Anxiety Disorders Flashcards
Types of Stress & Stressors
Stress
- Eustress- “Stress of winning”
- Distress- “Stress of losing”
Stressors
•Developmental- normal aspects of maturing
•Internal- “body, mind, spirit”
•Environmental- external and situational
–Biogenic- triggers stress without cognitive involvement:
caffeine, nicotine
–Psychosocial- real or imagined (anticipating or imaging a stressor can evoke the release of the same stress hormones that are released when the stressor actually occurs)
Manifestations/Indicators of Stress
•Physiological- “mind/body connection” •Psychological- fear, anxiety, anger, depression •Cognitive- –Changes in problem solving –Cognitive restructuring –Suppression- defense mechanism –Diminished or impaired self-control –Fantasizing
Lifespan & Cultural Considerations
- Children- manifest symptoms differently, may express their emotions through play and art, with PTSD may have form of play indirectly recreating traumatic event
- Older Adults- more stigma about mental illness, may not report symptoms or ask for help
The Cultural Formulation Interview (in DSM-V)
16 questions to assess patient in relation to his/her culture
Resilience
“The process of adapting well in the face of adversity, trauma, tragedy, threats and significant sources of stress” (American Psychological Association) 10 Resilience Factors (evidence based) •Realistic Optimism •Courage (facing fear) •Moral Compass •Religion/Spirituality •Social Support •Resilient Role Models •Physical Fitness •Cognitive/Emotional Flexibility •Brain Fitness •Meaning/Purpose
Alterations in Normal Coping DSM-5
•Anxiety Disorders- most common mental health d/o in U.S.
18% of all adults (40 million), occurs twice as frequently in
women, 6.8 million- GAD, 8.7% (19 million)- phobic d/o which
men are 2X as likely to develop
•Obsessive-Compulsive & Related Disorders- 1% of population (2.2 million), equally common between men and women
•Trauma & Stress Related Disorders- PTSD effects 3.5% of population (7.7 million), 65%-men (more due to history of military & violence) and 45.9%-women (more due to history of childhood sexual abuse or domestic violence)
Diagnostic & Statistical Manual of Mental Disorders-5 (DSM-5)
•Anxiety Disorders
–Generalized Anxiety D/O (GAD) –Separation Anxiety D/O –Panic D/O –Selective Mutism –Specific Phobia –Agoraphobia –Social Anxiety D/O (social phobia)
Levels of Anxiety
- Mild- heightened perception, increased awareness and alertness, enhanced learning, restless, irritable, increased motivation
- Moderate- reduced perception and alertness to environmental events, learning ability not optimal, decreased attention and concentration, increased restlessness, beginning physical symptoms, feeling discontented
- Severe- perception greatly diminished, only extraneous details noticed, very limited attention, unable to concentrate or problem- solve, effective learning cannot occur, feelings of dread, loathing, horror, increase in physical symptoms
- Panic- Cannot focus at all, misperceptions of the environment occur, unable to learn, concentrate or follow simple commands, sense of impending doom, terror, bizarre behavior, hallucinations, severe physical symptoms
Generalized Anxiety Disorder GAD
- Excessive, uncontrollable worry about everyday things. This constant worry effects daily functioning and can cause physical symptoms.
- GAD can occur with other anxiety disorders, depression or substance abuse.
- The focus of GAD worry can shift usually focusing on issues like finances, relationships, job issues; but it can also be focused on issues of less importance such as being late for an appointment or getting chores done.
- The intensity, duration and frequency of the worry are disproportionate to the issue.
GAD Symptoms
- Persistent worrying or obsession about small or large concerns that’s out of proportion to the impact of the event
- Inability to set aside or let go of a worry
- Inability to relax, restlessness, and feeling keyed up or on edge
- Difficulty concentrating, or the feeling that your mind “goes blank”
- Worrying about excessively worrying
- Distress about making decisions for fear of making the wrong decision
- Carrying every option in a situation all the way out to its possible negative conclusion
- Difficulty handling uncertainty or indecisiveness
GAD Physical Signs and Symptoms
- Fatigue
- Irritability
- Muscle tension or muscle aches
- Trembling, feeling twitchy
- Being easily startled
- Trouble sleeping
- Sweating
- Nausea, diarrhea or irritable bowel syndrome
- Headaches
GAD Complications
- Impairs ability to perform tasks quickly and efficiently due to inability to concentrate
- Takes time and focus away from other activities
- Saps energy
- Disturbs sleep
Can also lead to or worsen other mental and physical health conditions, such as: •Depression •Substance abuse •Trouble sleeping •Digestive or bowel problems •Headaches •Heart-health issues
GAD Risk Factors
- Personality. A person whose temperament is timid or negative or who avoids anything dangerous may be more prone to generalized anxiety disorder than others are.
- Genetics. Generalized anxiety disorder may run in families.
- Being female. Women are diagnosed with generalized anxiety disorder somewhat more often than men are
GAD Collaborative Interventions
•Psychotherapy –Cognitive Behavioral Therapy CBT •Medications –Antidepressants: SSRIs and SNRIs –Buspirone –Benzodiazepines
Panic Disorder DSM-5
An Anxiety Disorder based primarily on the occurrence of panic attacks, which are recurrent and often unexpected. Panic attacks must be associated with longer than 1 month of subsequent persistent worry about:
(1) having another attack or consequences of the attack, or
(2) significant maladaptive behavioral changes related to the attack
•The attacks are not:
–due to the direct physiological effects of a substance or a general medical condition.
–better accounted for by another mental disorder
Panic Attack DSM-5
Characterized by four or more of the following symptoms:
•Palpitations, pounding heart, or accelerated heart rate
•Sweating
•Trembling or shaking
•Sensations of shortness of breath or smothering
•A feeling of choking
•Chest pain or discomfort
•Nausea or abdominal distress
•Feeling dizzy, unsteady, lightheaded, or faint
•Feelings of unreality (derealization) or being detached from oneself (depersonalization)
•Fear of losing control or going crazy
•Fear of dying
•Numbness or tingling sensations (paresthesias)
•Chills or hot flushes
Agoraphobia DSM-5
- Significant and persistent fear when faced with at least two of the following: crowds, public places, public transport, going outside, open spaces, standing in line, being alone and over-dependence
- Participates in avoidance behaviors to prevent the fear or panic attack
- Obvious and out of proportion fear when anticipating or actually being in the situation
Immediate anxiety response when in situation
•Individual knows fear is out of proportion
•Situation is avoided or else is endured with intense anxiety or distress
•Distress from situations interferes significantly with normal routine, work, school, and social activities.
Fear of fear.
Duration of at least 6 months.
Agoraphobia
Contributing Factors or Stressors
- Psychological, biological and genetic factors
- Late adolescence or early childhood
- More common in women
- 1.7% of population
- Risk factors: stressful life events, poor health, lower education/income
