Anxiety Disorders Flashcards
1
Q
U.S. Prevalence
A
- • 29% of Adults
- • 20% to 25% of Adolescents
- • Women to Men = 2:1
- • Worry, edginess, panic, fright, alarm, terror, jitters, jumpiness, & uneasiness
2
Q
Should Anxiety be a Concern
A
- • Practice areas
- – Acute inpatient
- – Outpatient
- – Home Care
- • Reason for concern
- – Loss of function
- – Uncertainty of progress
- – Chronicity of symptoms
- – No limit to age group
3
Q
Anxiety Disorders Characteristics
A
- Excessive fear and anxiety
- Related behavioral disturbances
- Fear inducing stimuli
- Excessive and persisting beyond developmentally appropriate periods
- Diagnosed with symptoms are not attributable to other diagnoses or situations
4
Q
Anxiety Disorders
A
- Separation Anxiety Disorder
- SelectiveMutism
- SpecificPhobia
- Social Anxiety Disorder (social phobia)
- PanicDisorder
- Panic Attack Specifier
- Agoraphobia
- Generalized Anxiety Disorder
- Substance/medication-Induced Anxiety Disorder
- Anxiety Disorder Due to Another Medical Condition
5
Q
Separation Anxiety Disorder Diagnostic Criteria
A
- Developmentally inappropriate and excessive fear or anxiety concerning separation from those whom the individual is attached, as evidenced by at least 3 of the following:
- Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures.
- Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death
- Persistent and excessive worry about experiencing an untoward event that causes separation from a major attachment figure
- Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation.
- Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings.
- Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure
- Repeated nightmares involving the theme of separation
- Repeated complaints of physical symptoms when separation form major attachment figures occurs or is anticipated.
- The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and adolescents and typically 6 months or more in adults.
- The disturbance causes clinically significant distress or impairment in social, academic, occupational , or other important areas of functioning
- The disturbance is not better explained by another mental disorder
6
Q
Selective Mutism Diagnostic Criteria
A
- Consistent failure to speak in specific social situations in which there is an expectation for speaking
- The disturbance interferes with educational or occupational achievement or with social communication
- The duration of the disturbance is at least 1 month
- The failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation
- The disturbance is not better explained by a communication disorder and does not occur exclusively during the course of autism spectrum disorder, schizophrenia, or another psychotic disorder
7
Q
Specific Phobia Diagnostic Criteria
A
- Marked fear or anxiety about a specific object or situation (in children , the fear or anxiety may be expressed by crying, tantrums, freezing, or clinging)
- 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
- The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
- The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
- The disturbance is not better explained by the symptoms of another mental disorder or situation.
8
Q
Social Anxiety Disorder (social phobia)
A
- Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by 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 the sociocultural context.
- The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
- The fear, anxiety, or avoidance causes clinically significant distress or impairment in social; occupational, or other important areas of functioning
- The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance or another medical condition
- The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder
- If another medical condition is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive
9
Q
Panic Disorder
A
- A. Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur:
- Palpitations, pounding heart, or accelerated rate
- Sweating
- Trembling or shaking
- Sensations of shortness of breath or smothering
- Feelings of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, light-headed, or faint
- Chills or heat sensations
- Paresthesias (numbness or tingling sensations)
- Derealization or depersonalization
- Fear of losing control or “going crazy”
- Fear of dying
- At lease one of the attacks has been followed by 1 month (or more) of one or both of the following
- Persistent concern or worry about additional panic attacks or their consequences
- A significant maladpative change in behavior related to the attacks
- The disturbance is not attributable to the physiological effects of a substance (e.g., a drug or abuse, a medication) or another medical condition (e.g., hyperthyroidism, cardiopulmonary disorders.)
- The disturbance is not better explained by another mental disorder (e.g., the panic attacks do not occur only in response to feared social situations, as in social anxiety disorder; in response to circumscribed phobic objects or situations, as in specific phobia; in response to obsessions, as in obsessive-compulsive disorder
10
Q
Panic Attack Specifier
A
- • An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur:
- Palpitations, pounding heart, or accelerated rate
- Sweating
- Trembling or shaking
- Sensations of shortness of breath or smothering
- Feelings of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, light-headed, or faint
- Chills or heat sensations
- Paresthesias (numbness or tingling sensations)
- Derealization or depersonalization
- Fear of losing control or “going crazy”
- Fear of dying
11
Q
Agoraphobia
A
- A marked fear or anxiety about two (or more) of the following five situations:
- Using public transportation
- Being in open spaces
- Being in enclosed places
- Standing in line or being in a crowd
- Being outside or the home alone
- The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms.
- The agoraphobic situations almost always provoke fear or anxiety
- The agoraphobic situations are actively avoided, require the presence of a companion or are endured with intense fear or anxiety.
- The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the sociocultural context.
- The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more
- The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
- If another medical condition is present, the fear, anxiety, or avoidance is clearly excessive
- The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder
12
Q
Generalized Anxiety Disorder
A
- Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities
- The individual finds it difficult to control the worry
- The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):
- Note: Only one item is required in children
- Restlessness or feeling keyed up or on edge
- Being easily fatigued
- Difficulty concentrating or mind going blank
- Irritability
- Muscle tension
- Sleep disturbance
- The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
- The disturbance is not attributable to physiological effects of a substance or another medical condition
- The disturbance is not better explained by another mental disorder
13
Q
Substance/medication-Induced Anxiety Disorder
A
- Panic attacks or anxiety is predominant in the clinical picture
- There is evidence from the history, physical examination, or laboratory findings of both (1) and (2)
- The symptoms in criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication
- The involved substance/medication is capable of producing the symptoms in criterion A
- The disturbance is not better explained by anxiety disorder that is not substance/medication induced. Such evidence of an independent anxiety disorder could include the following:
- The symptoms precede the onset of the substance/medication use; the symptoms persist for a substantial period of time after the cessation of acute withdrawal or severe intoxication; or there is other evidence suggesting the existence of an independent non-substance/medication-induced anxiety disorder
The disturbance does not occur exclusively during the course of a delirium
- The disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning
Note: This diagnosis should be made instead of a diagnosis of substance intoxication or substance withdrawal only when the symptoms in Criterion A predominate in the clinical picture and they are sufficiently severe to warrant clinical attention
14
Q
General Treatment Strategies
A
- Psychopharmacology
- Counseling
- Cognitive-BehavioralTreatment
- Mindfulness
- Behavioral Approaches (exposure, desensitization)
- Biofeedback and Medication
- EMDR (Eye movement desensitization and reprocessing)
- Interpersonal Skills Training
- Occupational Therapy & Self Management techinques
15
Q
Psychopharmacology
A
- • Aims & Actions
- – to reduce the level of arousal through regulation of neurotransmitters and activating hormones in the brain
- – Antianxiety drugs (benzodiazapines): are effective for acute anxiety present in panic attacks, generalized anxiety, social anxiety, and phobias
- – Antidepressant Medications; especially with a coexisting affective disorder
- • Selective serotonin reup-take inhibitors (SSRIs)
- – Prozac
- – Zoloft
