anxiety disorder Flashcards
describe some behavioral changes
escaping
avoidance
reduced performance due to anxiety
self-medication
which brain structures process anxiety?
One of them is Amygdala
what are the chemical changes?
noradrenaline
cortisol
what are some interventions for anxiety?
-
exercise
diverts from the anxious focus
builds up resilience
decreases muscle tension
activated frontal regions of the brain which control the amygdala - relaxation
- exposure
- attitude change
- social support
- pharmacological intervention
for which person is fear= anxiety?
Charles Spielberger. He is also known for STAI (state-trait anxiety inventory)
Describe some physical changes
- rapid heartbeat and breathing
- Sweating
- Chest pain
- Abdominal pain
- Nausea
- Trouble sleeping
- Feeling tension
describe two of the worries in anxeity
- Thoughts about danger, threat, or
negative possibilities - “What ifs”?
- worries for the results of anxiety (as difficulty in attending,
going crazy, people noticing)
anxiety is learned by…
…association
escape and avoidance is learned by…
…reinforcement (negative)
reinforcement… behavior
increase
punishment…behavior
decrease
what is positive reinforcement
adding a pleasant stimulus
what is negative reinforcement
removal of unpleasant stimulus
what is positive punishment
adding a unpleasant stimulus
what is a negative punishment
removal of pleasant stimulus
what is cortisols function
- stress reaction
- Formation of glucose in response to low bloodglucose concentration
- It participates in metabolism of fat, carbohydrates and protein
how do you evaluate anxiety?
STAI- state-trait anxiety inventory
BAI- beck anxiety inventory
HAM-A- hamilton anxiety rating scale
exercise helps with…
- diverts from the anxious focus
- builds up resilience
- decreases muscle tension
- activates frontal regions of the brain which control the amygdala
- Increases the availability of neurochemicals
describe the relaxation response
- the ability of the body to induce decreased activity of muscles and organs
- contrary to the fight-or-flight response
mindfulness is a combination of…
…meditations and very easy yoga
describe the progressive muscle relaxation
tense a body part- then relax
breathe in relaxation, breathe our tension
when to use the systematic desensitization technique
when real exposure not is possible
describe the systematic desensitization technique
- learn muscle relaxation
- build a hierarchy of the anxiety-arousing stimuli from 1-10
- start with the first element of the hierarchy. Talk, imagine it- when you feel anxiety- relax
- when the first element no longer provoke anxiety, continue with the next one
describe attitude change
-trying to change interpretations of situations, self-confidence to cope and personal labels
what is socratic method
- Cognitive therapy uses
- asking questions in order to change the way of thinking
- main purpose- attitude change
what side effect is there of socratic method
some people feel guilty
name one pharmacological intervention
benzodiazepines
which anxiety subgroups is there
- specific phobia
- social anxiety disorder
- panic disorder
- agoraphobia
what are the symptoms of specific phobia
- an object or situation - possible danger
- provokes fear or anxiety out of proportion to the actual danger >6
- endured with intense fear or anxiety
- when possible, active avoidance
what is the diagnostic criteria for specific phobia
- Marked fear or anxiety about a specific object or situation.
- The phobic object or situation almost always provokes immediate fear or anxiety.
- The phobic object or situation is actively avoided or endured with intense fear or anxiety.
- The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context.
- Duration: > 6 months.
- Causes impairment in social, occupational, or other important areas of functioning.
- Not better explained by symptoms of another disorder or disease.
what subtypes is there of specific phobia?
- Animal type
-
Natural environment type
(thunderstorms, heights, etc.) -
Situational type
(small confined spaces such as elevators, airplanes, etc.) - Blood-injection-injury type
what is the prevalence of specific phobia
6-9%
what is the Comorbidity of specific phobia
- 75% of individuals with specific phobia (SP),
fear more than one situation or object.
what intervention is there for SP
Fear rating
what types of intervention is there for SP
- CBT (exposure therapy, real/imaginal/ VR exposure therapy
- pharmacotherapy (effective for acute symptoms not long term)
what are the symtoms for SOCIAL ANXIETY DISORDER
One or more Social Situations
Possible scrutiny by others:
- Social interations
- Performances
- To be the focus of attention–>
provoke almost always fear or anxiety out of proportion.
> 6 months–>
Endured with intense fear or anxiety–>
When possible, active avoidance
Diagnostic Criteria for social anxiety disorder
- Marked fear or anxiety about one or more social situations in which the
individual is exposed to possible scrutiny by others. Examples include social
interactions, being observed, and performing in front of others. - The individual fears that he or she will act in a way or show anxiety symptoms
that will be negatively evaluated. - The social situations almost always provoke fear or anxiety.
- The social situations are avoided or endured with intense fear or anxiety.
- The fear or anxiety is out of proportion to the actual threat posed by the social
situation and to the sociocultural context. - Duration: > 6 months.
- Causes impairment in social, occupational, or other important areas of
functioning. - Not better explained by symptoms of another disorder or disease.
which subtypes is there of social anxiety disorder
- Specific social phobia
- General social phobia
what is the prevalence of social anxiety disorder?
10%, most common anxiety disorder!
what is the comorbidity of social anxiety disorder?
66%
what is Inferiority Complex and who coined the term? social anxiety disorder
A often subconscious lack of
self-esteem,
which sometimes produces
Overcompensation:
*Achievement
*Asocial behavior
Alfred Adler
what is self-efficacy and who?
- Alfred bandura
- “The belief in one’s capabilities to organize and execute the courses of action required to manage propective situations”.
name some questionaries for social anxiety disorder
- SPIN (social phobia inventory
- SPAI-B (social phobia and anxiety inventory-brie
- SIAS (social interaction anxiety scale
what type of intervention is there for social anxiety
FIRST is CBT, for those who are not interested in psychological treatment- drugs
Describe different types of CBT for social anxiety disorder
- exposure therapy (social/ systematic desensitization/ VR
- cognitive training with socratic method
- social skills training (sandwich, heavy fog, endless replay)
how many symtoms of symtoms is needed for panic attack
4! EXAMPLE: sweating, sensations of shortness of breath, chest pain or discomfort, feeling dizzy
how long does a panic attack last
around 10 minutes
what symtoms is there of panic disorder
- Recurrent and unexpected panic attacks > 1 month (not attributable to drugs, medical condition or another mental disorder)
- Persistent worry about consequences (to die, going crazy, etc.)
- Avoidance of situations in order to prevent an attack
what is the diagnostic criteria for panic disorder
- Recurrent unexpected panic attacks.
- At least one of the atacks has been followed by 1 month (or more) of one or both of the following:
a) Persistent concern or worry about additional panic attacks or their consequences (e.g., losing control, having a heart attack, “going crazy”).
b) A significant maladaptive change in behavior related to the attacks (e.g., behaviors designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations). - The disturbance is not attributable to the physiological effects of a substance or another medical condition (e.g., hyperthyroidism, cardiopulmonary disorders).
- The disturbance is not better explained by another mental disorder.
what is agoraphobia
Fear and avoidance from (at least 2 of):
- Public transport
- Open spaces: Squares, markets, bridges, etc.
- Closed spaces: Elevators, tunnels, etc.
- Crowds
- To be alone far from home
what is the prevalence for panic disorder and agoraphobia
2.5%
what comorbidity is there for panic disorder and agoraphobia
- Suicide ideation and depression
- Obsessive-compulsive disorder
- Schizophrenia
describe the Cognitive Model of Panic
Trigger–> Perceived Threat–> Bodily sensations
–> Catastrophic misinterpretacion of bodily
sensations
what evaluations is there for agoraphobia and panic disoder
- ASI- anxiety sensitivity index
- PDSS- panic disorder severity scale
what intervention is there for agoraphobia
- CBT (efficacy 70% alone or combined with drugs). Methods:
- Exposure
– To bodily sensations (Interoceptive exposure)
– To avoided situations - Relaxation or meditation (But be careful with
breathing, because focusing in breathing is not
comfortable for some persons!) - Cognitive and attitude change
– “It’s only anxiety” (Be carefully! Say it respectfully)
– Positive self-talk
what pharmacotherapy is there for agoraphobia
–Benzodiazepines
–Antidepressants
which has most side effects of lorazepam (Benzodiazepines) and Escitalopram (Antidepressants)
Escitalopram
what is Escitalopram described for
- Depressive Disorders
- Panic Disorder
- Post Traumatic Stress Disorder (PTSD)
- OCD
what symtoms of GAD is there
> 6 months
worry: uncontrollable, excessive, recurrent
- Restlessness
- Muscle tension
- Fatigue
- Irritability
- Sleep disturbance
- Lack of concentration
describe the diagnostic criteria for GAD
- Excessive anxiety and worry (apprehensive expectation), occurring more days
than not for at least 6 months, about a number of events or activities (such as
work or school performance). - The individual finds it difficult to control the worry.
- The anxiety and worry are associated with three (or more) of the following six
symptoms (only one is required in children):
a) Restlessness or feeling keyed up or on edge.
b) Being easily fatigued.
c) Difficulty concentrating or mind going blank.
d) Irritability.
e) Muscle tension.
f) Sleep disturbance. - Clinically significant distress or impairment in social, occupational, or other
important areas of functioning. - The disturbance is not attributable to the physiological effects of a substance or
another medical condition (e.g., hyperthyroidism).
describe the worrying process
unexpected event–> finding explanations–> elaboration–> behavior planification
what kind of worries is there accordning to Adrian wells
- type 1 (worry)
- type 2 (worry about worry or metaworry)
- positives
- negatives
how to evaluate GAD
- PSWQ: Penn State Worry Questionnaire
- WDQ: Worry Domains Questionnaire
- WW: why worry
- GAD-7: Generalized Anxiety Disorder 7
is meditation better than placebo (GAD)
yes
is Placebo and Trascendental Meditation better than muscle progressive relaxation
no!
what is better: muscle progressive relaxation or CBT
same
Benzodiazepines vs Placebo
same
Venlafaxina vs Placebo
Venlafaxina
what symtoms is there of PTSD
- Exposure to actual or threatened: death, serious injury, sexual violence, etc. Danger perception
- Provokes one or more of the intrusion symptoms > 1 month: Physiological
reactions, Distress, Memories, Dreams, Dissociation - Persistent avoidance
- Negative alterations in cognitions and mood
- Causes impairment in social, occupational, or
other important areas of functioning
describe the diagnostic criteria for PTSD
- Exposure to actual or threatened death, serious injury, or sexual violence.
- Presence of one (or more) of the following intrusion symptoms associated with
the traumatic event, beginning after the traumatic event occurred:
a) Recurrent, involuntary, and intrusive distressing memories of the traumatic
event.
b) Recurrent distressing dreams in which the content and/or affect of the
dream are related to the traumatic event.
c) Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as
if the traumatic event was recuring.
d) Intense or prolonged psychological distress at exposure to internal or
external cues that symbolize or resemble an aspect of the traumatic event.
e) Marked physiological reactions to internal or external cues that symbolize or
resemble an aspect of the traumatic event. - Persistent avoidance of stimuli associated with the traumatic event.
- Negative alterations in cognitions and mood associated with the traumatic
event.
5.Duration:>1month
what subtypes is there for PTSD
According to duration:
– Acute (< 3 months)
– Chronic (> 3 months)
According to onset:
– Delayed (> 6 months after traumatic event)
According to development:
- Complex (only in ICD-11): prolonged or repeated experience of interpesonal trauma with little or no chance of escape.
what is the prevalence for PTSD
rapes: 32%
accidents: 20%
what comorbidities is there for PTSD
- depression and suicide
- addictive disorders (self-medication)
what is logotherapy
A humanistic psychotherapy trying to help people for finding their meanings in life.
what happens in the brain (PTSD)
reduced volume of hippocampus
how to evaluate PTSD
- Be careful with memory distorsions
- It is important to get information from friends and family.
- questionnaires: PTSD checklist for DSM-5 (PCL-5) and CPSS (child PTSD symptom scale)
which people really are in need for treatment (PTSD)
- suffers from reduced affect expression
- sustains revenge desire
- uses negative strategies to cope (like drinking, compulsive work etc)
- suffers from chronic pain
Which interventions is there for PTSD
- CBT: 80% effectiveness vs 50% for only drugs
(prolonged exposure, relaxation and meditation, behavioral activation, attitude and cognitive change - EMDR: eye movement dessensitization and reprocessing
- trauma- sensitive yoga (need more research)
what symtoms is there for OCD
- Having certain unwanted and intrusive thoughts, images, urges or doubts repeatedly. That provoke almost always anxiety
- Performing certain routines repeatedly in order to reduce anxiety
- Uncontrolled. Time-consuming: > 1 hour/day
consists of:
- images: “Image of abusing of someone”
- Doubts: “Have I left the cooker on?”
- Thoughts: “This could be contaminated”
- Urges: “Urge to punch a stranger”
is it better or worse to attempt to supress the symtoms of OCD
worse!
what are the diagnostic criteria for OCD
- Presence of obsessions, compulsions, or both
- The obsessions or compulsions are time-consuming (take more than 1 hour per day or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
describe obsessions (OCD)
- recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
- The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).
describe compulsions (OCD)
- Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the
individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly. - The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.
which are some Obsessions Subtypes
ordered by frequency:
* Contamination
* Agression
* Need of symmetry
* Somatic concerns
* Sex
* Religion
which are some Compulsions Subtypes
- Checking things
- Cleaning
- Hand washing
- Repeting actions
- Ordering items in a certain way
- Counting of things
- Accumulate
describe some rituals
- skin picking
- hair-pulling
- nail biting
what are the prevalence for OCD
- 2-2.6%
- similar prevalence in different cultures
- 50% of cases appear before 20 y/o
what are the comorbidity for OCD
bipolar disorders
what is obsessions for sigmund freud
- self-reproaches and rituals are attempts to neutralize them.
- A defense mechanism, the reactive formation, is formed when attitudes contrary to the true impulses appear.
what is OCD for jeffery schwartz (neuropsychological)
a bio-chemical imbalance where brain functions get “locked”.
which biological structures is involved (OCD)
- orbitofrontal cortex
- basal ganglia
- cingulate gyrus
what is the provisonal model (OCD)
Genetic Vulnerability–>
Environmental factors
- History of child abuse
- Stress-inducing events
- Some drugs: olanzapine –>
Biochemical imbalance–>
Psychological Vulnerability
Deficits in executive function or in modulatory control–>
OCD
what evaluation is there for OCD
- Y-BOCS: yale-brown obsessive compulsive scale
- FOCI: florida obsessive compulsive inventory
by wayne goodman
what interventions is there for OCD
- CBT: Education for the person, family and friends, Why is this happening?, Relaxation and meditation, Exposure and response prevention (ERP), Habit-reversal training, Attitude and beliefs change
what are some sentences in attitude and belief change for OCD
- It’s not me, it’s my OCD
- “If I succumb to the ritual, nothing happens, next time I will wait more”
medicine in OCD
- effective in some cases, 60%
- tricyclic antidepressants:
- SSRI: more side effects than TA
which is most effective TA or SSRI (OCD)
same, but ta more side effects
which is better CBT or sertraline (OCD)
CBT
is CBT alone or CBT+ sertraline better
CBT+ sertraline
what can you do for severe cases of OCD
- hospitalization
- surgery: cingulate cortex
- deep brain stimulation
