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ClinMed2: Psych > Anxiety disorders, OBD, Trauma and stress related disorders > Flashcards

Anxiety disorders, OBD, Trauma and stress related disorders Flashcards

1
Q

what falls under the umbrella of anxiety disorders

A

panic disorder
social anxiety disorders (social phobia)
specific phobia
agoraphobia
generalized anxiety disorder

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2
Q

what is a panic attack

A

not a DSM-5 diagnosis in and of itself
occur in many psychatric disorders
important: Panic dose not equal anxiety
‘uncued’ or unprovoked
short intense bouts of anxiety
associated with physical symptoms
abates within minutes

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3
Q

what is the treatment of panic attack

A

short term: reassurance, positive self talk, must rule out substance induced or medically induced
Long term: CBT, relaxation techniques

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4
Q

what is panic disorder

A

average age at onset: 20-30 yo
higher prevalence in educated pts
increased risk of suicide
co-occuring depression and SUD

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5
Q

what is the etiology of panic disorder

A

biology: autonomic hyperactivity, some evidence for heritability, heightened sensitivity to somatic symptoms
behavioral: ?conditioned response
Environmental: ?repressed memories/trauma

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6
Q

what are characteristics of panic disorder

A

recurrent, unprovoked panic attacks
characterized by intense fear of another attack
+/- agorphobia

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7
Q

what are the treatments for panic disorder

A

Antidepressants : SSRI (paroxetine), SNRI (venlafaxine)
Benzodiazepines (short term): additctive - alprazolam (xanax), clonazepam, diazepam, lorazepam
CBT and education

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8
Q

what are phobias

A

irrational fear of specific object/situation/place
-disproportionate to the trigger
-consistently present with exposure to trigger
-causes significant distress
-person is usually aware that their fearful reaction is excessive
etiology: poorly understood

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9
Q

what are the main types of phobias

A

specific phobia
social phobia (social anxiety)
Agoraphobia

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10
Q

what is specific phobia

A

a specific thing or situation (spiders, snakes, heights, needles, etc)

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11
Q

what is social phobias (social anxiety)

A

fear of being in a public/social setting
fear centers around potential embarrassment/humiliation

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12
Q

what is agoraphobia

A

fear of public places/places outside of home
fear centers around perceived inability to exit
often co-occuring with panic disorder

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13
Q

what are the treatment options for phobias

A

desensitization: gradually increase exposure
flooding: rapid, intense exposure
CBT
medication (primarily for social anxiety and agoraphobia) - SSRI first line (paroxetine)
- SNRI - venlafaxine also effective
-performance anxiety - propranolol

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14
Q

what neurotransmitters are associated with generalized anxiety disorders

A

Serotonin (5-HT) (excitatory)
Norepinepherine (excitatory)
GABA (inhibitory)

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15
Q

what is Generalized anxiety disorder characterized by

A

overwhelming worry that is excessive or persistent
involves multiple arenas of life: personal health, employment, school, social settings, intimate relationships, financial

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16
Q

what is the typical presentation of GAD

A

chronic fatigue
edginess + restlessness
irritability
difficulty concentrating
difficulty sleeping
muscle tension

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17
Q

what is the treatment of GAD

A

control symptoms, complete abatement is rare
CBT or other psychotherapy
medications such as antidepressants/anxiolytics

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18
Q

what medications are used to treat GAD

A

SSRI: Paroxetine (paxil) and Escitalopram (Lexapro)
SNRI: Venlafaxine (effexor) and Duloxetine (Cymbalta)
BZDs: short course - initiation of SSRI/SNRI or flare symptoms
Buspirone (Buspar): long-acting non-BZD anxiolytic - low abuse potential, takes 3-4 weeks for full effect

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19
Q

what is OCD

A

obsessive-compulsive disorder
obsessions and/or compulsions
typically onset early teens to 20s, most present prior to age 30
impair every day functioning

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20
Q

What is the etiology of OCD

A

Brain anatomy: associated with some neurologic disorder, abnormalities in basal ganglia, prefrontal cortex, caudate nucleus
Neurotransmitters: ?imbalance of serotonin
Genetics: rates higher in pts with + FH, no gene has been identified yet
Environmental: sometimes precipitated by stressful events, PANDAS and streptococcal infections

21
Q

what are obsessions

A

recurrent, intrusive thoughts
cause significant distress
follow common themes around the world

22
Q

what are compulsions

A

repetitive, intentional behaviors
aimed at relieving the obsession
cause significant distress
rigid behaviors (must follow certain rules/sequences)

23
Q

what are specifiers for OCD

A

good insight: pt recognize behaviors/beliefs are likely not true
Poor insight: pt believe their obsessions/compulsions are probably true
absent insight/delusional belief: pt believe the beliefs/behaviors are absolutely true
tic-related: associated with a tic disorder

24
Q

what are the non-pharmacologic treatments for OCD

A

behavioral therapies (Exposure to stimuli and prevention of response, desensitization, flooding, implosion therapy, conditioning, thought stopping)
support groups

25
what medications can be used to treat OCD
only 50-60% show improvement with only meds first line: SSRI's or Clomipramine All SSRI's are indicated for OCDs, fluvoxamine Clomipramine is more serotonergic TCA - very sedating
26
What is body dysmorphic disorder
preoccupation with perceived physical flaw or "ugliness" significant associated 'embarrassment' appears excessive to those around the patient often involves a facial characteristics
27
what are common symptoms of Body dysmorphic disorders
compulsive mirror checking compulsive grooming comparing to others soliciting reassurance
28
What are common symptoms of body dysmorphic disorder
CBT SSRI are pharmacologic treatment of choice if delusional, addition of anti-psychotic may help many will have surgical interventions (not recommended)
29
What is Tricholotillomania
'hair pulling disorder' - one of the body focused repetitive behaviors (BFRB) - nail biting, skin picking F>>M may involve any site: scalp, eyelashes, eyebrows, body hair, axillary hair, pubic hair
30
what is the treatment of trichotillomania
habit reversal: conditioning and barriers CBT ? hypnosis Medications: SSRI and Clomipramine (TCA)
31
what can hoarding be associated with
OCD, GAD, Major Depression, Personality disorder, neurologic disorders, dementia
32
what are the specifiers of hoarding
Accompanied with excessive acquisition good or fair insight poor inside absent insight/delusional beliefs
33
what is the treatment of hoarding
CBT SSRI Enlisting personal organizers/family and friends - cleaning up alone NOT helpful
34
what are stressor-related disorders
PTSD adjustment disorder
35
what is adjustment disorder
normal human response to stressor symptoms begin within 3 months of the stressor onset symptoms can cause significant distress or impairment in functioning
36
what are the treatment options for adjustment disorders
mainstay is psychotherapy (individual or group) +/- support groups +/- psychosocial interventions adjunctive medications for symptomatic treatment
37
What are risk factors of PTSD
age (younger = greater risk) history of psychiatric illness level of social support proximity to stressor or event severity and duration of stressor low socioeconomic status FH of depression
38
what is the typical presentation of PTSD
W>M highest prevalence in young adults can develop acutely or be delayed often associated with other psychiatric disorders increased risk of suicide
39
what is the etiology of PTSD
disruption in Neurotransmitters (NE, DA, 5-HT) other physiologic disruptions (noradrenergic dysfunction, endogenous opioids, benzodiazepine receptors) Endocrine dysfunction (disruption of the HPA axis, cortisol dysfunction)
40
what is PTSD characterized by
exposure to a significant stressful event - event is not a normal human experience reliving the trauma (thoughts/dreams) avoiding triggers associated with the event emotional changes hyper-reactivity
41
what are specifiers of PTSD
with dissociative symptoms (depersonalization or derealization) with delayed expression(>6 months after event)
42
What is the tool used to assess PTSD
PCL-5 PC-PTSD-5
43
what is the treatment for PTSD
psychotherapy (CBT, hypnosis, exposure therapy, eye movement desensitization and reprocessing, group therapy/support groups) Medications: SSRI first line (paroxetine (paxil) and sertraline (zoloft)) prazosin for nightmares BZDs for acute anxiety (short term)
44
what is dissociation
a response to significant stress unconscious defense mechanism processing related to the event is separate from the rest of your cognitive process episodes last several days, weeks or months
45
What is depersonalization
feeling as though you're looking at yourself from the outside feeling as though you aren't yourself feeling like you're living a dream feeling like you're not in control of yourself
46
what is derealization
feeling disconnected from your environment feeling completely emotionally cut off seeing your surroundings differently distorted perception of time
47
what is dissociative amnesia
most common dissociative disorder W>M patient unable to recall a specific memory, usually traumatic other cognitive functional remains intact symptoms terminate abruptly
48
what is dissociative fugue
subtype of dissociative amnesia inability to recall one's past - presumption of new identity classically involves travel away from home symptoms abate abruptly patient are able to recall pre and post-fugue events dont have any memories of the fugue itself

ClinMed2: Psych (10 decks)

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