anxiety ds Flashcards
anxiety facts
-approx 18% in US -> >40 mil adults
-treated by PCP 90% of time* (hard/expensive to get psychiatrist)
-MC mental health illness in USA
-5X more likely to seek medical care for a variety of conditions
-6X more likely to be hospitalized for a psychiatric condition
Comorbidity:
-high rates of comorbid psychiatric disorders, especially Depressive Disorder (50%)
-High rates of comorbid alcohol and drug abuse
-high rates of suicide attempts
children:
-Affects 1/8 children with strong genetic component
-Children -> increased risk of truancy (skipping school), substance abuse, being bullied and poor school performance
anxiety as normal vs abnormal response
Normal:
-Some amount of anxiety is “normal” and is associated with optimal levels of functioning
-Adaptive response to threat to self or environment
abnormal: when anxiety begins to interfere with social or occupational functioning
-can affect school, work, social relationships and physical health
- If its impacting day to day life -> mental health issue**
social effects of anxiety
-Prolonged anxiety can result in Major Depression
-less involved with family/friends the way you used to be
-Lowered quality of relationships
-Low energy, lethargy, dysphoria
-Lack of motivation to do the things you once looked forward to doing
-Unable to convey the person that you are
-Fear and avoidance of situations where previous attacks occurred
what is anxiety: clinical vs anthropological vs psychiatric
Clinical Answer:
-unpleasant emotional and physical state characterized by fear, apprehension, restlessness, tension, over-activity of the autonomic nervous system, cardiac and pulmonary sensations, and the expectation of impending disaster.
Anthropological Answer:
-“stress response” hardwired into the brain of most mammals triggered when survival is threatened.
Psychiatric Answer:
-Catecholamines: Decreased activation of serotonin and increased activation of norepinephrine
-Increased autonomic activity: increases HR, BP, force of cardiac contractions, and dilates airways in lungs
what is anxiety disorder? what manifestations and physical sx
illness that often manifests with psychological and somatic symptoms
produces:
-Intense, excessive, and prolonged states of apprehension and fear
-Autonomic arousal: elevated pulse, elevated BP, diaphoresis, rapid breathing)
-Physical discomfort: headache, dizziness, nausea, abdominal pain, diarrhea, myalgias, arthralgias
developmentally normal fears: chart
birth-6 months- Loud noises, loss of physical support, rapid position changes, rapidly approaching other objects
7-12 months- Strangers, looming objects, unexpected objects or unfamiliar people
1-5 year- Strangers, storms, animals, dark, separation from parents, objects, machines with loud noises
6-12 year- Supernatural, bodily injury, disease, burglars, failure, criticism, punishment
12-18- Performance in school, peer scrutiny, appearance, performance
6
ex: Nick is a 52 yr old pharmacist who can’t remember a time when he was not feeling anxious. Although he is competent at his job, he gets extremely anxious about work and feels that he might make mistakes. This worry also extends to his personal life where he is always worrying about his kids academic performance and if they are getting bullied.
He often has nightmares and feels tired and restless all the time. Although he has a great marriage, he worries constantly that he may not be able to provide for his family which causes him to have sleepless nights
generalized anxiety disorder pt
types of anxiety disorders
-Generalized Anxiety Disorder
-Social Anxiety Disorder
-Phobia
-Panic Disorders
-PTSD
-OCD
generalized anxiety disorder: definition and criteria for dx
Definition:
- presence of excessive anxiety and worry about various topics, events, or activities for at least 6 months
- difficulty controlling worrying: in both adults and children, the focus of the worry may easily shift from one topic to another
- must have at least 3 physical or cognitive sx (children only need one):
Sx: MEDIC - Fatigue = GAD
- muscle soreness/aches
- edginess or restlessness
- difficulty sleeping
- irritability
- concentration impaired or mind goes blank
- fatigue, tire more easily
social anxiety disorder: definition and criteria
Def:
- intense fear or anxiety specific to social situations where an individual feels scrutinized or judged by others -> causes significant distress or impairment
- individual often fears that they will display their anxiety and that this will lead to social rejection or negative judgment
- social interactions provoke distress -> avoided or painfully and reluctantly endured
- fear or anxiety experienced is grossly disproportionate to the actual threat of the situation
-sx last 6 MONTHS or longer AND
-cause personal distress and impairment of functioning in 1+ domains -> interpersonal or occupational functioning
social anxiety disorder: how will it show in adults vs kids and men vs women
EQUALLY common in men vs women*
Child:
- tends to occur with peers rather than adults
- sx: crying, cringing, or other obvious signs of distress
Adult:
- first date, job interview, meeting someone for the first time, delivering an oral presentation, speaking in class or meeting
-Bill is a 34 yr old accountant who was recently promoted to a mid level management position at his bank. Bill was wary about this promotion but felt he had not choice but to accept it. His fear stem from the fact that he has to make presentations to the senior management regarding projects his team is involved in.
-Weeks before any presentation, he has nightmares about how he might screw up, feels extremely anxious and his work starts suffering. Although he knows his anxiety is unreasonable, he just cannot help it.
social anxiety disorder example
phobic disorder: definition and criteria
-unreasonable, excessive fear
-triggered by specific object or situation
-out of proportion to actual danger
-instantaneously reacts when presented with object or situation
-goes out of way to avoid or endures with extreme distress
-significantly impacts the individuals school, work, or personal life
Criteria:
-at least 6 MONTH duration for all ages
-not caused by another disorder- first need to rule out similar conditions -> agoraphobia, OCD, separation anxiety -> before dx specific phobia
- The anxiety, panic attack, or phobic avoidance associated with the specific object or situation is not better accounted for by another mental disorder.
define the phobia
agoraphobia: definition
- an ANXIETY disorder that causes an intense fear of becoming overwhelmed/having a panic attack or unable to escape or get help
- Because of fear and anxiety they will avoid new places and unfamiliar situations
-DSM 5: last more than 6 MONTHS
Ex:
-Enclosed Places
-Driving
-Public Transportation
-Crowds
-Shopping Malls and Supermarkets
not a phobic ds
phobia: subtypes per dsm 5
-Animal
-Natural environment
-Blood-injection-injury
-Situational
-Other
-Phyllis works at her dream job as a marketing executive for a multinational firm. Recently her firm was acquired by another company which requires her to travel to distant sites for work reasons.
-Phyllis is extremely scared of flying due to a childhood incident when she endured extreme turbulence in an airplane, which led to an emergency landing. Her frequent attempts to delay flying to places has led to disciplinary action and she is seriously contemplating leaving her current job, which she loves.
phobic disorder example - aviophobia (fear of flying)
not agoraphobia:
Specificity: Phyllis’s anxiety is triggered only by flying, not by public transportation or open spaces in general.
Behavior: Her fear doesn’t seem to extend to being in crowded places or far from home; it is limited to airplanes.
Context: The scenario describes avoidance of flying for work-related travel, which aligns with aviophobia (fear of flying), a type of specific phobia.
post traumatic stress disorder: criterion overview (A-H)
Criterion A: Exposure to a traumatic event
- direct experiece
- first hand witness
- learning through relative or close friend who was exposed to trauma
- repeated or extreme exposure to aversive details of trauma - ex: first responders, medics, police officers
Criterion B: Presence of at least one of the following following an event:
- Recurrent distressing memories
- Recurring nightmares
- Flashbacks
- Intense psychological distress
- Domain: Re-Experiencing
Criterion C: Avoiding thoughts, feelings, and reminders of the trauma.
- domain: avoidance
Criterion D: At least 2 negative alterations to mood and cognition:
- Amnesia of event
- Negative perception about oneself or the world
- Blaming oneself or others for trauma
- Persistent negative emotional states
- Inability to experience positive emotions
- Diminished interest in activities
- Feelings of detachment or estrangement from others
- Domain: Negative Cognition/Mood
Criterion E: At least 2 alterations in arousal and reactivity
- Irritability/Angry outbursts
- Reckless and Self-destructive behavior (Dr. Shepherd’s fast driving)
- Hypervigilance
- Difficulty sleeping
- Problems with concentration
- Domain: Hyperarousal
Criterion F: Sx must last more than one month*
Criterion G: The symptoms must cause significant distress or impairment.
Criterion H: The symptoms cannot be explained by substance use or another medical condition
panic disorder definition
Def: Recurrent unexpected panic attacks
- attacks can occur from a calm state or an anxious state
panic attack: abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time 4+ sx occur: Da PANICS
- Derealization (feelings of unreality) or depersonalization (being detached from oneself), dizziness
- Palpitations or accelerated heart rate; -Paresthesias (numbness or tingling sensations).
- abdominal distress
- Nausea
- Intense fear of losing control or “going crazy.” or dying
- Chills or heat sensations; Chest pain or discomfort. Choking feeling
- SOB, sweating, shaking, smothering
post traumatic stress disorder: criteria A + B
Criterion A: Exposure to death, threatened death, serious injury, or sexual violence in one (or more) of the following way(s):
-Direct experience of trauma
-Witnessing first hand trauma
-Learning relative/friend was exposed to trauma
-Repeated or extreme exposure to aversive details of trauma, typically experienced by first responders, medics, police officers, etc.
Criterion B: Presence of 1+ intrusive sx associated with the traumatic event(s) after the event(s) occurred:
-Recurrent distressing memories
-Recurring nightmares
-Flashbacks, or disassociative reactions in which person feels the trauma repeating
-Intense or prolonged psychological distress in the face of reminders
-Physical reactions in the face of reminders
PTSD: criterion C and D
Criterion C: Avoidance of stimuli associated with the trauma, as evidence by one or more of the following:
-Avoidance of distressing memories and thoughts about the trauma
-Avoidance of distressing external reminders of the trauma, like people, places, conversations, and activities
Criterion D: Negative alterations to mood and cognition with 2+ of the following:
-Inability to remember important aspects of the trauma
-Exaggerated negative thoughts about oneself, others, or the world
-Blaming oneself or others for the trauma
-Persistence negative emotional state, like fear, horror, anger, guilt, or shame
-Diminished interest in activities
-Feelings of detachment or estrangement from others
-Inability to experience positive emotions
PTSD: criterion E and F
Criterion E: Alterations in arousal and reactivity, as evidenced by 2+ of the following:
-Irritability and angry outbursts with little or no provocation
-Reckless and self-destructive behavior
-Hypervigilance
-Exaggerated startle response
-Problems with concentration
-Difficulty sleeping
Criterion F: Duration is 1+ month
PTSD: criterion G and H
Criterion G: The disturbance causes significant distress or impairment in social, occupational, and other important areas of functioning.
Criterion H: Symptoms are not due to medication, substance use, or another medical condition
PTSD domains
Re-experiencing:
- Intrusive thoughts, images, flashbacks, nightmares, or stress from cues that remind one of the event
Avoidance: Avoiding
- thinking/talking about the event, affective numbing, amnesia, derealization, depersonalization, restricted emotions (unable to have loving feelings)
Negative Cognition/Mood:
- Anhedonia (everything is bland), difficulty remembering event, sense of self-blame
Hyperarousal:
- Insomnia, hypervigilance, exaggerated startle response, difficulty concentrating, anger
prevalence and age of onset of mental health disorders
GENERAL ANXIETY DISORDER IS THE MC PREVALANCE = on the test
