Anxiety Disorders Flashcards
GAD
Free floating anxiety associated w physical sx >6 months
Poor sleep/initial insomnia
Poor concentration
Increased arousal
Muscle tension
Irritability
Fatigue
Models of panic attack
trigger - perception of threat -fight or flight response - hyperventilation, release of adrenaline - sx of panic - perception of threat
CBT evidence based for
The modules in CBT
Social disorder
Panic disorder, agoraphobia with or without
- Relaxation training, breathing techniques
- Cognitive distortions - addressing
- Graded exposure therapy and systematic desensitisation- highest to least anxiety provoking situation, use 1 and 2 until mastered lowest level
OCD therapy
Habituation, extinction
Exposure response prevention
Exposed to distressing stimulus, asked to inhibit or response prevent the compulsion, stay in the state until the anxiety habituates or extincts on its own
PTSD
Reexperiencing trauma (severe life threatening injury or vicarious, witnessed or heard) e.g. intrusive memories, flashbacks, nightmares
Avoidance
Hypervigilance (emotional hyperarousal)
Emotional numbing - cognitive
Phase orientated therapy for mx of trauma
Short term - risk mx, sx containment, practical strategies, supportive counselling, sleep hygiene, short term meds
Long term - ask if engage in trauma therapy
Be mindful of trauma exposure in therapy
Indigenous trauma buzz words
Cultural sensitivity
Cultural awareness
Risk of disengagement, mistrust - therapeutic alliance over longitudinal period
Use of translators
Alternate belief systems/culturally appropriate models of illness
OCD sx
DDx
Obsessions
-prevention of harm to self and others from contamination
-prevention of harm from making mistake
-intrusive religious/sexual e.g being paedophile/violent or aggressive/need for order or symmetry
Compulsions
-checking
-cleaning/washing
-repeating actions
-mental compulsions
-ordering, symmetry or exactness
-hoarding
Senseless thoughts
One’s own thoughts
In children - can be part of stereotypies and rituals of pervasive developmental delay
Coping mechanism for stress e.g. relationship conflict
PANDAS - infection, organic
Tx resistant OCD - ddx
OCPD
Secondary depression - overvalued ideas misdx as depression
Prodromal psychosis
Worsening from stimulants, antipsychotics, methamphetamines
Organic - basal ganglia disorders, infections, neurocog e.g. hoarding
Planning CBT in OCD
ERP is the evidence based CBT technique
- Assessment, psychoeducation about disorder and tx planning
-formulation about anxiety disorder
-provide psychoed about OCD, O and C
-principles of habituation and extinction, principles that maintain anxiety
-identify triggers, fears and rituals
-address factors that facilitate or hinder therapy - Reduce physical sx through relaxation, exercise, exposure to real life situations in a hierarchical manner
Start with least anxiety provoking situation until patient gains confidence and is able to prevent compulsion
In vivo or imaginal exposure, 20 sessions - 1 hour
Encourage to face fears, extinction of fear occurs to repeated exposure
Safety response inhibition
Restricts compulsions that maintain anxiety cycle
Relinquishing safety signals, adaptive self efficacy
Increasing self confidence
Cognitive processing
What is learnt from rituals and provide hwk for practice outside clinic setting
Characteristics of BZD withdrawal
- Hypersensitivity to light, sound,
smell or taste - Feeling of things moving, as if
being on a boat - Tinnitus
- Distorted body image
- Muscle cramps and pains,
myoclonic jerks - Flu-like symptoms
- Suspiciousness
- Feeling confused
- Depersonalisation, derealisation
- Seizures (rarely)
BDD Tx
- Prevent adoption of sick role - unneccessary tx and surgery
- Tx of comorbidities - MDD, social phobia, OCD
- Psychological - CBT - exposure and behavioural experiments to reduce rumination and comparing
