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Behavioral Health 2 > Anxiety Disorders > Flashcards

Anxiety Disorders Flashcards

1
Q

Influence of gender on developing an anxiety disorder

A

Female more likely (3:2 or 2:1 to men)

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2
Q

3 complications/comorbidities associated with anxiety disorders

A
  • Suicide
  • Alcohol and drug abuse
  • Cardiovascular morbidity and mortality
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3
Q

Define Fear

A
  • Emotional response to real or perceived imminent threat
  • Threat is external and definite
  • Warns against body damage, pain, etc.
  • Associated with surges of autonomic arousal (flight or flight)
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4
Q

Define Anxiety

A
  • Anticipation of future threat
  • Threat is internal, vague, unknown
  • Associated with muscle tension, vigilance, and avoidance of behaviors
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5
Q

Anxiety pathophysiology

A
  • Genetic vulnerability
  • Stress
  • Situational
  • Traumatic life events
  • Vague, undefined causes
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6
Q

Mediators of

  • peripheral stress
  • central stress
A
  • Peripheral: SNS

- CNS: serotonin, norepinephrine, GABA

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7
Q

Physical manifestations of anxiety (11)

A
  • Restlessness, pacing
  • Syncope, dizziness, lightheadedness
  • Tachycardia, palpations
  • Tingling in extremities
  • Tremors
  • GI: Upset stomach, “butterflies”, nausea, diarrhea
  • Urinary frequency, hesitancy, urgency
  • Hyperhydrosis
  • Hyperreflexia
  • Hypertension
  • Pupillary mydriasis
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8
Q

Two anxiety assessment tools

A
  1. GAD-7
  2. OASIS (overall anxiety severity and impairment scale)
    * *always assess for suicide intentions
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9
Q

Toxic conditions that can cause anxiety (9)

A
  • Alcohol use/withdrawal
  • Illicit drug use/withdrawal
  • Caffeine use/withdrawal
  • Sympathomimetic agents (pseudoephedrine or phenylephrine)
  • Vasopressor agents (dopamine)
  • Penicillin
  • Sulfa drugs
  • Heavy metals
  • Other chemicals: phosphorus, organophosphates, carbon disulfide, etc.
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10
Q

Neuro med conditions associated with anxiety

A
  • Cerebral trauma
  • neoplasms
  • CVA
  • SAH
  • encephalitis
  • Huntingtons Dz
  • epilepsy
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11
Q

Cardiac med conditions associated with anxiety

A
  • MI
  • arrythmias
  • anemia
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12
Q

Endocrine med conditions associated with anxiety

A
  • *Hyperthyroidism
  • pituitary dysfunction
  • parathyroid disease
  • adrenal dysfunction
  • pheochromocytoma
  • hypoglycemia
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13
Q

Inflammatory med conditions associated with anxiety

A
  • Lupus
  • RA
  • polyarteritis nodosa
  • temporal arteritis
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14
Q

Deficiencies associated with anxiety

A
  • B12

- B3 (pellagra)

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15
Q

Other psych conditions associated with anxiety

A
  • depression
  • mania
  • schizophrenia
  • malingering
  • PTSD
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16
Q

Misc med conditions associated with anxiety

A
  • systemic malignancies
  • PMS
  • febrile illnesses
  • chronic infections
  • mononucleosis
  • uremia
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17
Q

Lab assessment when have low index anxiety is dt medical disorder

A 
CBC
CMP
Thyroid (graves disease)
UA
urine drug screen
r/o infections
18
Q

Lab assessment when have mod to high index anxiety is dt medical disorder

A
  • r/o CNS disorder – EEG, lumbar puncture, brain CT
  • r/o cardiac – EKG, treadmill stress test
  • r/o infection
19
Q

DMS 5 criteria

- separation anxiety

A
  • Developmentally inappropriate and excessive fear/anxiety concerning separation from people attached to
  • Must have three of the following
  • Excessive stress when anticipating separation
  • Persistent, excessive worry about losing/harm to attachment figure
  • Persistent, excessive worry about future event that separates one from attachment figure
  • Persistent reluctance/refusal to go out (school, work, etc.) bc of fear of separation
  • Persistent reluctance about being alone or without attachment figures at home or elsewhere
  • Persistent reluctance/refusal to sleep away from home or go to sleep without being near attachment figure
  • Repeated nightmares involving theme or separation
  • Repeated complaints of physical sx when separation is anticipated
20
Q

DMS-5 time criteria for separation anxiety

A

Fear/anxiety/avoidance lasts

  • at least 4 weeks in children and adolescents
  • 6 months or more in adults
21
Q

DSM 5 criteria

- specific phobia

A

Marked fear or anxiety about a specific object or situation

  • Object/situation provokes immediate fear or anxiety
  • Object/situation is actively avoided/endured with intense fear/anxiety
  • Fear/anxiety is out of proportion to the danger posed
  • Causes clinically significant distress in school, work, etc.
22
Q

DSM 5 criteria

- time for specific phobia

A

6+ months

23
Q

DSM 5 criteria

- social phobia / social anxiety disorder

A
  • Marked fear/anxiety about 1+ social situations that could involve possible scrutiny by others
  • Social interactions: conversation, meeting with unfamiliar people
  • Observation: eating or drinking
  • Performing: giving a speech
  • Fear will act in a way or show anxiety sx that are negatively evaluated (humiliated or embarrassed, leads to rejection by or offends others)
  • Social situations
  • Almost always provoke fear/anxiety
  • Are avoided/endured with intense fear/anxiety
  • Fear is out of proportion to actual threat
  • Causes clinically sig distress or impairment
24
Q

DSM 5 Social phobia timing

A

6+ months

25
Q

DSM 5 panic disorder

A
  • Recurrent panic attacks (periods of intense fear of abrupt onset, peaking in intensity within minutes)
  • Attacks are spontaneous, not associated with specific situation or object
  • 4 of the following:
  • Palpations, pounding heart, tachycardia
  • Sweating
  • Trembling/shaking
  • SOB
  • Sensation of choking
  • Chest pain, discomfort
  • Nausea, GI distress
  • Dizzy, unsteady, light-headed, faint
  • Chills/heat sensation
  • Paresthesias
  • Derealization (feeling of unreality) or depersonalization (being detached from self)
  • Fear of losing control or “going crazy”
  • Fear of dying
  • At least one attack was followed by 1+ months of:
  • Persistent concern/worry about additional panic attack or their consequences
  • Sig maladaptive change in behavior relating to attacks (to avoid another one)
26
Q

DSM 5 Agoraphobia criteria

A
  • Marked fear or anxiety about 2+ of:
  • Using public transportation
  • Being in open spaces (bridge, marketplace)
  • Being in enclosed spaces (shops, theater, cinema)
  • Standing in line, being a crowd
  • Being outside of home alone
  • Avoids these situations – thoughts that escape might be difficult, help might not be avail if panic-like sx develop
  • Actively avoided
  • Require presence of companion
  • Endured with intense fear or anxiety
  • Not sx of another disorder or medical condition
  • Out of proportion to actual danger
  • Can co-exist with panic disorder or be alone
27
Q

DSM 5 time criteria for agoraphobia

A

6+ months

28
Q

DSM 5 Criteria GAD

A
  • Excessive anxiety/worry (apprehensive expectation) about a number of events of activities (work, school performance, etc.)
  • Occurs more days than not for 6+ months
  • Hard to control the worry
  • Associated with 3+ of:
  • Restlessness, feeling keyed up/on edge
  • Easily fatigued
  • Difficult concentration, mind going blank
  • Irritability
  • Muscle tension
  • Sleep disturbance (hard to fall/stay asleep, restless, unsatisfying sleep)
29
Q

circumstances that might precede the development of a specific phobia

A
  • Might follow a traumatic event (attacked by a dog), observation of others going through traumatic event (see someone drown), informational transmission (news about plane crash)
  • Many are unable to recall specific reason for phobia
30
Q

Age of onset for most phobias

A

before 10

31
Q

Specific phobia treatment

A
  • behavioral therapy

- medications

32
Q

Behavioral therapy for specific phobias

A
  • Exposure therapy (systemic desensitization, flooding with prolonged exposure)
  • Hypnosis
  • Relaxation techniques
  • Family/supportive psychotherapy
33
Q

Medication tx for specific phobias

A

anxiolytics in severe cases for temp relief as behavioral therapy is started

34
Q

Ddx for social phobia

A
  • Depression
  • Schizophrenia
  • Avoidant personality disorder
  • Panic disorder with agoraphobia
35
Q

comorbidities associated with social phobia

A
  • Alcohol/drug dependence
  • Depression
  • Other anxiety disorders
  • Personality disorders
36
Q

2 Methods used in social phobia therapy

A
  1. Group therapy
    - Socialization, support, learning to perform tasks/fn without anxiety/fear
    - Recognize own and others’ excessive social critiquing
  2. Systemic desensitization with psychotherapist
    * * both use video feedback and fantasy situations
37
Q

Drug therapy overview for social phobia

A
  • SSRI, SNRI, MAOI
  • BB for performance anxiety
  • Benzodiazepines sparingly (dt risk of dependency)
38
Q

Tx for panic disorder (3)

A
  1. Cognitive therapy
    - Help reframe catastrophic thinking and expectations of panic
    - Often paired with relaxation training
  2. Behavioral therapy
    - Desensitization to panic sx paired with relaxation training
  3. Family and insight-oriented therapy often adjuncts
39
Q

First line meds for panic disorder

A
  • SSRI (paroxetine, fluoxetine, sertraline), - TCAs

- High potency benzodiazepines (clonazepam)

40
Q

Ddx for GAD

A
  • Caffeine/stimulants
  • Alcohol/sedative withdrawal
  • Psych disorders (OCD, panic disorder, phobias, depression, schizophrenia, anxious somatization, ADHD, atypical bipolar)
  • Medical (Hyperthyroid, pheochromocytoma, carcinoid, pulmonary dz, CVD)
41
Q

GAD meds

A
  • SSRI, SNRI, Benzos (short term), Buspirone

- Others: TCA, BB, antihistamine, hydroxyzine

Behavioral Health 2 (11 decks)

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