ANXIETY DISORDERS Flashcards
embraces the totality of a person’s mental attributes,
observable behavior, and reportable subjective
experience–the sum of which distinguishes one individual
from all others
personality
approximately _______percent of the general population,
certain personality traits are so pronounced as to
be distressing to the individual and disturbing to others,
even though the patient is not manifestly sociopathic
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Although considered to be the most frequent of mental
disturbances, the ________ are among the least
understood
anxiety disorders
all of the neuroses have been
again subsumed in three broad categories:
(1)______ (which include panic states, with and without
agoraphobia, and the phobic and obsessive-compulsive
neuroses);
(2) ________ (comprising hysterical
neurosis, orconversiondisorder, andhypochondriasis);
and
(3)__________
anxiety disorders
somatoform disorders
dissociative disorder
A syndrome of general irritability,
anxious expectation, anxiety attacks, somatic accompaniments
or equivalents of anxiety (breathlessness, chest
pain, asthenia), and nightmares
anxiety neurosis
the
sensory experience was all there was to emotion. What theory?
James-Lang theory of emotion
Many patients experience a constant uneasiness that
the spells may reoccur, especially in public; hence the
patient may be fearful of leaving home lest help not be
available should an attack occur. What phenomenon?
Agoraphobia
anxiety are also a prominent feature of
the ________ and ______
postconcussive and posttraumatic stress syndromes
Anxiety disorder has been attributed to a:
- genetic abnormality,
- to a “constitutional weakness” of the nervous
system, - to social and psychologic factors, and to
- physiologic and biochemical derangements
Ave age of acute and chronic anxiety
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T or F
The symptoms o f an anxiety attack resemble those of
fear in many ways, although nearly always the former are
longer in duration and less distinct.
T
it has been observed that anger provokes an excessive secretion
of ________, whereas fear is accompanied by
increased secretion of ________
norepinephrine
epinephrine.
lobes. In states
of fear, the tips of the _______ and ______i are known to become activated.
temporal lobes and the amygdaloid
nuclei
In the relaxed
period between panic attacks, the_________ and ________are abnormally active in
some studies.
right limbic system
and the parahippocampal gyrus
Indeed, some
psychiatrists believe that anxiety neurosis is accounted
for mainly by a variant of ______
depression
The presence of symptoms such as
overwhelming fatigue, self-deprecation, and feelings of
hopelessness and, of course, ideas of self-destruction
makes depression the fundamental diagnosis, with anxiety
an associated feature
anxious depression
Certain medications, particularly _____ and ______
are effective in suppressing panic attacks and
creating a sense of well-being
anxiolytics
antidepressants,
Anxiety disorder tx
the benzodiazepine
__________ is favored by some psychiatrists, but lorazepam and clonazepam are almost as effective and are considered slightly less likely to cause dependence.
alprazolam (2 to 6 mg/ d)
________ and________ are also effective
in the prevention of panic attacks and agoraphobia, but
their onset of action is delayed for weeks
Tricyclic antidepressants and drugs that raise serotonin
concentrations in the nervous system (selective
serotonin reuptake inhibitors [SSRis]
_______, a specific serotonin 5-HT
agonist, has been promoted as effective in the treatmen
of anxiety and as a surrogate for benzodiazepines, but
to us its benefit has seemed to be slight
Buspirone
T or F
during the initial weeks of admin istration of
antzdepressants, the underlying anxiety Symptoms may worsen and an anxiolytic is usually required until the antidepressant becomes effective
T
___________, reduces many of
the autonomic accompaniments of anxiety and is useful
to many patients.
Propranolol, 10 to 20 mg tid
With regard to psychotherapy, behavioral
therapy __________ is said to be beneficial, particularly
if agoraphobia is a major symptom
(progressive exposure of the patient to panicprovoking
situations)
The patient is
chronically fearful of a particular animal or situation
and becomes extremely anxious or panic stricken and
incapacitated when placed in a situation that evokes the
phobia.
Phobic d/o
ike the pure phobic states, a state dominated by _______ is relatively rare, occurring in less
than 5 percent of patients seeking help in a psychiatric
outpatient clinic, but it can be extremely disabling
obsessions
and compulsions
defined as imperative and distressing
thoughts and impulses that persist in the patient’s mind
despite a desire to resist and to get rid of them
Obsessions
in which phrases, rhymes, ideas, or vivid images
(these are often absurd, blasphemous, obscene, and sometimes
frightening) constantly intrude into consciousness
intellectual obsessions
in which the mind is dominated by
an impulse to kill oneself, to stab one’s children, or to
perform some other objectionable act
impulsive obsessions,
in which every act must be ruminated upon and
analyzed before it is carried out-a state that is cleverly
called doubting mania
inhibiting obsessions
________are acts that result from obsessions.
These are single acts or a series of acts (rituals) that the
patient must carry out in order to put his mind at ease
Compulsion
The most common of these obsessions and
compulsions center around _____
contamination concerns that
lead to repeated hand washing or bathing
Certain motor disturbances-namely, habit spasms
or tics-are, in a sense, _________. They consist
of repetitious movements of the shoulders, arms, hands,
and certain of the facial muscles
motor compulsions
Additional insight into obsessive-compulsive disorder
may be obtained from the many cases in which
acquired striatal damage may be linked to obsessional
behavior. One such entity is a_______
poststreptococcal tic
disorder termed PANDAS (pediatric autoimmune neuropsychiatric
disorders associated with streptococcal infections),
of multiple tics,
including vocal ones, beginning in childhood or adolescence
and lasting more than a year, has a strong
component of obsessive-compulsive disorder
Gilles de Ia Tou rette syndrome
Because_________ are beneficial in the management of the Tourette syndrome, a number of etiologic hypotheses
revolve around serotonergic and dopaminergic neurotransmitter systems
dopamine
antagonists
In the case of phobic neurosis,
the aim is to reduce the patient’s fear to the extent
that exposure to the phobic situation can be tolerated.
A popular form of therapy is _______
systematic desensitization,
What is systemic desensitization
which consists of increasing and graded exposure of the
patient to the object or situation that arouses the fea
Certain medications, particularly the SSRI types such
as _______, are considered to be effective in reducing
obsessions and compulsions in more than half of patients
fluoxetine
In the past, ______produced symptomatic
improvement in both phobic and obsessional neuroses
and was considered a reasonable procedure.
cingulotomy
________ is probably best reserved for a disease that
is largely confined to women and is characterized by
a distinctive age of onset, natural history, and certain
somatic symptoms and signs, which typically include
conversion symptoms, dissociative reactions, or states of
“multiple personality.”
hysteria
polysymptomatic disorder, involving
almost every organ system.
Sx include headache, blurred vision, lump in the throat, loss of voice, dyspnea, palpitation, anxiety attacks, anorexia, nausea and vomiting, abdominal pain, unusual food allergies, severe menstrual
pain, urinary retention, painful intercourse, paresthesias,
dizzy spells, nervousness, and easy crying
Classic Hysteria ( Briq u et d i sease)
This calm attitude toward a turbulent
illness and seemingly disabling physical signs is so common
that it has been singled out as an important characteristic
of hysteria called ______
Ia belle indifference
Characteristics of hysterical pain
1)
2)
3)
(4) its persistence, either continuous or intermittent, for long periods of time;
(5) the assumption of bizarre postures; and, most
important,
(6) the coexistence of other clinical features or
previous attacks of hysterical nature
(1) the patient’s
inability to give a clear, concise description of the type of
pain; (2) the location of the pain does not conform to the
pattern of pain in the familiar medical syndromes; (3) the
dramatic elaborations of its intensity
Characteristics of hysterical vomiting
The vomiting often occurs after a meal,
leaving the patient hungry and ready to eat again; it may
be induced by unpleasant circumstances
___________ in which the patient
wanders about for hours or days and carries out complex
acts may simulate temporal lobe epilepsy or any of the
conditions that lead to confusional psychosis
Hysterical trances or fugues,
In Hysterical paralysis,
Movements
are slow, tentative, and poorly sustained; often it can be
demonstrated that the strength of voluntary movement
is proportional to the resistance offered by the examiner,
thus imparting a__________ character
“give-way”
In a most remarkable and recalcitrant form of psychogenic
movement disorder, maintenance of the limbs
in a rigid or dystonic posture for a long time may result in
a bed-bound, crippled state with severe flexion ________ of the limbs
pseudocontractures
Characteritics of tremor of psychogenic
movement disorder
the cessation of tremor with distracting taskse.
g., complex finger movement patterns on the side opposite
the tremor (such as touching the fourth, second, and
fifth fingers in sequence rapidly), or refixation of the eyes
on a target, or walking on the outside of the heels
In psychogenic movement disorder
A fairly dependable sign is worsening of a tremor with loading that is accomplished by__________
(most basal ganglionic and cerebellar tremors are muted
by this maneuver)
placing a heavy object in the patient’s hand
Characteristics of hysterical blindness
Some such individuals can
reduce reflexive blinking in response to a visual threat
_______ occurring as an isolated phenomenon,
is practically always of hysterical nature
Convergence spasm,
In the ________ (amnesia, disturbance of
consciousness, and hallucinations) patients pretend
to have lost their memory or to have become insane
Ganser syndrome
_______ as in the classic form of hysteria,
multiple symptoms are reported; many of the symptoms
are the same as those listed under female hysteria
compensation neurosis,
_________, which held that both conversion
and dissociative symptoms are based on particular
psychodynamic mechanisms, is impossible to affirm or
refute
Psychoanalytic theory
The presence of
extreme suggestibility and the tendency to dramatize
symptoms as measured by one part of the ______________ and other psychometric
tests is helpful in diagnosis but not pathognomonic
Minnesota
Multiphasic Personality Inventory
Goals of Tx for Hysteria
the amelioration of the long-standing basic
personality defect and relieving the recently acquired
physical symptoms
How to address hysterical d/o
Some of our better results have been obtained by
indicating that the neurologic symptoms are a “pattern
of brain circuits” or “constitutional” weakness that can
be overcome by physical and other therapies
This is the preoccupation with bodily functions or physical
signs and sensations, leading to the fear or belief
of having serious disease
Hypoch ondriasis
It is estimated that 85
percent of hypochondriasis is secondary to other mental
disorders, chiefly________ but also schizophrenia and
anxiety neuroses.
depression,
Of all the abnormal personality types,
the ________ is the best defined and the one most likely
to cause trouble in the family and community
antisocial
What personality disorder?
always in trouble, profiting not from experience or punishment, unable to empathize with family or friends or to maintain lm;alties to any person, group, or code. He is likely to be shallow, callous, and hedonistic, showing marked emotional immaturity with lack of sense of responsibility;, lack of judgment, and an
ability to rationalize his behavior so that it appears warranted, reasonable and justified.
antisocial
It consists essentially of deviant
behavior in which individuals seem driven to cause difficulty
in everything they do or behave in a way that most
societies identify as grossly criminal
Sociopathic behavior
it is advised that the diagnosis of
antisocial personality disorder be reserved for adults;
the same behavior pattern in children is designated as
__________
conduct disorder.
EEG abnormalities, taking the form of ____________ are more frequent in criminals and sociopaths than they are in the normal population in some series, but the validity of this finding is uncertain
mild to moderate bilateral slowing,
refers to the conscious
and deliberate feigning of illness or disability in order
to attain a desired goal
M a l i n geri n g
Difference between Malingering and Hysteria
(1) the conscious or unconscious quality of the motivation, which seems more unconscious in the _____patient and more conscious in the ______;
(2) the influence of persuasion, which is usually effective in _____ and not in the______; and
(3) the attitude of the patient
hysteria
malingerer
hysteria
malingerer
A particular form of sociopathy or malingering,
which consists essentially of systematically and specifically
deceiving the medical profession, has been
described as ________
Munchausen’s syndrome
Some persons with intermittent
explosive disorder have, from early childhood,
reacted to frustration with a loss of self-control, striking
out in blind rage at anyone who crossed them ______
(episodic
dyscontrol syndrome);
In intermittent explosive behavior, Polymorphisms of the ___________ receptor have
been implicated in several preliminary studies
androgen
__________ i s a behavioral disorder o f previously
healthy girls and young women living in affluent societies,
mainly from upper and middle social classes, who
become emaciated as a result of voluntary starvation
Anorexia nervosa
As a rule, anorexia nervosa begins shortly after
________sometimes later, but seldom after 30 years of
age
puberty-
The patient shows no concern about
her obvious emaciation and remains active. If left alone,
these patients waste away, and approximately ____ percent
have succumbed to some intercurrent infection or other
medical complication, placing it among the most lethal of
psychiatric conditions.
5
______ and _____ are indicators
for hospitalization in Anorexia
Bradycardia and hypotension
Pubic hair and breast tissue (except for loss of
fat) are normal, and, in this respect, anorexia nervosa
is unlike___________
hypopituitary cachexia (Simmonds disease).
In Anorexia Nervosa, ______ is practically always present and may precede the extreme weight loss
Amenorrhea
___________ fails to stimulate a rise in
LH, as it does normally. Administration of gonadotropicreleasing
factor raises the LH and follicle-stimulating
hormone (FSH) levels, suggesting a hypothalamic disorder.
Clomiphene citrate
T or F,
In anorexia, The basal metabolic rate is low; triiodothyronine (T 3) and thyroxine (T4) are low, while levels of physiologically inactive 3,3,5-triiodothyronine (reverse T3) are decreased
F
T 3 is Normal or increased
The pathologic fear of becoming
fat and the obsession with weight might be interpreted
as a phobic or ________
obsessional neurosis.
Probably important is that
anorexia nervosa has its onset in relation to _________, at
a time when the female exhibits rather large fluctuations
in appetite and weigh
menarche
A disorder of infants described under the
title of _________ causes progressive and
ultimately fatal emaciation (“failure to thrive”) despite
normal food intake in an otherwise alert and cheerful
infant.
“diencephalic syndrome”
In “diencephalic syndrome”
The causative lesion has usually proved to be a
low-grade astrocytoma of the ______ or ______
anterior hypothalamus or
optic nerve region
In Anorexia, The menses do not return until considerable weight has been gained (approximately ______percent above the weight
10
Drugs that may be effective in Anorexia
imipramine or
fluoxetine
