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Clin Med III - Psych, Genetics > Anxiety Disorders > Flashcards

Anxiety Disorders Flashcards

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1
Q

Define fear

A

Emotional response to real or perceived imminent threat

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2
Q

Define anxiety

A

Anticipation of a future threat

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3
Q

What is most a/w ANS arousal - fear or anxiety?

A

Fear

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4
Q

What is anxiety most associated with in relation to body response?

A

Hyper-vigilance and muscle tension in preparation for future danger

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5
Q

How do anxiety disorders differ from general fear/anxiety?

A

Anxiety disorders are excessive or persist beyond developmentally appropriate periods (a 4 yr old being scared of monster in the closet is appropriate vs. a 51 yr old)

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6
Q

Who is MC affected by generalized anxiety disorder (GAD)?

A
  • Females 2:1

- Diagnosis peaks in middle age (decreases in later years)

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7
Q

Etiology of GAD

A
  • Learned
  • Cognitive theory (anxiety results from incorrect views of oneself, the environment, future)
  • Neurobiology (abnormal functioning of serotonin and cortisol, increased NE)
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8
Q

Proposed neurobiological model of GAD?

A
  • Hyperactive amygdala results in hyperactive ANS activity and cortisol secretion
  • Chronically increased cortisol results in increased serotonin uptake and other changes
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9
Q

Clinical presentation of GAD

A
  • Excessive and persistent worrying
  • Hyperarousal, muscle tension
  • HAs, neck/shoulder pain w/o specific cause
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10
Q

How to diagnose GAD?

A
  • 3 or more symptoms (present on more days than not) for over 6 months
  • GAD 7 scale (99% negative predictive value)
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11
Q

Treatment of GAD

A

Psychotherapy/CBT (along with some meds)

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12
Q

Pharm treatment of GAD

A

Use anxiolytics (short acting)

  • BZD used with SSRI/SNRI
  • Buspirone (no abuse potential, no cognitive impairments, takes longer than BZDs, may work better w/SSRI or SNRI)
  • SSRIs and SNRIs
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13
Q

Define panic disorder

A

Recurrent unexpected panic attacks

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14
Q

Define panic attack

A

Abrupt surge of intense fear/discomfort that reaches a peak within minutes and 4 or more specific symptoms occurs

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15
Q

Types of panic attacks?

A

Expected and unexpected

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16
Q

Define unexpected panic attack

A

No obvious cue or trigger (when relaxing, waking up)

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17
Q

Define expected panic attack

A

Obvious cue or trigger at time of occurrence (spiders, public speaking)

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18
Q

DSM V panic disorder definition

A

BOTH 1 and 2

  1. Recurrent, unexpected panic attacks
  2. At least one panic episode has been followed by at least 1 month of: persistent worry about additional attacks or maladaptive behavior related to attack
    * Also panic attacks are NOT related to substance abuse or other medical condition
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19
Q

Who is MC affected by panic disorder?

A
  • Females 2:1

- Onset usually 15-35 yo

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20
Q

If person 40 or older presents with panic attacks, what should be considered?

A

Think depression or medical cause - onset of panic disorder is usually younger

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21
Q

Treatment of panic disorder

A
  • Psychotherapy alone for mild disease

- Meds are started if functionally impaired

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22
Q

Pharm treatment of panic disorder

A
  • SSRIs
  • TCAs (many side effects though)
  • MAOis (low tyramine diet to avoid HTN crisis)
  • BZDs
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23
Q

Define agoraphobia

A

Fear and/or avoidance of places or situations where escape may be difficult or embarrassing or help may not be available

24
Q

What often occurs concurrently with agoraphobia?

A

Panic disorder

25
Q

Diagnosis of agoraphobia

A

Marked fear/anxiety about 2 or more of:

  • Using public transportation
  • Being in open spaces
  • Being in enclosed spaces
  • Standing in line or a crowd
  • Being outside of home alone
26
Q

Treatment of agoraphobia

A

Same as panic disorder

27
Q

Define social phobia

A
  • Clinically significant anxiety provoked by certain social or performance situations
  • Often leads to avoidance behavior
28
Q

Clinical presentation of social phobia

A

Psychological AND physiologic symptoms

  • Panic attacks
  • Anticipatory anxiety
  • Avoidance of social situations (or endured w/extreme embarrassment)
29
Q

Treatment of social phobia

A
  • Psychotherapy (exposure therapy w/videotape feedback)

- Meds (SSRIs, BZDs, MAOis)

30
Q

What meds are used for general social phobias vs. specific phobias?

A
  • General social: SSRIs, BZDs, MAOis

- Specific: BBs 1 hr before, can give small BZD dose w/it

31
Q

What is the MC mental disorder in the US?

A

Specific phobias

32
Q

Define specific phobia

A

Clinically significant and EXCESSIVE anxiety/panic provoked by a specific feared object/situation

33
Q

Treatment of specific phobias (including pharm tx)

A
  • Exposure therapy
  • Hypnosis
  • Insight oriented psychotherapy
  • BZDs, BBs
34
Q

Define obsession

A

Intrusive, repetitive thoughts/desires/urges (losing things, harming someone, anxiety of contamination)

35
Q

Define compulsion

A

Repetitive mental or behavioral acts that an individual feels driven to perform (in response to an obsession or rigidly held belief)

36
Q

What does anxiety in OCD arise from?

A

Interruption or suppression of rituals

37
Q

Treatment of OCD

A
  • Insight psychotherapy
  • Exposure therapy
  • CBT (best outcome w/pharm tx)
38
Q

Pharm treatment of OCD

A
  • SSRIs
  • SNRIs
  • TCA (Clomipramine)
  • BZD (limited, short term use for acute anxiety)
  • Antipsychotics (Risperdal w/SSRI)
39
Q

Last resort treatment of OCD?

A

Neurosurgery (deep brain stimulation)

40
Q

Define PTSD

A

Re-experiencing of an extremely traumatic (out of range of normal human experience) event

41
Q

Types of trauma at risk for PTSD?

A
  • Military combat
  • Rape
  • Childhood sexual abuse
  • ICU hospitalization
42
Q

Diagnosis of PTSD

A

Symptoms must be present x 1 month with significant clinical, occupational disruption

43
Q

Classification of PTSD

A
  • Acute (less than 3 months from exposure)
  • Chronic (over 3 months)
  • Delayed onset (greater than 6 months)
44
Q

Describe ASD vs. PTSD

A
  • ASD has PTSD-like symptoms

- ASD has complete recovery by 30 days after stress exposure

45
Q

What are PTSD and ASD associated with?

A

Dissociative disorder

46
Q

Define dissociative disorder

A

Interruption of integrated functions of memory, identity or perception of the environment (from severe trauma)

47
Q

Types of dissociative disorder

A
  • Dissociative amnesia
  • Dissociative fugue
  • Dissociative identity disorder
  • Depersonalization disorder
48
Q

Define dissociative amnesia

A

Pt cannot recall traumatic event w/no other cognitive deficit

49
Q

Define dissociative fugue

A

Pt assumes new identity with impulsive sudden relocation away from home and no recall of prior life/identity

50
Q

Define dissociative identity disorder

A
  • Multiple personality disorder
  • Greater than 2 personalities (usually approx 8 for men, 15 for women)
  • A/w severe child abuse
51
Q

Define depersonalization disorder

A

Persistent, recurrent sense of detachment from oneself (dreamlike) - derealization

52
Q

Define derealization

A

Sense of strangeness of external world

53
Q

Primary treatment of PTSD

A

Exposure therapy to trigger stimuli

-Goal is to tolerate avoidance behavior and associate these w/positive emotions/outcomes

54
Q

Debriefing treatment of PTSD

A
  • Asked to recount what happened to them

- Does NOT work (might make things worse)

55
Q

Pharm tx of PTSD

A
  • SSRIs for anxiety
  • BBs for tremors
  • Prazosin for nightmares
  • Cautious use of BZDs
56
Q

Why are BZDs not helpful in PTSD treatment?

A
  • Addictive

- Impedes behavior modification w/exposure therapy and psychotherapy

Clin Med III - Psych, Genetics (9 decks)

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