Anxiety disorder Flashcards
panic attack
discrete periods of heightened anxiety in pt with panic disorder. peak in several min and subside in 25min. rarely >1hr. sudden rush of fear. Palpitations Abdominal distress Numbess/nausea Intense fear of death Choking, chills, chest pain DD MI
panic attack DSM
discrete period of intense fear and discomfort accompanied by at least 4: palpitations, stating, shaking, SOB, choking sensation, chest pain, nausea, light headedness, depersonalization, fear of losing control or going crazy, fear of dying, numbness or tingling, chills or hot flushes
panic disorder
panic attacks + persistent fear of additional attacks. suspect in pt with chest pain but normal angiogram.
late teens -thirties
F>M
varible course but often chronic.
10-20% have sig sx that interfere with daily functioning
50% have mild infreq sx
30-40% sx free after tx
PD DSM
1) spontaneous recurrent PA with no obvious precipitant
2) at least 1 attack has been followed by a min of 1 mo of persistent concern about additional attacks, worry of implication, sig change in behavior related to attacks
PD NT
dyers of autonomic NS, CNS, cerebral blood flow. decr activity of 5HT and GABA
PA Tx
acute: benzo
chronic: SSRI (paroxetine, sertraline) 2-4wks to become effective. higher doses than for depression. start at low dose then incr to avoid activation SE (anxiety sx that mimic PA)
agoraphobia
fear of being alone in public places. often dev secondary to PA in 50-70%
agoraphobia DSM
axiety about being in places or situations from which escape might be difficult or help not available if PA
situations either avoided or endured with severe distress or face only with companion
sx not better explained by another mental disorder
agoraphobia tx
also tx with SSRI ~ panic attack
when associated with PA, when PA resolve so does agoraphobia
when unassociated with PA, usually chronic and debilitating
specific disorder DSM
persistent excessive fear brough on by specific situation or object
exposure to situation brings about immediate anxiety response
pt recognize that fear is excessive
situation is avoided when possible or tolerated with intense anxiety
if under 18, need to be at least 6mo
specific phobia
F>M. most common mental disorder in the US
more have substance related disorder
1/3 have major depression
specific phobia tx
pharmacological tx ineffective.
use systemic desensitization with or w/o hypnosis and supportive psychotherapy.
social phobia tx
paxil. beta blocker for controlling sx of performance anxiety. cog and behavioral therapy used in adjunct
OCD
axis I disorder. obscession causes the anxiety which is relieved by the compulsion.
puts are aware of their problems and irrationality (insight). sx bother them and they want to get rid of them - ego -dystonic
can interfere with life
OCD dsm
1) either obsession or compulsion as defined below
Obsessions: recurrent and persistent intrusive thoughts or impulses that case anxiety and are not simply excessive worries about real problems. person attempts to suppress the thoughts. realizes thoughts are product of their own mind
compulsion: repetitive behavior person feels drive to perform in response to an obsession. aimed at reducing distress but no realistic link btw behavior and distress
2) person aware that obsession and compulsions are unreasonable and excessive
3) obsessions cause marked distress, are time consuming or significantly interfere with daily functioning.
