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Module 6 (Psych Mental Health) > Anxiety and Stress-related Disorders > Flashcards

Anxiety and Stress-related Disorders Flashcards

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1
Q

What is the most common mental disorder in the US?

A

Anxiety and stress disorders

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2
Q

What often is most common comorbid with?

A

depression - underlying
eating disorders
bipolar disorder
substance abuse

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3
Q

What gender is anxiety more prevalent in a lifetime?

A

women 30% to men 19%
- cultural underreported

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4
Q

What percentage of people with anxiety receive tx?

A

36.9%

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5
Q

What is the recovery rate of anxiety?

A

low

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6
Q

What is the recurrence rates of anxiety?

A

high

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7
Q

Anxiety interferes with

A

personal
academic
occupational
social functioning

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8
Q

Stress can go both ways, what are the ways?

A

High eustress
Low distress

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9
Q

Eustress

A

good stress
- motivation
- exciting anticipation

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10
Q

Stress distress

A

negative
- cause emotional, physical, or psychological problems

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11
Q

What are the different types of stress?

A

psychosocial
psychological
physical
spiritual

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12
Q

Psychosocial stress

A

in their appearance or lost opportubity
- break up no acceptance
- low self-esteem

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13
Q

Psychological stress

A
  • new baby
  • intense emotion
  • can be positive intense
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14
Q

Spiritual stress

A

crisis of faith
- difficulty connecting with faith
- what is my purpose and why am i here

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15
Q

Stress can contribute to

A

worsening s/s of a mental health condition

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16
Q

If a patient has schizophrenia and anxiety, then

A

hallucinations and delusions will excel

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17
Q

If a patient has bipolar disorder and anxiety, then

A

triggers both mania and depression
- paranoia and anger with self-harm

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18
Q

Healthy coping defense mechanisms for anxiety

A

Altruism
Sublimation
Humor
Suppression (short term)

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19
Q

Intermediate defense mechanisms for anxiety

A

Repression
Displacement
Reaction formation,
Somatization
Undoing
Rationalization

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20
Q

primitive(immature) defense mechanisms of anxiety

A

Passive aggression
Acting out behaviors
Dissociation
Devaluation
Idealization
Splitting
Projection

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21
Q

Altruism

A

stress goes to motivation of other welfare
- do nice things for others

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22
Q

Sublimation

A

takes stress and puts it into something socially acceptable
- working out
- long-term permanent conversion

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23
Q

Managing Stress: relaxation/calm techniques

A

reframing/de-catastrophizing = realistic
- “You will look forward to the end of it”
sleep
physical exercise
reduce caffeine

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24
Q

Physiology of Anxiety and Stress

A

Originates in amygdala
- alerts hypothalamus
- engages SNS
- physiological s/s

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25
Q

Physiology of thoughts about anxiety

A

the limbic system sends neural messages to cerebral cortex

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26
Q

What neurotransmitters affect anxiety disorders?

A

Serotonin
Norepinephrine
GABA

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27
Q

With anxiety, serotonin is

A

decreased

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28
Q

What is the reason for giving SSRIs to anxiety patients?

A

decreased serotonin levels

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29
Q

With anxiety, norepinephrine is

A

increased

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30
Q

What is the reason for giving noradrenergic drugs to anxiety patients?

A

norepinephrine is increased

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31
Q

Norepinephrine medications for anxiety

A

propanolol
clonidine

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32
Q

What is the reason for giving Benzodiazepines to anxiety patients?

A

GABA altered
- benzo receptors sensitivity diminished

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33
Q

What is given for acute anxiety?

A

Benzodiazepines

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34
Q

Short-term effects of Epinephrine and Norepinephrine

A

Elevated heart & resp rate
Elevated FFAs, glucose, &triglycerides
Increased platelet aggregation
Increased kidney clearance
Increased blood to skeletal muscles
Increased muscular tension
primitive help to run away from the bear

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35
Q

Long-term effects of Epinephrine and Norepinephrine

A

High resting heart rate
Heart disease
Platelet aggregation
Reactive high BP
Hypercholesteremia & hyperlipidemia
Renal/hepatic problems
Glucose intolerance
Chronic muscle tension
Hyperventilation
Digestive problems
Chronic anxiety/anger

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36
Q

Short-term effects of Cortisol

A

Decreased fluid loss
Increase glucose/gluconeogenesis
Less inflammation
Less brain norepinephrine

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37
Q

Long-term effects of Cortisol

A

Immune system compromise
Atherosclerosis
Depression
Insulin insensitivity
Obesity
Hyperlipidemia
Protein breakdown in blood,bones (osteoporosis), muscle (heart) immunoglobulins

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38
Q

Chronic Stress results in

A

HTN
Heart disease/stokes
Diabetes
CA
Ulcers/Chronic GI problems
Atherosclerosis
Arthritis
Autoimmune diseases/allergies/eczema
Kidney and liver diseases
Chronic GI problems
HA

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39
Q

PTSD dx criteria

A

Exposure to actual or threatened death, injury, or sexual violence
Presence of intrusion symptoms
Avoidance of associated stimuli (external reminders)
Negative alt in cognitions/mood
Altered arousal & reactivity
Symptoms lasting longer than one month
Often presents with suicidal ideation & depression
NOT attributed to the physiological effects of a substance

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40
Q

What type of exposure can cause PTSD?

A
  • direct experience
  • witnessing in person
  • occurs to close family members or friends and actual or threatened death violent or accidental
  • experience repeat or extreme exposure to aversive details of the events (first responders, police)
    does not apply to media, TV, movies, or pictures unless work-related
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41
Q

Presence of 1+ intrusion s/s with traumatic events

A

-recurrent and involuntary memories
-dissociative reactions (flashbacks)
-intense or prolonged distress with exposure to internal or external cues
- physiological reactions that symbolize or resemble trauma

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42
Q

What are negative alterations in cognition and mood with PTSD?

A

dissociative amnesia (not head injury, alcohol, or drugs)
negative beliefs (I am bad, no one can be trusted, completely dangerous, permanently ruined)
constant negative emotional state
diminished interest in interest or activities
detachment or estrangement
unable to experience positive emotions

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43
Q

PTSD alteration arousal and reactivity

A

irritable and angry outbursts (no provocation)
- verbal/physical with people or objects
reckless or self-destructive behaviors
hypervigilance
exaggerated startle response
concentration problems
difficulty sleeping, staying asleep, or restless sleeping

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44
Q

PTSD with dissociative s/s

A

PTSD s/s and depersonalization and derealization
- NOT attributed to substance (blackouts, intoxication, complex partial seizures)

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45
Q

Depersonalization

A

persistent experience of detachment (like outside observer)
- dream, sense of unreality of self/body/time moving slowly

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46
Q

Derealization

A

persistent unreality of surroundings
- feels dreamlike, distant, distorted

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47
Q

S/S of PTSD (mnemonic)

A

Traumatic event
Re-experience the trauma
Avoiding things associated with trauma
Unable to focus
Month (1)
Arousal increase (hypervigilance, startle response)

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48
Q

PTSD Tx

A

Cognitive behavioral therapy
Prolonged exposure therapy
EMDR: Eye movement & reprocessing
Adaptive disclosure
Meds: SSRIs
Meds: Others to treat target symptoms (such as psychosis) - Antipsychotic, low dose olanzapine
prazosin for nightmares

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49
Q

Acute Stress Disorder Dx criteria

A

Exposure to actual or threatened death, injury, or sexual violence - medical emergency, car wreck
Negative mood
Dissociative & avoidance behaviors
Arousal Symptoms
Intrusion Symptoms
Hypervigilance
Longer than 3 days but Resolution of symptoms within 1 month

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50
Q

Tx of acute stress disorder

A

May resolve without treatment
- support and coping
Meds: Benzos prn for severe symptoms

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51
Q

Dissociative Identity Disorder formerly known as

A

multiple personality disorder

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52
Q

Dissociative amnesia

A

unable to recall info about self

53
Q

Dissociative amnesia with fugue

A

amnesia for identity involve travel or wandering

54
Q

Depersonalization

A

experience unreality or detachment from mind/self/body

55
Q

Derealization

A

experience unreality or detachment from surroundings

56
Q

Trauma-informed care high ACE scores

A

increased risk for physical and psychiatric disorders and adverse childhood experiences

57
Q

for dissociative disorders = TIC recognizes the impact of trauma on

A

health
how trauma impacts behavior seeking treatment
awareness that service systems have potential to retraumatize victims

58
Q

Anxiety order

A

Normal (good)
Acute (with loss/change of someone)
Pathological (absent of a threat and cause loss of functioning)

59
Q

Different Anxiety Disorders

A

Generalized Anxiety Disorder (GAD)
OCD
Phobic Disorders (Agoraphobia, Social Anxiety, specific phobics)
Panic Disorders (w/ or w/o agoraphobia)

60
Q

Neurobiological theory for anxiety disorders

A

Lower levels of serotonin-serotonin dysfunction
Increased levels of norepinephrine-alterations in the noradrenergic system
Altered GABA-Alterations in the benzodiazepine receptors

61
Q

genetics theory for anxiety disorders

A

40% hereditary

62
Q

behavioral theory for anxiety disorders

A

learned response

63
Q

cognitive theory for anxiety disorders

A

cognitive distortion in thinking

64
Q

cultural considerations for anxiety disorders

A

Sociocultural variations (transition mental to physical)
- tinnitus, neck soreness, HA, uncontrollable screaming or crying (not counted)
Somatic symptoms and cognitive symptoms vary between cultures

65
Q

Mild anxiety s/s (green)

A

Heightened awareness
Still able to work, learn, & solve problems
slight psychomotor agitation - slight restless, pacing, tapping foot

66
Q

Mild anxiety interventions

A

Reframing that this is a positive thing
Allow ventilation
Activity to release energy
Identify triggers
Focus on communication
Monitor level of anxiety
NO MEDS

67
Q

Moderate anxiety s/s (yellow)

A

Narrowed perceptual field
Selective inattention
Less able to problem-solve
HR & RR up
Somatic complaints - tinnitus, HA

68
Q

What level of anxiety will cause VS changes?

A

moderate
- start anxiolytics PRN

69
Q

Moderate anxiety interventions

A

Reframing
Allow ventilation
Activity to release energy
Identify triggers
Focus on communication
Monitor level of anxiety
PRN anxiolytic

70
Q

Severe anxiety s/s (orange)

A

Perceptual field very limited
Scattered attention,
Distorted perceptions
Diminished problem-solving ability
**Tunnel vision
Sense of impending doom
Somatic symptoms - Intense difficulty breathing, freeze, GI upset, Nausea **
Pt can still be redirectable and in control of their behavior

71
Q

Severe anxiety interventions

A

Remain calm
Stay with patient and be calm and low pitched with simple sentences
PRN anxiolytics
Pt can still be redirectable and in control of their behavior - main difference

72
Q

Panic level anxiety s/s (red)

A

Unable to focus on environment
Feeling of doom
Disorganized thinking
No problem solving
Emotional paralysis
Increased HR, Respirations
Irrational
Agitation = self harm and violence

73
Q

Panic-level anxiety interventions

A

Stay with patient - guide them
Remain calm
Simple direct statements
Assure safety
- if violent last option is sedatives
PRN anxiolytic
Minimize environmental stimulation
- no groups

74
Q

Panic Disorder Dx criteria

A

recurrent unexpected panic attacks w/o clear triggers
rapid onset from calm to anxious (peak at 10 minutes) 0 to 100 real quick
4+ s/s
followed by 1 month of fear of reoccurrence and maladaptive change in behavior

75
Q

Panic Disorder s/s

A

Palpitations, pounding heart, or accelerated heart rate.
Sweating.
Trembling or shaking.
Sensations of shortness of breath or smothering.
Feelings of choking.
Chest pain or discomfort.
Nausea or abdominal distress.
Feeling dizzy, unsteady, light-headed, or faint.
Chills or heat sensations.
Paresthesias (numbness or tingling sensations).
Derealization (feelings of unreality) or depersonalization (being detached from oneself).
Fear of losing control or “going crazy.”
Fear of dying.

76
Q

Panic Disorder is comorbid with

A

agoraphobia and depression

77
Q

Panic Disorders are usually followed for a month of

A

persistent concern about additional panic attacks or consequences (losing control, heart attack, “going crazy”
behaviors to avoid exercise of unfamiliar situations
not explained by a cardiac or hyperthyroidism problem

78
Q

Panic Disorder Tx

A

CBT (reframing)
1 - antidepressants (longer term)
2 - Benzo (short term)

79
Q

Phobic Disorders Dx

A

fear or anxiety about an object or situation
- provokes immediate fear or anxiety
- actively avoids/endures with intense fear or anxiety
OUT OF PROPORTION to actual danger and sociocultural context
significant distress o impairment in social, work, or functioning
6+ months
not explained by another mental disorder

80
Q

Agoraphobia

A

Fear of leaving the house
Using public transportation
Being in open spaces (eg, parking lot, marketplace)
Being in an enclosed place (eg, shop, theater)
Standing in line or being in a crowd
Being alone outside the home

81
Q

Agoraphobia Dx consists of s/s for

A

Marked fear with 2+ s/s in 5 situations
6+ months
disproportionate to the risk of danger
distress or impairment

82
Q

Social Anxiety Dx

A

6+ months of fear and anxiety of social situations where they will be scrutinized by others

83
Q

The Social Anxiety must involve

A

A negative evaluation by others (eg, that patients will be humiliated, embarrassed, or rejected or will offend others).

84
Q

What must be present for SAD?

A

The same social situations nearly always trigger fear or anxiety.
Patients actively avoid the situation.
Fear/anxiety/avoidance
Is out of proportion to the actual threat (taking into account sociocultural norms).
Causes significant distress or significantly impair social or occupational functioning

85
Q

Specific Phobias Dx is the

A

fear of 1+ specific objects or situations

86
Q

Acrophobia

A

fear of heights

87
Q

Claustrophobia

A

fear of closed spaces

88
Q

Arachnophobia

A

fear os spiders

89
Q

Pteromechanophobia

A

fear of flying

90
Q

Tx for Phobias

A

CBT
Assertiveness Training (agoraphobia)
systematic desentization
social skills training (Social Anxiety Disorder)
Meds: SSRIs, beta blockers, benzo
Benzo will help in the moment but not the overall disorder

91
Q

GAD Dx

A

excessive worries/anxiety < 6 months
- Ask if they can’t control the worrying
- 3+ s/s
- R/o SUBSTANCE ABUSE OR OTHER DISORDERS

92
Q

S/S of GAD

A

Restlessness or a keyed-up or on-edge feeling
Easily fatigability
Difficulty concentrating
Irritability
Muscle tension
Disturbed sleep

93
Q

GAD Tx

A

CBT
Stress Mgmt
psychical activity
meds: SSRI, SNRI, buspirone
- teach that effectiveness will take a while
Benzo - acute

94
Q

Anxiety r/t other medical conditions

A

COPD
Parkinson’s
Metabolic disorders
Hyperthyroidism

95
Q

OCD S/S

A

Presence of obsessions, compulsions, or both
Unable to ignore or suppress thoughts or actions
Obsessions & compulsions are time consuming; > 1 hour a day
1st degree relative has it as a childhood

96
Q

Questions to ask OCD patients

A

do you do certain thinks repetitively
do you have intrusive thoughts you cant shut out
do you have to do things in a specific certain way

97
Q

Obsessions in OCD

A

Recurrent & persistent thoughts, urges or images which are unwanted and intrusive causing distress to the individual

98
Q

Compulsions of OCD

A

Repetitive behaviors that the individual is compelled to perform in response to related obsession

99
Q

What is aimed to alleviate anxiety in OCD

A

compulsions

100
Q

Obsession of contamination = compulsion of

A

washing and cleaning

101
Q

Obsession of loss, fear of loss = compulsion of

A

acquiring, collect, save

102
Q

Obsession of symmetry = compulsion of

A

order, arranging, and repeating (counting)

103
Q

Obsession of causing harm = compulsion of

A

avoid contact

104
Q

Tx of OCD

A

Exposure / Response Prevention - force delay between thoughts and compulsions
Medication: SSRIs

105
Q

OCD-related disorders

A

Body dysmorphia
hoarding
trichotillomania
skin picking disorder

106
Q

Trichotillomania

A

hair pulling out and bald spots

107
Q

Assessment for Anxiety Disorder

A

Level of anxiety
Suicide risk
Use of coping/defense mechanisms

108
Q

Standardized Scale Ratings for Anxiety

A

The Clinically Useful Anxiety Outcome Scale
Generalized Anxiety Disorder Screener
Hamilton Rating Scale for Anxiety

109
Q

Priority for Anxiety pts

A

safety and therapeutic communication

110
Q

Medications for Anxiety

A

Antidepressants - SSRI, SNRI
Anxiolytics - Benzo, buspirone, hydroxyzine, beat blockers

111
Q

Interventions for Anxiety

A

communication
expression of feelings and thoughts
decrease environmental stimuli
limit stimulants
diversional activities and stress reduction techniques
milieu therapy

112
Q

What are the first line antianxiety drugs?

A

SNRI SSRI

113
Q

SSRI works

A

blocks reuptake of serotonin

114
Q

SSRI example

A

Paroxetine = GAD

115
Q

SNRI works with

A

blocks reuptake of serotonin and norepinephrine

116
Q

SNRI example

A

Venlafaxine = mixed anxiety and depression, anxiety, and nerve pain

117
Q

Noradrenergic drugs

A

Propanolol
Clonidine

118
Q

Propanolol MOA

A

blocks adrenergic receptor activity

119
Q

Clonidine MOA

A

stimulates adrenergic receptors

120
Q

Propanolol use

A

short-term relief of social anxiety and performance anxiety

121
Q

Clonidine used

A

anxiety disorders, panic attacks

122
Q

Benzodiazepines MOA

A

Binds to benzodiazapine receptors, facilitates GABA, slows neural transmission

123
Q

benzo example

A

Alprazolam – may be used short term to treat panic disorder and agoraphobia

124
Q

Buspirone MOA

A

serotonin receptor partial agonist

125
Q

Buspirone tx

A

worry associated with GAD

126
Q

What drug is only FDA-approved for GAD?

A

Buspirone (Buspar)

127
Q

Benzodiazepines
- onset
- sedating?
- dependence and withdrawal?
- change with age
- PRN

A

Rapid onset
Sedating
Dependence & withdrawal
Tolerance varies with increased age
May be used PRN

128
Q

Buspirone (Buspar)
- onset
- sedating?
- dependence and withdrawal?
- change with age
- PRN

A

Delayed onset
Non-sedating
No dependence or withdrawal
No pharmacokinetic change with age
Not suitable for PRN use

129
Q

Hydroxyzine pamoate (Vistaril)
- onset
- sedating?
- dependence and withdrawal?
- PRN

A

Rapid onset
Sedating
No dependence or withdrawal

May be used PRN

Module 6 (Psych Mental Health) (12 decks)

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