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Adv. Psychopathology Final > Anxiety Dxs > Flashcards

Anxiety Dxs Flashcards

1
Q

All anxiety Dxs are loosely modeled off of which anxiety Dx?

A

Specific phobia Dx

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2
Q

Specific Phobia
Criteria:
A. Marked ____ or _____ about a ______ object or situation

A

fear; anxiety; specific

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3
Q 
Specific Phobia
Criteria: 
B. The phobic object is...
1. Actively \_\_\_\_\_\_
2. Endured with intense \_\_\_\_\_ or \_\_\_\_\_
A

avoided;

fear or anxiety

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4
Q

Specific Phobia
Criteria:
C. Anxiety and avoidance lasts at least ____ months

A

6

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5
Q

Specific Phobia
Criteria:
D. Causes marked _____ or _______

A

distress or impairment

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6
Q

Specific Phobia
Criteria:
E. Not better explained by ________

A

another Dx

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7
Q 
Specific Phobia
Specifiers:
An\_\_\_\_
Nat\_\_\_\_\_\_ \_\_\_\_\_
Bl\_\_\_\_\_/In\_\_\_\_\_/In\_\_\_\_\_
Sit\_\_\_\_\_\_\_
Ot\_\_\_\_

Note: If more than one applies, code _____.

Average person fears ___ different objects or situations

A 
Animals
Natural environment
Blood/Infection/Injury
Situational
Other

Code all

3 different objects

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8
Q

Specific Phobia
Basic info:

Most common phobia?
Prevalence: ___% - ___ %
Sex ratio: 2:1
Course: If extended into adulthood ______

A

Heights

7-9%

Female to Male

unlikely to remit.

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9
Q

Specific Phobia
Etiology:

Phobias can develop three different ways. What are they?

A
  1. Direct conditioning - I was pinched by a lobster.
  2. Modeling - I saw someone pinched by a lobster.
  3. Informational - I was told you can lose a finger if you get pinched by a lobster.
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10
Q

Specific Phobia
Tx:

Behavioral Therapy for a specific phobia is also known as…

A

systematic desensitization

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11
Q

Specific Phobia
Tx: Systematic Desensitization

  1. Establish a _____ hierarchy
    - Has many _____
    - Begins with items likely for ______
  2. Practice ______ and ______
  3. Slowly pair each item with ______ versus ______
    - Want to break _____-____ pairing
    - Want to create a new pairing of ______/______ when faced with stimulus
A
  1. fear/exposure;
    - many levels;
    - success;
  2. relaxation and coping
  3. relaxation versus fear response
    - stimulus-fear pairing
    - mastery/efficacy
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12
Q

Social Anxiety Dx
Criteria:

A. Marked fear about at least 1 _______ where they will be _____ by others.

Note: For children - anxiety needs to occur in _____ settings; not just with _______

A

social situation; judged

Note: peer; adults

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13
Q

Social Anxiety Dx
Criteria:

B. Person ______ _____ ___ ___ in a way that leads to ______, _______, _______

A

fears they will act;

embarrassment; humiliation; rejection

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14
Q

Social Anxiety Dx
Criteria:

C. Social situations almost always _______ _____ ______.

Note: Children - fear/anxiety may be expressed by ______, _______, ________. _______, ________, or ________

A

provoke fear or anxiety

crying; tantrums; freezing; clinging; shrinking; failing to speak in social situations

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15
Q

Social Anxiety Dx
Criteria:

D. The person either _____ the situation or _______ it with _________

A

avoids; endures; intense fear

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16
Q

Social Anxiety Dx
Criteria:

E. Fear is _____ ________ to the threat

A

out of proportion

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17
Q

Social Anxiety Dx
Criteria:

F. Lasts at least ___ months

A

6

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18
Q

Social Anxiety Dx
Specifier:

There is only one specifier for SAD. What is it?

A

Performance only

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19
Q

SAD - Basic Info

Prevalence 
Sex ratio: ~ 2:1
Onset: 
Comorbidity: 
Course:
A
  • 8%
  • Female to male
  • age 13
  • Alcohol Use Dx (11% of those with Alcohol Dependence have SAD)
  • About 1/2 will spontaneously recover
20
Q

Social Anxiety Dx
Etiology:

Which two neurotransmitters play a part?

A

Serotonin (mixed support)

Dopamine

21
Q

Social Anxiety Dx
Etiology:

What was Kagan’s temperament research showing?

A

White middle class 4 month old children displayed two types of behavior in response to unfamiliar stimuli: Inhibited and Disinhibited:
Inhibited children are shy, timid, and fearful.
Disinhibited children display bold, sociable, and outgoing behaviors.

Variations in behavior accord to motor behavior and crying in response to unfamiliar visual, auditory, and olfactory stimuli. High reactive children are likely to grow to become inhibited and low-reactive children are likely to grow to become uninhibited.

22
Q

Social Anxiety Dx
Etiology:
Parent Modeling:

  1. Anxious parent models fearing _______ _____ & ______
  2. Parent creates fewer chances for child to learn and practice ______ so the child then actually does get _______ more from others
A
  1. negative evaluation & judgment

2. social skills; rejected

23
Q

Social Anxiety Dx
Tx:

SSRI’s and MAO inhibitors are roughly equal to what other kind of treatment?

IPT and Mindfulness are less effective than what other kind of treatment?

45% of clients don’t respond to which kind of treatment?

Combined psychotherapy + meds provide….

A

CBT;

CBT;

CBT;

inconsistent results - it’s unclear if combined treatment is better than either treatment alone.

24
Q

Selective Mutism
Criteria:

A. Consistent failure to _____ in specific ________ where there is an expectations to _______, despite ______ in other situations.

B. Disturbance interferes with ______ or ______ achievement or with _______ communication.

C. Duration is at least ___ (not limited to ____ of school)

D. Not attributable to a ______ ______ of, or comfort with, the _________

E. The disturbance is not better explained by a _________ Dx and does not occur exclusively during _____ or a _______ Dx

A 
A. speak; social situations; speak; speaking
B. educational; occupational; social
C. 1 month; 1st month
D. lack of knowledge; spoken language 
E. communication; ASD; psychotic
25
Q

Selective Mutism
Basic Info:

Prevalence
Sex Ratio
Onset
Comorbidity

A
  • Less than 1%
  • About equal in sex ratio
  • Less than 5 years
  • Social Anxiety Dx
26
Q

Selective Mutism will often morph into ________ later on in a child’s life.

A

Social Anxiety Disorder

27
Q

How is selective mutism reinforced for a child in social situations?

A

Adults will jump in to protect their own feelings for the child not speaking. The child recognizes this behavior and learns that they don’t have to speak if they just wait.

Child is prompted to engage verbally or behaviorally ===> child experiences distress and inhibits ===> environment observes distress ===> adults rescue ===> everyone feels relief ===> negative reinforcement cycle restarts

28
Q

How is selective mutism treated?

A

Exactly the same way as specific phobia treatment: exposure therapy. Gradual increase in exposure; build positive experiences; generate a success framework.

SSRI’s can also be used.

Integrated Behavioral Tx = psychoeducation, inclusion of family, and gradual exposure to talking.

29
Q

Separation Anxiety Dx
Criteria:

A. Developmentally inappropriate & excessive ______ or ________ re: separation from _________ figure, shown by at least 3 of the following:

  1. They experience recurrent and excessive distress when they anticipate or are actually what?
  2. They excessively and persistently worry about losing who because of what?
  3. They persistently and excessively worry about themselves experiencing what that will cause a separation from who?
  4. They experience a persistent reluctance or refusal to go where because of what?
  5. They persistently and excessively fear a reluctance to be what or without whom and where?
  6. They have a persistent reluctance or refusal to do what without being close to who.
  7. They experience repeated what involving what?
  8. They make repeated what when separated from major attachment figures or when separation is what?
  9. The fear, anxiety, or avoidance lass for how long for children and adolescents? How long for adults?
  10. What does the disturbance have to cause?
  11. The disturbance cannot be better explained by what?
    Note: For adults, who can the attachment figure be?
A

A. fear; anxiety; attachment

  1. Separated from an attachment figure
  2. major attachment figures because of harm in the form of illness, injury, disasters, or death.
  3. experiencing an untoward event (getting lost or kidnapped) that will cause them to be separated from their major attachment figure.
  4. to go anywhere because of a fear of separation.
  5. to be alone or without major attachment figure at home or other settings.
  6. sleep away from home or going to sleep without being near a major attachment figure.
  7. nightmares involving fear of separation.
  8. complaints of physical Sxs (headaches, stomachaches, nausea, vomiting) when separated or separation is anticipated.
  9. ≥ 4 weeks for children/adolescents and ≥ 6 months for adults.
  10. It has to cause distress or impairment in functioning.
  11. Another mental disorder.
    Note: It can be spouse or offspring.
30
Q

Agoraphobia
Criteria:

A. They experience a marked what or what about ≥ 2 of the following situations:

  1. Using what?
  2. Being in what kind of spaces?
  3. Being in another kind of space, but the opposite to the kinds of spaces in criteria 2.
  4. Standing in or being in a what?
  5. Being outside of what alone?

B. Individual fears or avoids these situations because of:

  1. They have thoughts that what might be difficult
    OR
  2. What might not be available if what happens?
    OR
  3. They fear what kind of event happening?
  4. Agoraphobic situations almost always provoke what?
  5. Agoraphobic situations are actively what, require the presence of who, or are endured with what?
  6. The fear or anxiety is out of proportion relative to what?
  7. How long does the fear, anxiety, or avoidance last?
  8. There is distress or impairment in what?
  9. If there is another medical condition, the fear, anxiety, or avoidance is clearly what?
  10. It cannot be better explained by what?
A

A. fear or anxiety

  1. public transportation
  2. open spaces
  3. enclosed spaces
  4. line or a crowd
  5. outside of their home
  6. escape might be difficult
  7. help won’t be available if they develop panic-like symptoms
  8. incapacitating or embarrassing symptoms (fear of falling in elderly; fear of incontinence)
  9. fear or anxiety
  10. actively avoided, require the presence of a companion, or are endured with intense fear or anxiety.
  11. relative to the danger posed and sociocultural context
  12. It lasts ≥ 6 months.
  13. distress or impairment in functioning
  14. the fear, anxiety, or avoidance is clearly excessive
  15. another mental Dx.
31
Q

Agoraphobia:

Agoraphobia does not occur merely as a fear of leaving the home. Rather it’s a fear of what happening outside of the home that is the reason for their marked fear or anxiety?

A

Some embarrassing event that’s out of their control.

32
Q

Agoraphobia
Basic info:

Coding note: Agoraphobia is Dx’ed irrespective of the presence of ______, so if the person meets criteria for both, the therapist should what?

Prevalence: Percentages

Sex Ratio: 2:1

Onset: Most cases are before the age of…?

Course: duration is…?

A

Coding note: panic Dx; diagnose both

Prevalence 1.3% to 1.7%

Sex ratio: Female to male

Onset: 35

Course: chronic

33
Q

Agoraphobia
Basic Info:

  1. There is significant overlap with what other disorder?
  2. What are the treatments?
A
  1. Panic Disorder - 1/3 to 2/3 have agoraphobia
    Agoraphobia - 1/2 have panic attacks
  2. SSRIs and exposure therapy.
34
Q

Panic Attacks:

Panic attacks occur in many different anxiety Dxs. Do we diagnose Panic Dx as a comorbidity when the person has a separate anxiety Dx?

A

Only if they meet all the criteria as a separate Dx. If not, add a panic attack specifier to the original Dx.

35
Q

Panic Attack
Symptoms:

A: Panic attack: An abrupt surge of what that peaks within what amount of time?
-How many symptoms does the person need to have?

  1. Palpitations, pounding, or _________
  2. Swe______
  3. Trembling or ______
  4. Shortness of ______ or sensation of being _______
  5. Feelings of ch______
  6. Chest _______ or _______
  7. Nausea or _______ distress
  8. Feeling ______, unsteady, _______ _____, faint
  9. Chills or _______ sensations
  10. Parathesias ( ______ or _______ sensations)
  11. Derealization or __________
  12. Fear of losing _______ or “going _______”
  13. Fear of dy____
A

A: fear and discomfort that peaks within minutes
- At least 4

  1. accelerated HR
  2. Sweating
  3. shaking
  4. breath or smothered
  5. choking
  6. pain or discomfort
  7. abdominal
  8. dizzy; lightheaded
  9. heat
  10. numbing or tingling
  11. depersonalization
  12. control; “going crazy”
  13. dying
36
Q

Panic Dx
Criteria:
1. There are recurrent and unexpected what?

  1. ≥ 1 of the attacks have been followed by ≥ 1 months of 1 or both of the following:
    a. persistent ______ or ______ about additional ______ or their consequences
    b. a significant ________ change in behavior related to the attacks (behavior designed to avoid having panic attacks)
  2. Not attributable to what?
  3. Not better explained by what? (Panic attacks don’t occur only in response
    a. A specific social situation (which disorder?)
    b. Circumscribed phobic objects or situations (which disorder?)
    c. Obsessions (which disorder?)
    d. Reminders of trauma (which disorder?)
    e. Separation from attachment figure (which disorder?)
A
  1. Panic attacks
    2a. concern or worry about additional panic attacks
    2b. maladaptive
  2. substance or medical condition
  3. Another Dx
    a. social anxiety dx
    b. specific phobia
    c. OCD
    d. PTSD
    e. separation anxiety dx
37
Q

Panic Dx:

True or false: Panic attacks can be predicted before they occur?

A

False. They’re unexpected, the onset cannot be predicted, and there’s no way to discern the reason for the panic.

38
Q

Panic Dx
Basic Info:

Prevalence: percentages
Sex Ratio: 2:1
Onset: what age range?
Course: 
Comorbidity:
Note: Approximately 1/3 are \_\_\_\_\_\_ panic attacks where the individual \_\_\_\_\_\_\_ in a panic
A

Prevalence: 2-3%
Sex ratio: F:M
Onset: 20-24 years at onset
Course: Waxing and waning
Comorbidity: Highly comorbid and often seen with other anxiety Dxs, depression, and substance Dxs
Note: nocturnal panic attacks; wakes up in a panic

39
Q

Panic Dx:

Describe the Sanderson, Rapee, and Barlow Panic Dx experiment:
Hints: Light bulbs, dials, and CO2 levels

A
  1. An increase in CO2 is associated with panic attack onset
  2. Patients were placed in a room with elevated CO2
  3. Patients were told they could control CO2 levels with a dial when a light bulb came on
  4. For half the subjects, the light bulb never came on. For the other half, the light bulb was always on.
  5. The dials were not actually connected to anything and patients had no control over CO2 levels.
  6. Results: 80% who felt they had no control (the half where the light bulb never illuminated) had a panic attack. 20% of those who felt like they had control (other half where the light bulbs did come on) had panic attacks. Both groups were exposed to same amount of CO2. So, perception of control is affects panic attacks.
40
Q

Panic Dx
Etiology:

Genetic: How heritable is it?

Cognitive Distortions:

  1. Hypersensitivity and hyperactivity to what?
  2. Catastrophic misappraisals of what?
  3. Lack of perceived control over what?
A

Genetic: Moderate heritability (.3 to .4)

  1. Hypersensitivity and hyperactivity to bodily/physical sensations
  2. Catastrophic misappraisals of those bodily sensations
  3. Lack of perceived control, particularly over their thoughts and Sxs
41
Q

Panic Dx Tx:

Meds: Which class of drugs are effective in reducing panic? What often occurs when meds are stopped?

CBT: How effective is it compared to meds?

Combined (Meds + CBT): Is combined therapy more, equally, or less effective?

A

Meds: SSRIs. Relapse often occurs when stopped

CBT is about as effective compared to meds. Equal in efficacy

Combined therapy > meds alone

42
Q

Generalized Anxiety Disorder
Criteria:

A. Excessive anxiety and worry that occurs _____ than not and about a number of _______ and _______

B. Difficult to control the ______

C. ≥ ____ months

D. Plus at least __ other Sxs more days than not (note: only need ___ if a child)

  1. Restless, ______, on edge
  2. Easily fa_____
  3. Difficulty _____
  4. Irr_____
  5. Muscle ______
  6. Sleep ______
A 
A. more days than not; events and activities
B. Difficult to control the worry
C. ≥ 6 months
D. 3 other Sxs (note: 1 if a child)
1. keyed up
2. fatigued
3. concentrating
4. irritable
5. muscle tension
6. sleep problems
43
Q

GAD
Basic Info:

Prevalence: percentages
Sex Ratio: 2:1
Onset: Mean = \_\_\_ years (wide standard deviation)
Course: 
Comorbidity: 
1. > 40% have \_\_\_
2. ~ 30-40% have \_\_\_\_
2a. Lots of symptom overlap with \_\_\_\_\_
A 
Prevalence: 2.9% adults; .9% adolescents 
Sex Ratio: F:M
Onset: 30 years (GAD is likely to occur in every age group but 30 years is slightly younger than middle of life span - that's why mean onset is named at this age)
Course: Chronic; waxing and waning
Comorbidity: High
1. Social Anxiety Dx and Panic Dx
2. MDD
2a. MDD
44
Q

GAD
Etiology:

A. Dysregulation in _____. It takes longer to recover from a stressor
B. Difficulty with _____ regulation. More intense_____ and more difficulty managing _______ ______
C. Cognitive _____:
1. Catas______
2. Bias to attend/remember _________ stimuli
3. Encode neutral stimuli as _______
D. Intolerance of ________. Better to anticipate the _____ vs. dealing with _______

A 
A. CNS
B. affect; emotions; negative affect
C. biases
1. Catastrophizing
2. threatening
3. threatening
D. uncertainty; anticipate the bad vs. dealing with unknown/uncertainties
45
Q

GAD Tx:

CBT - _____ to _____ effect 12 months post Tx

Meds (SSRIs mostly) had _____ effect than psychotherapies

CBT is ____ effective in Tx of GAD because the anxieties can be so generalized and unspecific that the treatment of worry A, B, C _______ for the person’s worry about D, E, and F.

A

CBT - small to medium effect

Meds had larger effect than psychotherapies

CBT is less effective. Worries about A, B, C do not account for the person’s worries about D, E, and F. CBT for GAD is kind of like whack-a-mole.

Adv. Psychopathology Final (7 decks)

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