Anxiety Disorders, Trauma, and Stress Related Disorders Flashcards
types of anxiety disorder
generalized anxiety disorder
panic disorder
phobic disorders
types of phobic disorders
specific phobia
social phobia
what do you think when you see a pt with uncontrollable worry x 1 year - she has daily sx consisting of sleep disturbance, difficulty concentrating, and irritability
generalized anxiety disorder
excessive anxiety and worry ocurring more days than not - for at least 6 mo - about a number of events or activities
gad
dsm 5 for gad
-6 months of worry that is difficult to control
-causes significant distress/impairment
-no other cause/mental disorder
-anxiety is associated w. 3 or more of the following:
-restlessness
-easily fatigued
-difficulty concentrating
-irritability
-muscle tension
-sleep disturbance
tx for gad (5)
SSRIs
SNRIs
buspirone
benzos
bb
psychotherapy
which 2 SSRIs are used for gad
paroxetine
escitalopram
what SNRI is used for gad
venlaxafine
how long does buspirone take to be effective
2 weeks
tx for acute gad
benzos
bb
what do you think when you see a pt who presents w. sudden, frequent episodes of palpitations accompanied by sweating and a feeling that she is going to pass out (but she never has) - these began when she started PA school and she is afraid to go to school for fear of having an “attack”
panic disorder
dsm 5 definition of panic attack
sudden, unexpected period of intense fear or discomfort
dsm 5 for panic d.o
-3 panic attacks in 3 weeks
-at least one attack must be followed by one month or more of one or both:
-persistent worry about additional panic attack
-significant maladaptive change in behavior related to attacks
tx for panic d.o
SSRI’s
benzos
CBT
what SSRI’s are used for panic disorder (3)
paroxetine
sertraline
fluoxetine
venlafaxine
tx for acute panic attacks
benzos
dsm 5 for social phobia (aka social anxiety d.o)
- > 6 mo of marked and persistent far of social or performance situations in which one is exposed to unfamiliar people or possible scrutiny by others
- fear of acting in a humiliating/embarrassing way - public speaking, initiating conversation, dating, eating in public
social phobia (social anxiety d.o) may coexist w. what other disorder
avoidant personality disorder
dsm 5 for specific phobias
-exessive and persistent fear of a specific object, situation, or activity that is generally not harmful
-lasts for 6 mo or more
-pt knows fear is irrational but they can’t overcome it
-distress causes pt to go to extreme lengths to avoid fear
first line tx for specific phobias
exposure therapy - relax and try to understand/overcome fear
pharm for specific phobias
SSRI + CBT
benzos for acute
tx for agoraphobia
SSRI + CBT
% of pt’s w. gad have at least one other similar psychiatric d.o at some time in their life
80%
what type of therapy used for gad challenges the distortions in a patients thinking that trigger and heighten anxiety
cbt
t/f: combining cbt w. other behavioral techniques is more effective than cbt alone for gad
t!
what other behavioral techniques are useful to combine w. cbt for gad
-relaxation training: deep breathing/progressive muscle relaxation
-biofeedback and imagery
list benzos in order of shortest to longest half life
- alprazolam (xanax)
- clonazepam (klonopin)
- diazepam (valium), clorazepate (tranzene), chlordiazepoxide
what tx may be useful for specific phobia when exposure to feared object or situation can not be avoided
benzo - lorazepam
bb - propranolol
when should prophylactic tx for specific phobia be given when fear can not be avoided
1-2 hr before exposure
a phobia is an excessive fear of an object or place that leads to or can be preceded by
panic attack
mc psychiatric d.o in the US
specific phobia
types of phobias (4)
animals
natural environment
situational
injury
what do you think when you see a pt who has experienced a traumatic event that causes an acute stress reaction with symptoms that persist past 1 month
ptsd
tx for ptsd (4)
ssri’s + CBT - 1st line
prazosin
benzos
what is prazosin used for in ptsd
nightmares
if benzos are used for ptsd, they should not be used longer than
2 weeks
disproportionate reponse to a stressor (job loss, physical illness) that impairs ADLs
adjustment disorder
adjustment disorder begins w.in _ months of the stressor and end w.in _ months after stressor has resolved
begin: 3 months
end: 6 months
stressors for adjustment disorder include (6)
marital conflict
financial conclift
family conflict/parental separation
school problems/changing schools
sexuality issues
death/family illness
tx for adjustment disorder
psychotherapy
what do you think when you see a pt w. a 3 month hx of feeling depressed and extremely distressed at work after accepting a managerial position and experiencing interpersonal conflict w. 2 employees
adjustment disorder
common precipitant of adjustment disorder in young adults
leaving home and going to college
adjustment disorder is characterized by _ behavior
and _ symptoms
maladaptive behavior
emotional symptoms
typical presentation of adjustment disorder (3)
tearful
depressed
reckless behavior
hallmark features of ptsd (8)
intrusive recollections
uncontrolled thoughts
flashbacks
emotional numbing
avoidance
difficulty sleeping
severe anxiety
feelings of danger, helplessness, horror
t/f: MAOIs, TCAs, clonidinem propranolol, lithium, and buspirone have all shown efficacy with ptsd
t!
why do you have to be especially careful when using benzos for ptsd
high rates of substance abuse disorders in this pt pop
only 2 FDA approved meds for ptsd
sertraline
paroxetine
what therapy is effective for decreasing symptoms of reexperiencing and hyperarousal in ptsd (4)
relaxation training
systematic desensitization
flooding
cognitive reframing
what type of therapy is effective for processing traumatic memories in ptsd
emdr (eye movement desensitization and reprocessing)
what class of drug is prazosin
alpha 1 antagonist
effective for nightmares and insomnia in ptsd
