Anxiety Disorders; Trauma and Stress Related Disorders Flashcards
What is generalized anxiety disorder?
excessive anxiety and worry occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance)
-the individual finds it difficult to control the worry
What are the symptoms of anxiety?
the anxiety is associated with three (or more) of the following six symptoms
- restlessness or feeling keyed up or on edge
- being easily fatigued
- difficulty concentrating or mind going blank
- irritability
- muscle tension
- sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep)
What are the characteristics of generalized anxiety?
- the anxiety causes clinically significant distress or impairment
- the disturbance is not attributable to the physiological effects of a substance or another medical condition
- the disturbance is not better explained by another mental disorder
What is the tx of generalized anxiety disorder?
- SSRIs: paroxetine and escitalopram; SNRIs: Venlafaxine
- Buspirone is also effective; the starting dose is 5 mg PO bid or tid, however, buspirone can take at least 2 week before it begins to help
- Benzodiazepines (short-term use), beta blockers
- Psychotherapy
What is panic disorder?
an occurrence of three panic attack (sudden unexpected periods of intense fear or discomfort) episodes in three weeks
What are the characteristics of panic disorder?
- at least one of the attacks has been followed by one month (or more) of one or both of the following
- persistent concern or worry about additional panic attacks or their consequences
- a significant maladaptive change in behavior related to the attacks
What is the tx of panic disorder?
- SSRIs: Paroxetine, sertraline, fluoxetine
- Benzodiazepines: for acute attacks (watch for abuse)
- CBT (relaxation, desensitization, examining behavior consequences)
What is social phobia?
social anxiety disorder
- marked and persistence (> 6 months) fear of social or performance situations in which one is exposed to unfamiliar people to possible scrutiny by others
- fear of acting in a humiliating or embarrassing way
- public speaking, initiating conversation, dating, eating in public
- may coexist with avoidant personality disorder
What is specific phobias?
excessive and persistent fear of a specific object, situation or activity that is generally not harmful
- lasts for 6 months or more
- patients know their fear is excessive, but they can’t overcome it
- these fears cause such distress that some people go to extreme lengths to avoid what they fear
- examples are fear of flying or fear of spiders
What is the tx specific phobias?
treat with exposure therapy (first line), teach to relax and try to understand/overcome the fear
- SSRI + CBT
- benzodiazepines (i.e. prior to flying)
- treat agoraphobia just as GAD with SSRIs and CBT
What is post-traumatic stress disorder?
the patient has experiences a traumatic event which causes an acute stress reactions
-once the symptoms persist past 1 month it is now considered post-traumatic stress disorder
What is the tx for PTSD?
- SSRIs are first-line
- Cognitive Behavioral Therapy (CBT)
- Prazosin for nightmares
- Benzodiazepines, if used, should not be continued more than 2 weeks after a traumatic event
What is adjustment disorders?
the disproportionate response to a stressor that would normally be expected (job loss, physical illness) which begin within 3 months of stressor and end within 6 months after stressor resolved
-reaction out of proportion to the stressor or impairs daily functioning
What are the stresses that cause adjustment disorders
- marital conflict
- financial conflict
- family conflict/parental separation
- school problems/changing schools
- sexuality issues
- death/illness in the family
What is the tx of adjustment disorders?
psychotherapy
