32
Q

Treatment for Panic disorder

Therapy? 7

A

Cognitive Behavioral Therapy

  1. Education
  2. Self-Monitoring
  3. Breathing retraining
  4. Muscle relaxation
  5. Cognitive restructuring
  6. Exposure
  7. Relapse prevention
33
Q

Panic disorder medications:

  1. First line?
  2. Second line?
  3. Third line? 2
A
  1. First-line: SSRIs
    Fluoxetine, Paroxetine, Sertraline, Fluvoxamine, Citalopram, Escitalopram
  2. Second-line: another SSRI or SNRI
  3. Third-line
    - Tricyclic antidepressants

-Benzo’s

34
Q
  1. Which SNRI would you use for Panic disorder?
  2. TCA? 2
  3. Benzos? 2
A
  1. SNRI: Venlafaxine ER
  2. Imipramine & Clomipramine
  3. Alprazolam & Clonazepam (FDA approved)
35
Q

What is Agoraphobia?

A

A person feels fear and often avoid places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed

36
Q

Agoraphobia: Fear of an actual anticipated situation? 4

Usually associated with what?

A
  1. Using public transport
  2. Open or enclosed spaces
  3. Standing in line or being in a crowd
  4. Feel unsafe in public, and need someone with you

Usually associated with panic
disorder

37
Q

Agoraphobia:

  1. Onset?
  2. Risk of developing this? 3
A
  1. Usually starts before age 35
    Women more often than men
  2. Risk of developing
    - Tendency to be nervous or anxious
    - Experiencing stressful life events
    - Having a blood relative with agoraphobia
38
Q

Agoraphobia
S and S
5

A
  1. Fear of leaving the house
  2. Dependence on others
  3. Fear of being alone
  4. Fear of being in places that would be difficult to escape
  5. Symptoms of a panic attack
39
Q

Agoraphobia
Treatment?
3

A 
Psychotherapy 
CBT
1. Exposure therapy
2. Service dogs or other animals
Medication 
3. Same as with Panic Disorder
40
Q

What is a Specific phobia?

What is a social phobia?

A
  1. Specific phobia
    Intense fear, anxiety, and avoidance of specific object or situation
  2. Social phobia (Social Anxiety DO)
    Intense fear, anxiety, and avoidance of social situations where there is the potential of being scrutinized or negatively judged by others
41
Q

Specific phobia

5 major specifiers

A
  1. Animal
  2. Natural environment
  3. Blood-injection-injury
  4. Situational
  5. Other
42
Q

Phobias:

  1. Genetic?
  2. First appearance when?
A
  1. Run in families

2. First appear in adolescence or adulthood

43
Q

Specific phobia
Symptoms
3

A
  1. Persistent fear that is excessive or unreasonable
  2. Exposure to the phobia provokes immediate anxiety response
  3. Fear or anxiety is out of proportion to the actual danger posed
44
Q

Social phobia (SAD)

  1. Affects what gender?
  2. Usually begins when?
A
  1. Women and men equally

2. Usually begins in childhood or early adolescence

45
Q

Social phobia signs and symtpoms? 3

A
  1. Anxious about being with other people and have hard time talking to them
  2. Be self-conscious and feel embarrassed
  3. Afraid other people will judge them
46
Q

Psychotherapy for:

  1. Specific phobias?
  2. Social phobias?
A
  1. Specific phobias: most effective treatment (1st line)
  2. Social phobias: Group and individual (combo/mono) (1st line)

FIRST LINE

47
Q

Medications for Phobias:
Specific? 2
Social? 3

A

Specific phobias

  1. Benzo’s (2nd line)
  2. SSRI (3rd line)

Social phobias

  1. SSRIs & SNRIs: combo/mono (1st line)
  2. Beta-blockers (performance anxiety)
  3. Benzo’s (2nd line)

SECOND AND THIRD LINE

48
Q

OCD is characterized by what?

A

Characterized by intrusive thoughts that produce uneasiness, apprehension, fear or worry (obsessions), repetitive behaviors aimed at reducing the associated anxiety (compulsions), or a combination of such obsessions and compulsions

49
Q

OCD

  1. Average age of onset?
  2. Gender?
A
  1. Average of onset is 19 y/o

2. Equally common in men and women

50
Q
  1. What are obcessions?

2. What are compulsions?

A
  1. Recurrent and persistent thoughts, impulses, or images that cause distressing emotions such as anxiety or disgust
  2. Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession
    - Cleaning
    - Repeating
    - Checking
    - Ordering and arranging
    - Mental compulsions
51
Q

OCD treatment:

  1. First line?
  2. Alternative first line? 3
  3. 2nd line?
  4. 3rd line?
A
  1. Psychotherapy
    CBT
    -Exposure and Response Prevention (1st line)

Medication
2. SSRI (Alternative 1st line)
Fluoxetine, sertraline, paroxetine

  1. Tricyclic Antidepressant (2nd line) Clomipramine
  2. SNRI (3rd line)
    Venlafaxine
52
Q
  1. What is ANXIETY DISORDER DUE TO A MEDICAL CONDITION?

2. What must be done to determine this?

A
  1. When fear and anxiety symptoms are the direct effect of a medical condition
  2. Careful and thorough medical evaluation must be done to determine the presence of the medical condition that leads to the anxiety
53
Q

Associated General Medical Conditions that may cause Anxiety disorder? 5

A
  1. Endocrine conditions (Thyroid)
  2. Cardiovascular conditions
  3. Respiratory conditions
  4. Metabolic conditions
  5. Neurological conditions
54
Q

ADMC treatment?

3

A
  1. Treat the medical condition
  2. Short acting Benzo’s
  3. SSRIs

Behavioral Health (20 decks)

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