anxiety disorders Flashcards
anxiety: general concept
universal, basic emotion
apprehension, uneasy, tension, uncertain, dread from real or perceived threat (unknown, vague, conflictual)
reponse to internal or external stimuli
phys, emotoinal, cog, bheavioral s/s
evolutionary response to impending doom -> f/f (autonomic response)
conscious, subconscious, unconscious
pathological anx
no real threat, passed long ago, sub adaptive coping with maladaptive
greater anx than expected of situation -> flashback, obsessions, compulsions; side tracks daily activities
lasts longer than expected
anx v fear
anx = stress response from thoughts
fear = rxn to specific danger
normal anx = necessary for survival
theories of anx d/o
bio (genetic - fam; neurobio - amygdala)
psych: shy, timid, low self esteem
cultural: parents
env: abuse, tobacco, caffeine
learned behavior
early unmet needs
cultural considerations
some express via somatic, others cog
mild anx
normal, every day, adaptive, motivate to survive
mild anx: perceptual field
heightened -> see, hear, grasp more info; sharper obs, focus is flexible and aware of anx
mild anx: ability to problem solve
work effectively toward goal, examine alternatives
mild anx: phys s/s
slight discomfort, attention seeking, restless, easily startled, irritable/impatient
mild tension relieving behavior -> foot or finger tapping, lip chew, fidget
moderate anx: perceptual field
narrowed: some details excluded, grasp less of what is going on
focus on source (selective attention), less able to pay attention
moderate anx: ability to problem solve
not optimal, can follow directions
moderate anx: phys s/s
sympathetic NS
tension, pounding heart, tachy, tachypnic, perspiration
mild somatic: HA, urinary freq, backache, insomnia
voice tremor, poor [], shake
mild and mod
can alert that something is wrong, can take action to correct
severe anx: perceptual field
greatly decreased and distorted, focus on details or 1 specific, scattered attention
severe anx: ability to problem solve
feels impossible, cant see connections btw events/details, dazed and confused
severe anx: phys s/s
behavior automatic and aimed at decreasing or relieving anx, dread, confusion, purposeless activity, impending doom, diaphoretic, withdrawal, loud and rapid speech, threats and demand
more intense somatic complaints: chest discomfort, dizzy, n, insomnia
panic: perceptual field
most extreme
cant process env, focus lost -> depersonalization (feel unreal) and derealization (world unreal)
panic: problem state
cant process, disorganized or irrational reasoning
panic: phys s/s
terror, immobile, hyperactive, flight
unintelligible com or inability to speak, amplified or muffled sounds
somatic = paresthesia, SOB, dizzy, chest pain, n, tremble, chills, overheat, palp
severe withdrawal
hallucinations and/or delusions
out of touch with reality
severe and panic
no problem solving
defense against anx
automatic coping, protect from anx
enable individual to maintain self image by blocking: feelings, conflicts, mem
unhealthy/healthy
not always apparent to individual using them
defense mechanism: altruism
unconscious, caring and concern about well being of others
defense mechanism: compsensation
counterbalance perceived deficiencies by emphasizing strengths
defense mechanism: conversion
anx into phys s/s w/o cause
defense mechanism: denial
ignore thoughts to escape
defense mechanism: displacement
transfer emotions associated with something else to something non threatening
defense mechanism: dissociation
disrupt consciousness, mem, identity, perception -. result in compartmentalization of uncomfortable aspects of oneself
defense mechanism: identification
attributing characteristics of person or group to self
defense mechanism: intellectualization
events analyzed based on remote cold facts w/o passion
defense mechanism: projection
reject emotionally unacceptable features in attributing them to others
defense mechanism: rationalization
justify illogical/unreasonable ideas, develop acceptable explanations that satisfy teller and listener
defense mechanism: rxn formation
acceptable feelings controlled, kept out of awareness, dev opposite emotion or behavior
defense mechanism: regression
revert to earlier primitive behavior
defense mechanism: spliting
cant integrate good and bad
defense mechanism: sublimation
transform negative into less damaging and even productive
defense mechanism: suppression
consciously exclude unacceptable thoughts and feelings
defense mechanism: undoing
make up for regrettable act
use of defense mech
often use variety to different degrees
freq, intensity, duration varies
effective mediation decreases anx
ineffective = increased anx and other issues
adaptive defense mech
problem solve, talk, cry, sleep, exercise, deep breathe, imagery, relax
maladaptive defense mech
blame, negative self talk, obsessive compulsive behaviors, aggressive acting out behaviors, withdrawal, excessive eating, drinking, spend, gambling, drug use, sex
take action: mild - mod anx
identify, anticipate anx provoking nonverbal comm, feelings/concerns, clarify, thoughts and feelings prior to onset, problem solv,e alternative solutions, outlets for excess energy
decrease anx: calm, recognize, listen, explore behaviors that helped in past, provide alternative coping
take action: severe to panic
safety in all areas, always remain with
clear and simply, repeat if needed, low pitch, speak slow
quiet env with minimal stim, reinforce reality, need for meds?, r/o suicide
anx d/o overview
most common, all ages and gender (F 2:1), v treatable, chronic and persistent
ineffective coping
all d/o have excessive irrational fear and dread
basic principles: strong genetic, s/s begin child/early adult, recognize thoughts/behaviors to decrease anx, allow continuation of behavior until other strategies are in place
separation anx d/o
normal infant dev (8 mo, peak at 18 mo, then decrease)
dev appropriate levels of concern about being away from s/o, scared something will happen to cause perm separation
intense anx -> interfere with normal F
adults: harm avoidance, worry, shy, uncertain, lack of self direction, impaired social and occupational F
generalized anx
anx >6 mo, excessive and persistent, F > M
accompanied by muscle tension, autonomic hyperactive, startle, difficult []
comorbid: MDD and other anx, OH abuse, most have other d/o
generalized anx: dsm5
excessive worry and anx occuring more days than not for at least 6 mo, about several events or activities
difficult to control worry
anx and worry accompanied by at least 3 for at least 6 mo (only 1 for kids): restlessness/on edge, easily fatigued, difficult [] or blank mind, irritable, muscle tense, sleep disturbance
anx, worry, or phys s/s cause sig distress or impair F
not caused by something else
generalized anx: rf
unresolved conflicts, cog misinterpretations, life stressor, genetic predis
behavioral inhibition: shy, fear, withdrawal in familiar situations
generalized anx: children and adolescents
excessive worry and fear without cause
future and past, school acceptance, fam, finance, personal abilities, school
perfectionist, overzealous, reassurance
generalized anx: children and adolescents - tm
CBT, antidep, antianx
generalized anx: clinical course
chronic, fluctuate severity, all ages
may have mild dep
often present in primary care with somatic - muscle ache, sore, GI
poor sleep, irritable, tremble, twitch, poor [], exaggerated startle, sense of ill being, uneasy, fear of imminent disaster
generalized anx: tm
pharm and psych
SSRI, SNRI, TCA, BB, antiH (hydroxyzine), antianx, anticonvulsants, antipsych
behavioral (thought stopping), CBT -> change faulty thinking thats leads to d/o
med considerations: SSRI, SNRI are first line, assess suicide, 4-8 wk for efficacy (dose, change class, 2nd)
generalized anx: tm - antianx
somatic and psych
generalized anx: tm - BB
controversial, interact with SSRI and TCA
CV s/s
dont d/c abruptly bc hypoT, nightmare, brady, dep
short term phys s by bringing down HR or BP
generalized anx: tm - benzos
quick onset, no long term benefit, dependency issue, wd, rebound anx with abrupt stop
use lowest dose, sedative so fall risk and machinery
avoid OH/sedatives and caffeine
take with food
caution in those with hx substance abuse
enhance gaba for calming effect
promote sleep
muscle relaxant properties
promote amnesion: flunitrazepam - date rape
tertatogenic - no preg
antidote: flumazenil
generalized anx: tm - MAOI
used less often
refractory dep and atypical dep
htn crisis when taken with tyramine
SE: CNS stim, ortho hypoT, can lead to rapid increase in BP, stroke, coma
significant drug to drug interactions: antihtn, SSRI, indirect acting sympathomimetics (ephedrine), TCA, merperidine
generalized anx: tm - buprorpion
atypical antidep
stim affect, decrease appetite
1-3 wks for effect
doesnt tend to affect libido and sexual F, combo therapy to counter SE of other meds
SE: seizure, agitation, HA, dry mouth, c, weight loss, GI upset, dizzy, tremor
generalized anx: tm - anti anx meds teaching
interact with antacids, decrease abs
dont change dose or freq without hcp
may be unsafe to handle mech equip
OH and other antianx meds can potentiate effects
caffeine and nicotine decrease desired effects
can be excreted in breast milk
benzos and SSRIs may cause w/d
take meds after meal for GI s/s
drug interaction can occur
generalized anx: tm - therapy
systemic desensitization: gradually introduced to feared object and taught to relax
flooding: exposed to large amount of undesirable stim to extinguish anx response, prolonged exposure to survival possible, anx decrease
self care, deep breathing, exercise, progressive muscle relax, mental imagery, meditate, biofeedback
generalized anx: tm - busprione
anti anx med
when pt sensitive to SSRI
+ results after several weeks
relieve anx with less drowsy and abuse potential
low tox and non habit forming
generalized anx: tm - hydroxyzine
antiH but has different moa that makes it effective for reducing anx s/s
specific phobias
persistent irrational fear, desire to aovid
almost always provokes immediate fear or anx -> overwhelm, crippling, decrease F
never unexpected
meds not successful -> psychotherapy, desensitize, flood
specific phobias: agroaphobia
most persistent and severe
escape may be difficult or embarrassing, help may not be avail
common situations: alone outside, alone at home, traveling, bridge, elevator, crowd
associated with ACe, stress, overprotective/emotional cool fam, genes
tm: SSRI, antidep, benzo, desensitize, flooding, CBT
social anx d/o
social or performance (public speaking) situation that could be “-“ eval
public speaking
self conscious
ex: criticize, humiliate, negative eval/embarrassment, w/d or intense discomfort
can worry for days or weeks before, uncomfortable throughout encounter
interfere with F
social anx d/o: s/s
blush, diaphoretic, tremble, n, difficulty talking, all eyes on them
social anx d/o: rf
mistreatment, SCE, shy, parents shy (genetics and modeling)
increased risk of MDD, SUD
social anx d/o: tm
SSRI and benzo
panic d/o
attacks
sudden extreme apprehension/fear, impending doom, mins then subside
suspend normal F, decrease perceptual field, misinterpret reality
OH or SUD common -> self medicate
etiology: fam hx, genetics, early childhood stress
epidemiology: associated with dep, med conditions (htn, smoke, marijuana), F with agoraphobia more likely to experience s/s after remisison
panic d/o: s/s
chest pain, palp, pounding heart, tachy, diaphoretic, tremble/shake, SOB/smother, choke, n or abd distress, sizzy, unsteady, lightheaded, faint chills/heat, paresthesia, derealization, depersonalization, fear of losing control or going crazy, fear of dying
panic d/o: 2 important psych s/s
anticipatory anx: fearful expect of panic anx onset
avoidance anx: strategies in crease feelings of control, decrease risk of panic anx
panic d/o: tm
CBT, distraction, + self talk, flooding, relax
antidep: SSRI, SNRI, TCA, MAOI, benzo = 2nd line
panic d/o: emergency care
rule out life threatening -> esp cardiac, stay with, reassure, clear directions, decrease stim, walk with, prn anti anx
obsessions
unwanted, intrusive, persistent impulses or images, recur so they cant be dismissed even when attempt to do so
seem senseless - may not see it as out of ordinary, not consistent with self perception or usual thought pattern
ex: contamination, symmetry, hurting someone
compulsions
behaviors performed repeatedly (bc short term relief), ritualistic, goal of prevent/relieve anx and distress caused by obsessions
ex: hand washing, touch in sequence, counting, lock and unlock
OCD
cycle
time consuming, distressing to self and others
repetitive unwanted thoughts/obsessions
repeated activities/rituals/compulsions
usually center around theme
gradual onset, impair F, humiliation/shame, cog impair maybe, stress can increase s/s, abuse can increase R, genes, usually occur with anx d/o
continuum, F>M, 20s-30s onset, M affected more often younger and mostly obsessions, F = more cleaning and checking rituals with onset early 20s, most only seek tm when d/o sig affect life
OCD: tm
v difficult
can help control s/s
SSRI: clomipramine, fluoxetine, fluvoxamine, paroxetine, sertraline
CBT: exposure and response
exposure
DBS: 18+, last resort
TMS: 22-68, last resort
OCD: children and adolescents
1/3 onset here
and/or, take 1+hr/day, think behavior will prevent bad thing from happening
OCD: children and adolescents - tm
meds: clomipramine, fluvoxamine, fluoxetine, sertraline
therapy: behavior (exposure and response prevention) and CBT for adolescents only
body dysmorphic d/o
preoccupation with 1+ perceived defect of flaws that aren’t visible to appear slight to others
obsessive thinking and compulsive behaviors or mental acts (compare to others)
compulsive behaviors: check mirror and camouflaging, excess groom, skin pick, seek reassurance
cosmetic sx provide temp relief
intrusive, unwanted, time consuming, difficult to control, embarrassed, shame, anx, disgust, dep
12-13 onset, most before 18, increased r/o suicide
body dysmorphic d/o: tm
chronic tm response limited
CBT, SSRI
alternative therapies like biofeedback, meditation, relaxation
hoarding
difficulty discarding or parting with possessions regardless of value
cause sig distress and impair F
M > F
s/s begin in adolescence, interfere with F in 20s, sig impair in 30s, worsen
MDD or anx, OCD
safety w/n home
may or may not be aware of problem
trichotillomania
hair pulling
any body region: scalp, brows, lashes
pain decreases anx, like NSSI, most unaware until notice clump
wks - decades, F > M
tm: behavior, SSRI
excoriation d/o
skin picking
result in lesions - swollen or broken skin
also rub, squeeze, lance, bite
deal with stress, relieve anx or without realizing
F > M, w/ OCD, trichotillomania
tm: SSRI and CBT
usually chronic -> fluctuate
wks - yrs if untreated
several hrs/day
