Anxiety I & II Flashcards
List some physical manifestations of anxiety
- sympathetic NS symptoms: diaphoresis, mydriasis, tachycardia
- GI/GU symptoms (diarrhea, increase urinary frequency)
- hyperventilation –> dizziness and syncope
- numbness and tingling in extremities and around mouth
List some psychological manifestations of anxiety
restlessness
irritability
trouble concentrating
worry
What 3 symptoms must someone have to be diagnosed with anxiety
1) be persistent (generally >/- 6 months)
2) interfere with normal functioning
3) cause significant distress
In general, what are the levels of NTs like in someone with anxiety?
decrease 5-HT, decrease GABA, increase NE, increase glutamate
General anxiety disorder is defined as excessive anxiety/worry, occurring more days than not for >/- 6 months. It’s difficult to control worry and causes signifcant impairment. There is also no other explanation for the anxiety. It must have at least 3 of the 6 symptoms. List the 6 symptoms
- restlessness
- easily fatigued
- difficulty concentrating
- irritability
- muscle tension
- sleep disturbance
Can general anxiety disorder improve without treatment?
No, it tends to worsen over time.
What’s the psychotherapy of choice for someone with generalized anxiety disorder?
-Cognitive behavioral therapy
List the classes of drugs that can be used in the treatment of generalized anxiety disorder
- antidepressants
- buspirone (a 5-HT1a receptor agonist)
- benzo
- beta blockers –> for relief of performance anxiety & symptoms; not really for GAD
What defines a panic attack?
abrupt surge of intense fear or discomfort, peaks within minutes that is unexpected with at least 4 of the long list of symptoms (palpitations, sweating, shaking, SOB, choking feeling, chest pain/discomfort, nausea, dizziness, chills, etc)
What defines a panic disorder?
- recurrent unexpected panic attacks
- concern abt additonal panic attacks or conseq, significant maladaptive change in behavior related to attacks
- no other explanations for symptoms
What is Agoraphobia?
- fear/anxiety about >/- 2 of the following situation:
1. using public transportation
2. being in open spaces
3. being in enclosed spaces
4. standing in line or in a crowd
5. being outside the home alone - fear of not being able to escape situations
- situation almost always produces fear/anxiety
- avoids situations
- fear/anxiety out of proportion to actual danger
- > /- 6 months
- causes significant impairmnet
- no other explanation for symptoms
Social anxiety disorder (social phobia). What are some symptoms.
- > /- 6 months
- causes significant impairmnet
- marked fear/anxiety when exposed to social situation w/ possible scrutiny by others
- fear of acting in ways that will be negatively scrutinized
- social situations provokes fears
- avoids social situations
- fear/anxiety out of proportion to actual threat
- no other explanation for symptoms
What is performance anxiety? what’s the firstline treatment?
- fear is restricted to public speaking or performing and does not generalize to other social aspects of life
- first-line treatment is beta blockers
Do patients with OCD have insight?
Like other patients with anxiety disorder, they do.
What’s the difference btw obsessive compulsive disorder (OCD) and obsessive-compulsive personality disorder (PD)?
OCD involves an obsession that is relieved by performing repetitive actions (compulsions) while PD is when there’s a conscious need for perfection that is manifested in repetitive behavior. In PD, there is no insight. Also, rituals like hand-washing isn’t prominent.
OCD must have presence of obsessions and compulsions that must be either
- time consuming (> 1h/d) or
- cause clinically significant distress
In OCD, what is an obsession?
-recurrent/persistent thoughts, urges and/or images that are intrusive and unwanted that cause the person anxiety/distress
How does ego defense mechanism apply to OCD?
People are embarassed by their obsessions and try to ignore/suppress these intrusive thoughts/images/urges. However, when they follow thru on these obsessions, they are undoing ego defense mech.
What is a compulsion?
repetitive behavior or activity that the patient performs in response to an obsession or as a set of rules that must be strictly adhered to. A compulsion typically reduces anxiety (e.g. anxiety caused by an obsession).
Are men and women more affected by OCD? Onset of OCD different or the same?
equal incidence
onset for males: 19
onset for females: 22
T/F: OCD anxiety might be the hardest anxiety to treat
True
What’s the first-line psychotherapy for treatment of OCD?
Cognitive-Behavioral Therapy using Exposure and response prevention (ERP) and Acceptance and Commitment Therapy
ERP –> help patient get rid of obsession gradually (for ex: germophobe to touch dirty table and wait longer than usual to use purrell; next time wait even longer, eventually, no purrell)
ACT –> desensitize ppl’s thoughts; they may not be purrelling but might still feel very dirty, anxious, etc.
What’s the first-line pharmacotherapy for OCD?
-SSRI (HIGHER DOSAGE than when treating MDD)
Other options:
- TCA, specifically Clomipramine approved for OCD
- Antipsychotics
NEVER BENZOS
What 3 other conditions will be included in your dx of OCD?
- Tourette’s disorder
- Temporal lobe epilepsy
- Obsessive compulsive personality disorder (OCPD)
