Anxiety disorders, OCD, and trauma/stressor related disorders Flashcards

Question

TCAs for anxiety

Answer 1

effective but multiple receptors and so more AEs this means noncompliance

Answer 2

Buspar- helpful adjunct (Not PRN) Gabapentin- pain and craving tx too propranolol-- performance anxiety, usually adjunct

Answer 3

clonidine guanfacine

Answer 4

discrete episodes/attacks sudden onset intense apprehension fearfulness terror often associated with sense of impending doom

Answer 5

discrete episodes sudden onset, peaking within 10 min of onset of 4+ of: Paresthesias Chills or hot flushing Fear of losing control or of going crazy Fear of dying SOB or smothering sensation Palpitations/pounding/ Inc HR Chest pain, tightness, or discomfort Sweating Trembling/Shaking Nausea or Abdominal distress

Answer 6

After 1st attack: persistent concern over having another/worry about consequences of 1st/significant behavior change r/t 1st R/t high somatic sensations, often sensitive to new somatic experiences or perceptions intolerant of or concerned with common AE ashamed of failure to control emo, over concern about dying

Answer 7

2/3 major depression 1st 1/3 panic disorder 1st

Answer 8

Hyperthyroid hyperparathyroid pheochromocytosis vestibular dysfunction Sz Cardiac like SVT CNS stimulants Alt anx like PTSD/phobias Consider general med dx if panic sx are atypical like vertigo, LOC, incont, HA, slurred speech, amnesic pattern post attack Note panic is sudden onset, discrete, self limiting, paroxysmal

Answer 9

SSRI BZO for short term or bridge to SSRI Buspar as adjunct to SSRI

Answer 10

agoraphobia anxiety r/t fear of developing panic like sx never met criteria for panic disorder avoidant behavior as a result of agoraphobia anxiety

Answer 11

SSRI BZO short term BB off label for discrete episodes of social anxiety

Answer 12

adults this exists in conscious recognition that the fear is excessive or unreasonable children insight increases with age

Answer 13

past trauma observe another trauma excessive info transmission genetic loading Blood/injection/injury type is most familial 1st deg relative

Answer 14

content: varies with culture, ethnic/age Dx only with significant functional impairment (full avoidance school r/t spider etc) Exposure to specific provokes onset of clinically significant levels of anxiety - may fit criteria for cued panic attack -directly r/t proximity or degree of escape -children manifest as cry/freeze/tantrum/excess cling avoidant behavior is distressful with implications

Answer 15

situational- most common (driving, spaces, tunnel etc), bimodal peak (child/mid 20s) natural environment- cued by objects natural (storm/lightning/water/heights etc), onset usually child blood injection injury- seeing or receiving, strong vasovagal animal- cued by animals, onset usually childhood other- range of stimuli (choking/vomit/specific illness) , children: loud sounds or costumed characters -note 1 class means more likely for another within that class

Answer 16

SSRI TCA short term BZO

Answer 17

mid teens, often following stressful or humiliating experience and tends to remit with age

Answer 18

awareness that people with it do not feel better or experience decreased anxiety when accompanied by a trusted companion

Answer 19

Hypersensitivity to criticism negative self evaluation Sensitivity to rejection Low self-esteem Inferiority feelings Lack of assertiveness may have anticipatory anxiety distress/impaired function--poss association with SI

Answer 20

excess worry apprehension anxiety about events/activities more days than not for 6+ mo hard to control no clear link to life event/stressors interfere with ADL nature and focus of worry shifts pattern of waxing/waning of sx sx worsen as life events stress

Answer 21

Common but important to assess normal versus pathological Manifested in excessive worry over competence or quality of performance Common over punctuality, or catastrophes like earthquakes Often accompanied by overly conforming behavior, perfectionist, excessive seeking of approval, need frequent reassurance

Answer 22

Abnormal after four described as excessive distress, when faced with separation from a major attachment figure

Answer 23

Presence of anxiety provoking obsessions OR compulsions that function to reduce the persons, subjective anxiety level recognize that they are excessive or unreasonable cause marked distress/time consuming/interfere with normal day recognize as product of own mind attempt to suppress/ignore to override (worse if resist) avoid situations where content may be encountered (public restroom etc)

Answer 24

Recurrent and persistent thoughts, impulses, images that anxiety in distress Intrusive and inappropriate Ego dystonic: feels the content is alien to belief structure, and not common/usually experienced

Answer 25

Repetitive behaviors or mental actions that you feel driven to perform in response to an obsession

Answer 26

Familial, higher with first degree Higher with first- degree with Tourette's Good to consider PANDAS in kids with sudden onset Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections

Answer 27

Repeated thoughts about contamination/dirt/germs Repeated doubts (left the oven on etc) Need to have things in specific order and distress if not Aggressive/horrific thought May occur in pregnancy/postpartum and manifest as intrusive thoughts about the baby (highly ego-dystonic Sexual imagery NOT often real world (finance etc)

Answer 28

Repetitive actions, usually behavioral a.k.a. rituals -handwashing -excess cleaning -lights off, stove off, doors locked -needing to place objects in a certain order

Answer 29

counting silently repeating words praying

Answer 30

SSRI - often need higher dose range for sc control TCA -clomipramine 2nd gen antipsychotic - risperidone (off label) but data support adjunct with SSRI

Answer 31

CHILDREN - common with prepubertal onset -more boys - most common washing/checking/ordering - common comorbid with learning disorder, disruptive behavioral disorders, tourettes -associated with PANDA OLDER ADULTS -more obsession than compulsion -obsessions often about dying -compulsions often washing/cleaning

Answer 32

The reexperiencing of an extremely traumatic event Accompanied by symptoms of increased arousal, and avoidance of stimuli from the trauma Can be experienced directly or witnessed There is a relationship between physical proximity and likelihood of symptom onset

Answer 33

observed/learning of death/significant injury (learning of would be family/close friend) unexpected witnessing of common PTSD experienced traumas

Answer 34

Three subtypes - acute: <3 mo -chronic: >3 mo -Delayed onset: 6+ mo b/t event and onset

Answer 35

sx 1+ mo exposure to trauma - experienced/witnessed/or confronted with an event involving death/threatened death/serious injury AND -response is intense fear, helplessness, or horror The event is persistently re-experienced in one or more ways: -recurrent/intrusive/distressing recollection -flashbacks -dissociative state lasting hours to days (rare) -recurrent distressing dreams about the event -acting/feeling like event is reocurring -intense, psychological distress and exposure to cues -physiological reactivity on exposure to cues 3+ avoidance sx -persistent, avoidance of stimuli associated -efforts to avoid talking about, or thinking about even -avoidance of activities/places/people that arouse recollections of event -inability to recall important aspects of event -marked decreased interest/participation in activities -feelings of detachment or estrangement from others -restricted range of affect -sense of foreboding/certain future/premature death/no expectation for success/happy 2+ increased arousal sx -diff falling asleep -irritability -diff concentrating -hypervigiliance - exaggerated startle response Sx cause impaired activities of daily function sx usually within 3 mo of event

Answer 36

highly variable 1/2 remit within 3 mo common waxing/waning r/t internal and external cues that resemble trauma

Answer 37

SSRI TCA BZO not recommended for PTSD antipsych maybe during flashback episodes alpha agonists - prazosin -maybe during tx for nightmares -off label

Answer 38

CBT ERP supportive group therapy relaxation therapies EMDR

Answer 39

Fear/horror occurs in disorganized or agitated behavior Repetitive play behaviors show themes or aspects of trauma Frightening dreams, but without recognize content are common Young children may get from learning about trauma to parent or caregiver

Answer 40

Dissociative amnesia depersonalization or derealization dissociative identity disorder

Answer 41

a defense mechanism that protects a person from overwhelming anxiety by emotionally separating causes gaps/interruption in the person's memory

Answer 42

persistent feeling of oneself not being real, or the environment not being real; reality testing remains intact generally thought as uncomfortable etiology physical or psychological -Physical: seizure, migraine, drugs, etoh -psychological: severe anxiety/traumatic stress

Answer 43

2+ personality states (alters) generally split from one another -leads to gaps in recall of everyday events Sx cause distress/impair function comorbid PTSD etiology is hx of severe physical/sexual trauma or both in childhood

Answer 44

preoccupation with 1+ perceived defects or flaws in physical appearance repetitive behaviors (mirror, reassurance) as response to concern preoccupation causes significant distress insight ranges from good to poor to absent (fixed delusion)

Answer 45

persistent difficulty in discarding possessions, regardless of value distress in response to pressure results in accumulation, compromise living space/ability to function insight ranges from good to poor to absent (fixed delusion)

Answer 46

recurrent pulling hair out despite trying to stop causes distress/impair function hair pull not attempt to improve perceived defect/flaw

Answer 47

recurrent skin picking that results in lesions despite attempt to stop results in significant distress/impair behavior not better explained by substance or intentional self harm