Anxiety Disorders, OCD and Related Disorders, Trauma and Stressor Related Disorders Flashcards
What are the different anxiety disorders?
Panic Disorder Agoraphobia Social Anxiety Disorder Specific Phobia Generalized Anxiety Disorder Separation Anxiety Disorder Selective Mutism
What theme do all the anxiety disorders share?
inappropriate anxiety
Anxiety is abnormal when it is?
- Elicited by inappropriate cues
- Excessive intensity
- Excessive duration
What is the cause of anxiety?
caused by overstimulation of the HPA (hypothalamic-pituitary-adrenal) axis resulting from activation by the amygdala
HPA activation releases cortisol and catecholamines, which are responsible for many physiological and psychological changes
What are the general treatments for anxiety?
- Cognitive-Behavioral Therapy (CBT) –> modifying ones thoughts to change emotion; using exposure techniques to extinguish the emotion
- Anxiolytic Medications —> Benzodiazepines (Short term)
and Antidepressants (SSRIs)
What is the general diagnostic criteria for panic disorder?
Diagnosis requires panic attack followed by 1 month of one or more of the following:
- Fear of future panic attacks or
- A significant change in behavior related to the attacks
what is a panic attack?
intense fear with somatic or cognitive symptoms
abrupt onset with episodic peak within minutes
What is the diagnostic criteria for agoraphobia?
a person excessively and persistently fears >2 of the following:
* Using public transportation
* Being in open Spaces
* Being in enclosed spaces
* Standing in line or being in a crowd
* Being outside of the home alone
The person fears/avoids these situations because escape may be difficult in the event that embarrassing symptoms develop.
Agoraphobic often develops in what kind of patients?
panic disorder patients
diagnosed as a separate illness
What is the diagnostic criteria for specific phobia?
Phobia –> excessive, persistent and disproportional fear of an object or situation
The fear response invariably occurs when exposed to the stimulus, or the person avoids the phobic situation
The fear causes marked distress/impairment and isnt accounted for by a different disorder
What is the etiology of specific phobia?
classically-conditioned response (the feared situation/object was once associated with a fear producing stimulus/object)
What is the diagnostic criteria for social anxiety disorder?
Excessive, persistent and unrealistic fear of social situations involving possible scrutiny by others due to fear of negative evaluation
What is the diagnostic criteria for generalized anxiety disorder (GAD)
Persistent uncontrolled anxiety about multiple events
Trigger of Anxiety–> EVERYTHING
What symptoms are associated with GAD?
Restless, on edge decreased concentration muscle tension fatigued irritability insomnia
When in a persons life do symptoms of GAD start?
young age
What other medical conditions should be ruled out before diagnosis of anxiety is made?
Anxiety Disorders due to Another Medical Condition (hyperthyroidism)
Substance-Induced Anxiety Disorders (caffeine, sedative withdrawal)
What is the diagnostic criteria for obsessive-compulsive disorder? (OCD)
- Recurrent obsessions or compulsions
- Obsessions/compulsions are time consuming or distressful/disruptive
- Symptoms are not explained by another disorder
Define obsession
Intrusive recurrent thoughts, urges , or images that increase distress
Define Compulsions
Repetitive behaviors/mental acts that are performed to decrease distress
what is meant when individuals have the diagnosis of OCD with absent insight (delusional beliefs)
the person is completely convinced that OCD beliefs are true
What is the cause or etiology of OCD?
- Prefrontal-Striatal Overactivity
2. Serotonin Deficiency
In rare cases OCD begins after what type of infection?
Streptococcal Infection knows as PANDAS
What are some treatments of OCD?
- Cognitive Behavioral Therapy and/or SSRIs
- Psychosurgery –> lesioning of the anterior cingulate gyrus or anterior limb of the internal capsule (GLEN from the video)
- Deep Brain Stimulation –> electrical impulses are delivered by an indwelling brain electrode attached to an implanted thoracic pacemaker.
What are the OCD related disorders?
Hoarding Disorder
Body Dysmorphic Disorder
Excoriation Disorder
Trichotillomania
What is the diagnostic criteria for Hoarding Disorder (HD)?
Difficulty parting with possessions due to perceived need to save items or distress about discarding them
Accumulation of possessions clutters living areas and substantially compromises their intended use.
Specifying if HD is with absent insight (delusional beliefs) means what?
person is certain that HD beliefs/behaviors are not problematic despite contrary evidence
What is the diagnostic criteria for body dysmorphic disorder (BDD)?
Preoccupation with a perceived flaw in physical appearance
Repetitive behaviors or mental acts are performed in response to appearance concerns
BDD must cause functional impairment
If the dx is BDD with muscle dysphoria, what does this mean?
preoccupation with belief that one’s body is too small or insufficiently muscular
If the dx is BDD with absent insight (delusional beliefs), what does this mean?
person is completely convinced that BDD beliefs are true
What is the diagnostic criteria for excoriation disorder?
recurrent skin picking resulting in lesions
attempts to stop picking
picking results in significant distress/functional impairment
picking is not explained by another disorder
What are some feature of excoriation disorder?
time consuming (usually >1 hr/day) social avoidance medical complications
What is the diagnostic criteria for trichotillomania?
Recurrent pulling out of one’s hair resulting in hair loss
attempts to stop hair pulling
pulling causes significant distress/functional impairment
what are features of trichotillomania?
any body region can be affected and change over time
pulling usually occurs during sedentary activities
episodes can be frequent but brief or infrequent by sustained
What are the trauma and stressor related disorders?
Posttraumatic stress disorder Acute stress disorder Adjustment Disorder Reactive Attachment Disorder Disinhibited Social Engagement Disorder
What is the etiology of trauma/stressor related disorders?
these disorders share in common psychological distress in response to a traumatic/stressful event
psychological distress can manifest in many forms
What is a traumatic stressor?
Involves actual/threatened death or serious injury
What is a non-traumatic stressor?
Situations in which a person perceives that environmental demands exceed one’s resources to cope
What is the diagnostic criteria for posttraumatic stress disorder (PTSD)?
Exposure to a traumatic stressor:
- Actual or threatened death or serious injury or sexual violence
- Exposure may include direct experience of event, witnessing event or learning about event to close family member/friend
What are the four types of symptoms associated with PTSD that may develop at any time? (each card will go through one)
- Intrusion Symptoms –> dreams, recollections, feeling event reoccur, psychological or physiological distress when encounters symbols
2nd type of symptom with PTSD?
- Avoidance Symptom –> symptoms such as avoidance of thoughts, places, or conversations, that are reminders of events
3rd type of symptom with PTSD?
- Negative Alterations in Cognition and Mood –> persistent –> negative beliefs/expectations, negative emotional states, inability to experience positive emotion, diminished interest/participation in activities, detachment/estrangement from others and dissociative amnesia
4th type of symptom with PTSD?
- Alteration in Arousal and Reactivity –> sleep disturbance, irritable and angry outbursts, reckless or self destructive behavior, concentration problems, hypervigilance, and exaggerated startle response
What is the duration and onset of PTSD?
Duration –> last greater than 1 month
Onset –> within 3 months of trauma but can begin ANYTIME
What is the diagnostic criteria for acute stress disorder (ASD)?
- Exposure to a traumatic stressor
- Numerous PTSD-like symptoms develop from any of the PTSD symptom categories
- Duration of the disorder is 3 days to 1 month after trauma exposure
What is the key in differentiating PTSD and ASD?
Timeline
ASD: symptoms start and resolved within the first 30 days after the trauma
PTSD: symptoms start anytime after the trauma and last more than 30 days
What is the diagnostic criteria for adjustment disorder?
Development of significant emotional/behavioral symptoms
Due to an identifiable stressor (often an ordinary life experience): Acute Onset and Brief Duration
Symptoms do not meet criteria for another disorder (aka major depression) –> if criteria for another disorder is met, diagnose the other disorder
What is treatment of adjustment disorder?
Treatment typically involves: learning of coping strategies in therapy sessions or involvement in support groups
Treatment may involve crisis intervention: hospitalization and psychotropic medications
What are the dissociative disorders?
- Dissociative Amnesia
- Dissociative Identity Disorder
- Depersonalization/Derealization Disorder
What is the diagnostic criteria for dissociative amnesia (psychogenic amnesia)?
Memory loss for autobiographical information, which doesnt occur due to another disorder
What are the different types of memory loss in dissociative amnesia?
Localized –> total loss of personal memory during a circumscribed period
Selective –> Some (but limited) recall of personal memories during a circumscribed period
Generalized –> loss of personal memory of entire life up to and including event
During a mental status exam (MSE) how does one identify if the memory problem is physiological or psychological?
Physiological basis: patient has difficulty learning NEW information in addition to past memory loss
Psychological (dissociative) basis: patient learns new information well; only past memory loss will be present
If patient has dissociative amnesia with dissociative fugue, what does fugue mean?
purposeful travel or bewildered wandering associated with amnesia for identity or other autobiographical information
(usually brief, rarely recurs and spontaneous termination of amnesia)
What is the diagnostic criteria for dissociative identity disorder?
1) Disruption of identity characterized by >2 distinct personalities states: the primary and an alter
2) Inability to recall personal information (as evidenced by frequent memory gaps in host while an alter takes control)
What is a hint for remembering DID?
Amnesia along with mistaken identity experiences and changes in personal possessions
What is the diagnostic criteria for depersonalization/derealization disorder?
Either (or both)
- Depersonalization: Experiences of unreality, detachment or being an outside observer with respect to one’s thoughts, feelings, sensations, body or actions
- Derealization: Experiences of unreality or detachment with respect to surrounding (objects seem unreal or dreamlike)
What is a common therapy for dissociation disorders?
typically involves psychotherapy
hypnosis is often used
