Anxiety Disorders, Trauma & Stress-Related Disorders Flashcards
What is the diagnostic critera for GAD?
excessive worry or anxiety for ≥ 6 months PLUS ≥ 3 sxs
How is GAD treated?
CBT + SSRIs (1st line, Paroxetine) or SNRI (Venlafaxine, Duloxetine)
* Buspirone: can be used as an adjunct, non-sedating & non-addictive
* BZDs: can be used short-term only until SSRIs/SNRIs take effect
What is a panic attack?
NOT a stand-alone mental disorder
* Sudden, discrete episode of intense fear, anxiety, or discomfort that peaks within 10 min & resolves within 1 hour
What are symptoms of a panic attack?
≥ 4 of the following
* Dizziness, trembling, choking feeling, paresthesia, sweating, SOB, CP, chills/hot flashes, fear of losing control or dying, palpitations or tachycardia, nausea, depersonalization or derealization
* Hallmark: sense of impending doom or dread
What can be used for acute relief of a panic attack?
BZD – Alprazolam
What is the diagnostic criteria for panic disorder?
≥ 2 panic attacks PLUS ≥ 1 month of
* persistent concern about future attacks or implications
* significant maladaptive behavior to try & avoid potential trigger
How is panic disorder treated?
CBT + SSRI (Paroxetine, Sertraline)
* May initiate w/ SSRI + BZD, then taper and discontinue BZD
What is agoraphobia?
Fear of being in places where escape is difficult (open/public/crowds) & may lead the pt to confinement at home
How is agoraphobia diagnosed?
sxs ≥ 6 months & cause significant functional impairment
How is agoraphobia treated?
CBT + SSRI
* Sertraline, Citalopram, Fluoxetine
What is the most common type of phobia?
Public speaking AKA social anxiety disorder
What is the diagnostic criteria for social anxiety disorder?
Fear of social scrutiny of others d/t fear of embarrassment for ≥ 6 months
* Fears they will act in a way or show anxious sx that will be humiliating, embarrassing, or lead to rejection
* Almost always provoke fear or anxiety and are avoided or endured with intense fear/anxiety
How is social anxiety disorder treated?
CBT + SSRIs (Paroxetine)/SNRIs
* Performance only: beta-blockers (propranolol, atenolol) or BZDs (clonazepam or lorazepam)
What are specific phobias?
Fear of a specific object or situation that leads to the endurance of the anxiety &/or avoidance of the feared object/situation
* Animal/insects
* Natural phenomena
* Blood-injection injury
* Situational: bridges, flying, confined spaces
* Other: vomiting, choking, becoming sick, death
What is the diagnostic criteria for specific phobias?
Intense fear or anxiety of a specific situation, object or place for ≥ 6 months
* Exposure triggers an immediate response out of proportion to any real danger/threat
* Avoided when possible or tolerated w/ intense anxiety
How are specific phobias treated?
exposure & desensitization
* Short-term BZDs or beta-blockers can be used
What is adjustment disorder?
Occur when behavioral or emotional sxs develop after a non-life-threatening, stressful life event (divorce, death of loved one, fired)
What is the diagnostic criteria for adjustment disorder?
≥1 sxs that occur w/in 3 months of sxs onset
* Marked distress that is out of proportion to the severity or intensity of the stressor
* Significant impairment in social, occupational, or other important areas of functioning
* Once the stressor is relieved, sxs resolve within 6 months
How is adjustment disorder treated?
psychotherapy
What screening test can be used for PTSD?
Primary Care PTSD (PC-PTSD-5) – score ≥ 3 = high likelihood
What is the diagnostic criteria for PTSD?
stressor, duration, recurrent intrusions, avoidance, negative alterations in moos, alterations in arousal/reactivity
* Stressor: exposure to actual or threatened death, serious injury, or sexual violence
* Duration: Sx last > 1 month, traumatic event occurred anytime in the past
* Recurrent intrusions (1): distressing dreams, nightmares, memories, flashbacks
* Active avoidance of triggers
* Negative alterations in mood (2): dissociative amnesia, negative emotions, anhedonia, inability to feel positive feelings
* Alterations in arousal & reactivity (2): angry outbursts, irritable, reckless, self-destructive, hypervigilance
How is PTSD treated?
trauma-focused therapy + SSRIs (Sertraline, Paroxetine) or SNRIs
* Trazodone: insomnia
* Prazosin: nightmares, sleep disturbance, hypervigilance
What is the difference between acute stress disorder and PTSD?
- ASD: trauma occurs < 1 month AND sx last < 1 month in duration, tx w/ CBT
- PTSD: trauma occurred at any time in the past > 1 month OR sxs > 1 month
What is malingering?
NOT a mental illness
* internal falsification or exaggeration of sxs of a medical ot psychatric illness for external gain
* financial (insurance/lawsuits), food, shelter, avoid school/work/prison
