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Psychiatry Exam 1 > Anxiety Disorders > Flashcards

Anxiety Disorders Flashcards

1
Q

Fxn of amygdala

A

Processing emotionally salient stimuli (central in anxiety)

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2
Q

Fxn of medial PFC

A

Includes ACC, subcallosal cortex, and medial frontal gyrus, modulates affect

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3
Q

Fxn of hippocampus

A

Memory encoding and retrieval

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4
Q

Psychodynamic model of anxiety

A

Anxiety is a signal of presence of danger in unconscious – result of psychic conflict between sexual/aggressive wishes and corresponding threats from superego or external reality (never verified)

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5
Q

Behavioral model of anxiety

A

Anxiety is a conditioned response to a specific stimulus

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6
Q

Cognitive behavioral model of anxiety

A

On top of behavioral model, also has to do with how one perceives threats (overpercieves danger and underestimates coping skills)

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7
Q

CBT is effective for…

A

Panic, social anxiety, PTSD

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8
Q

Exposure therapy is effective for…

A

Agora and specific phobias

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9
Q

Exposure therapy + response prevention is effective for…

A

OCD

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10
Q

Medical conditions assc w anxiety

A

Endocrinopathies, cardiac, respiratory

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11
Q

Medications that can cause anxiety

A

Corticosteroids, OCP, inhalers, decongestants, SSRIs

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12
Q

Drugs of abuse that can cause anxiety

A

CAFFEINE, cocaine, MJ, MDMA, alcohol

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13
Q

W/drawals assc. w anxiety

A

CAFFEINE, cocaine, MJ, alcohol, beta blockers, corticosteroids

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14
Q

Panic attack criteria

A

Discreet period of intense fear/discomfort w/ 4+ of following developed quickly and peaking in minutes:

  • Palpitations, pounding heart
  • Sweating
  • Trembling, shaking
  • SOB or smothering
  • Choking feeling
  • Chest pain/discomfort
  • Dizziness
  • Abdominal distress
  • Chills/hot flashes
  • Feelings of unreality
  • Fear of losing control or going crazy
  • Fear of dying
  • Paresthesias
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15
Q

Panic Disorder criteria

A
  • Reccurent, unexpected panic attacks
  • At least 1 mo of persistent concern about another attack, worry about possible implications/consequences, or significant behavioral change re: to attacks
  • Panic attacks not due to physiologic effects of substance/med condition
  • Attacks not accounted for by another disorder
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16
Q

Neurotransmitters involved in panic

A

NE, 5HT, GABA

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17
Q

Neuroanatomy of panic

A

Brain stem: fires to create ANS symptoms
Amygdala/limbic system: anticipatory anxiety
PFC: phobic avoidance

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18
Q

Panic Tx

A
  • Elimination of alcohol/drugs/caffeine/OTC stims etc from diet
  • CBT
  • SSRIs, Venlafaxine, TCAs, benzos
  • FDA APPROVED: Fluoxetine, Paroxetine, Sertraline, Alprazolam, Clonazepam
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19
Q

Agoraphobia criteria

A 
Marked fear/anxiety for 6+ mo about 2+:
- Public transportation
- Open spaces
- Encloses spaces
- Standing in line/in a crowd
- Being outside of the home alone
Because escape may be difficult or help unavailable
20
Q

Agoraphobia tx

A

Exposure therapy, CBT (NO MEDS!)

21
Q

Specific phobia tx

A

Systematic desensitization (delayed by alcohol)

22
Q

Social anxiety disorder criteria

A

Fear/avoidance of social situations where individuals exposed to scrutiny by others – fears that they will act in a way or show anxiety –> negative evaluation; feared situations avoided or endured w/ extreme fear/anxiety and interferes w/ work, social, family activities; persists 6+ mos

23
Q

Social anxiety disorder tx

A
  • Social skills training, behavior therapy
  • CBT
  • FDA APPROVED: Paroxetine, sertraline (SSRIS) and venlafaxine
24
Q

Generalized anxiety disorder criteria

A

Excessive anxiety and worry more days than not for 6+ mos about many events that is difficult to control, 3+ of:

  • Restlessness/feeling keyed up or on edge
  • Easily fatigued
  • Difficulty concentrating
  • Irritability
  • Muscle tension
  • Sleep disturbance

And causes significant distress/impairment

25
Q

GAD Tx

A

Medications: Busipirone, benzos, antidepressants (SSRIs, venlafaxine, imipramine)
CBT

26
Q

PTSD Diagnostic criteria

A

Exposure to actual or threatened death in 1+ of the following:

  • Direct experiencing of event
  • Witnessed in person event as it occured to others
  • Learning event happened to someone close to them
  • Experiencing repeated/extreme exposure to aversive details of trauma

After the event, 1+:

  • Recurrent, involuntary and intrusive memories of event
  • Recurrent trauma-related nightmares
  • Dissociative rxns
  • Intense physiological distress at cue exposure
  • Marked physiological reactivity at cue exposure

Persistent avoidance by one or both:

  • Avoidance of distressing memories, thoughts, feelings of event
  • Avoidance of external reminders that arouse memories of event

Negative alterations in mood assc w events as evidenced by 2+:

  • Inability to remember important aspect of event
  • Persistent distorted cognitions about cause/consequence of event that lead to blame of self or others
  • Persistent negative emotional state
  • Marked diminished interest
  • Feeling detached from others
  • Persistent inability to experience positive emotions

Marked alterations in arousal/reactivity w/ 2+:

  • Irritable behavior and angry outbursts
  • Reckless/self-destructive behavior
  • Hypervigilence
  • Exaggerated startle response
  • Problems w/ concentration
  • Sleep disturbance

Duration of disturbance is greater than 1mo and causes significant impairment in fxn

27
Q

PTSD Specifiers

A 
Dissociative symptoms (derealization or depersonalization)
Delayed expression (don't meet criteria until >6mos after event)
28
Q

Biologic considerations in PTSD

A

Increased activity of NE system and hyperregulation of HPA axis

29
Q

PTSD Tx

A

CBT, exposure, trauma informed CBT
Group therapy
Medications – antidepressants, mood stabilizers, beta blockers, clonidine, prazosin

30
Q

Acute stress disorder criteria

A

> 9 checks from PTSD features of intrusion, negative mood, dissociation, avoidance, and arousal related to trauma, but duration is 3days to 1mo after trauma; significant impairment

31
Q

Acute stress disorder tx

A

CBT…maybe beta blockers

32
Q

Adjustment disorders criteria

A

Development of emotional/behavioral symptoms in response to an identifiable stressor w/in 3 mos of stressor

Symptoms are clinically significant and evidenced by 1+ of:

  • Marked distress out of proportion to severity/intensity of stressor
  • Significant impairment in social, occupational, or other important areas of fxning

When stressor is terminated, symptoms do not last more than 6 mos

33
Q

Adjustment disorder specifiers

A

W/ depressed mood: low mood, tearfulness/feelings of hopelessness predominant
W/ anxiety: nervousness, worry, jitteriness, or separation anxiety predominant
W/ mixed anxiety and depression: combination predominant
W/ disturbance of conduct: DOC predominant
W/ mixed disturbance of emotion and conduct

34
Q

Adjustment disorder tx

A

Counseling/supportive therapy, crisis interventions, family/group therapy, CBT; pharmacotherapy for brief symptomatic tx of anxiety or sleep disturbance

35
Q

OCD Criteria

A

Obsessions defined by:

  • Recurrent/persistent thoughts, urges, or images that are experienced at some point during the disturbance as intrusive/unwanted and cause marked anxiety or distress
  • Individual attempts to ignore/suppress thoughts or neutralize them w/ other thought/action (i.e. compulsion)

Compulsions as defined by:

  • Repetitive behaviors (e.g. hand washing) or mental acts (e.g. counting) that the person feels driven to perform in response to an obsession/according to rigidly applied rules
  • Behaviors/acts aimed at reducing disress or preventing some dreaded event or situation, but not connected realistically w/ what they’re designed to fix or are excessive

Obsessions/compulsions are time consuming or cause clinically significant distress/impairment in fxn

Specify if w/ good/fair insight, poor insight, or absent insight

36
Q

PANDAS

A

Pediatric Autoimmune Neuropyschiatric Disorders Associated w Streptococcus infxns

37
Q

OCD Tx

A

Behavioral: exposure + response prevention
Pharmacotherapy: Comipramine and SSRIs
Neurosurgery: cingulotomy (tx refractory), or capsulotomy

38
Q

Body dismorphic disorder criteria

A

Preoccupation w perceived defect(s) or flaw(s) in physical appearance that are not observable or appear slight to others

At some point in course of disorder, repetitive behaviors or mental acts in response to appearance concern

Specify if good or fair or poor insight, w/ w/o delusional beliefs

39
Q

BDD tx

A

CBT, SSRIs (not FDA app)

40
Q

Hoarding disorder criteria

A

Persistent difficulty discarding/parting w/ possessions regardless of actual value

Difficult is due to perceived need to save the items and distress assc w discarding them

Possessions accumulate to congest/clutter libing areas and compromise intended use of areas

41
Q

Hoarding disorder tx

A

Behavioral therapies, SSRIs (not FDA app)

42
Q

Tricotillomania criteria

A

Recurrent pulling out of ones hair resulting in hair loss

Repeated attempts to stop hair pulling

43
Q

Trichotillomania perpetuating behaviors

A

Negative emotions – hair pulling is a way of dealing w/ negative or uncomfortable feelings

Positive reinforcement – hair pulling provides sense of relief

44
Q

Trichotillomania tx

A

Psychotherapies, no FDA indicated tx (maybe clomipramine or SSRIs)

45
Q

Excoriation disorder criteria

A

Recurrent skin picking resulting in lesions

Repeated attempts to decrease or stop skin picking

46
Q

Excoriation disorder tx

A

CBT, acceptance and commitment therapy, no FDA app meds (but SSRI’s – fluoxetine, fluvoxamine, and escitalopram)

Psychiatry Exam 1 (9 decks)

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