Anxiety and Stress Disorders Flashcards
Types of Exposure therapy
Desensitization: combines relaxation w/ gradual exposure
Flooding: prolonged exposure
Modeling: Witness another handle feared object w/o anxiety
Two components of Anxiety
Awareness of physiologic sensations - sweating, palpitations
Awareness of being nervous/frightened
Both emotional and physical symptoms
Neurotransmitters involved in anxiety
Norepinephrine overactivation
Serotonin underactivation
PTSD
Month-long or more symptom duration
Re-experience symptoms, avoid triggers, hyperarousal symptoms
Children: bedwetting, forget how to talk, act out event, clingy
Dx: w/in 3 months of incident, last for >1 month
Tx: Psychotherapy 1st line - CBT and exposure therapy with SSRI/SNRI
PTSD Clinical Presentation
TRAUMA
Traumatic event
Re-experience
Avoidance
Unable to function
Month long or more of symptoms
Arousal increased
Acute Stress Disorder (ASD)
Lasts for 3 days minimum, 4 weeks max -> Becomes PTSD
Most occur w/in 4 weeks of traumatic event
Tx: CBT, short-term benzos (Clonazepam 0.5-2 mg/day)
General Anxiety Disorder (GAD)
Constantly worried/anxious that everything will go badly
Occurs on more days than not for >6 months
Dx: GAD-7, lasts for >6 months
Tx: 1st line is CBT+SSRI/SNRI
2nd line is TCA, Benzos
If one SSRI doesn’t work - titrate them down and off and then up on new SSRI
Panic Disorder
Sudden, repeated fear attacks
Last for several minutes, peak @ 10 min
Occur randomly - feel loss of control
Tx: CBT + SSRI 1st line
2nd: SNRI
3rd: TCA, benzo
Agoraphobia
Feeling fear and avoiding places/situations that may cause panic or make them feel trapped/helpless/embarrassed
Feel unsafe in public, need someone with them
Lasts for >6 months
Tx: CBT, SSRIs 1st
2nd: SNRI
3rd: TCA/Benzo
Specific Phobias
Intense fear, anxiety - avoid specific object/situation
Runs in family - appears in adolescence/adulthood
Excessive & unreasonable persistent fear out of proportion to actual danger
Tx: CBT 1st line
Benzos are 2nd line, SSRIs are 3rd
Social Phobias
Fear/anxiety with social situations where there is potential for judgement from others
Equal in gender, usually begins w/ childhood/early adolescents
Tx: CBT 1st line with SSRI/SNRI
2nd: Benzos
BB with performance anxiety
Obsessive Compulsive Disorder (OCD)
Intrusive thoughts (obsessions) with repetitive behaviours (compulsions)
Onset ~19 yo
Obsessions are involuntary, compulsions to suppress obsessions
Tx: CBT 1st line
SSRI alt 1st line
TCA 2nd, Benzos 3rd
Anxiety Disorder Due to Medical Condition (ADMC)
Fear and anxiety as a direct result of medical condition
Need careful evaluation to determine presence of condition
Tx: Treat medical condition
-Short-acting benzos and SSRI to treat anxiety
ADMC Common conditions
Endocrine (thyroid)
CV (CHF, PE, Arrhythmia)
Respiratory (COPD, pneumonia)
Metabolic (B12 deficiency)
Neurologic (encephalitis)
Most common specific phobias
Animals
Natural Environment
Blood-infection injury
Situational
Other - choking, clowns
