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)
What’s the most common thing that could cause PTSD? What’s the actual most likely thing to cause PTSD?
most common thing that could cause PTSD is death of a loved one but what’s most likely to cause PTSD is assault.
What’s the assoc btw fracture in a car crash and likelihood of PTSD?
abt 15% of ppl get PTSD
What are the 3 greatest variables associated with PTSD?
- proximity (e..g closer to grenade, more likely to exp PTSD)
- harm by another human (assault vs hurricane)
- repetition (more grenades)
PTSD is caused by exposure to actual or threatened traumatic event that causes symptoms for at least a month. What are 4 modes of exposure?
- directly experiencing events
- witnessing
- learning that a family member or a friend experienced it
- directly experiencing repeated/extreme exposure to horrific details of an event
Briefly state the PTSD criterion A-E
A) exposure to death, serious injury, or sexual violence
B) at least one intrusion symptoms associated with event, such as reliving of events, distressing dreams/nightmares, flashblacks –> unawareness of surroundings, psychological distress
C) Avoidance of stimuli assoc w/ traumatic events
D) Negative changes in cognition and mood associated with the event (e.g. dissociative amnesia or repression, anhedonia, inability to exp positive emotions, too high expectations of oneself, others or world)
E) alterations in arousal/reactivity (e.g hypervigilance, exaggerated startle response)
What is acute stress disorder and how is it different from PTSD?
Acute stress disorder is similar to PTSD except symptoms are experienced only for 3 days - 1 month whereas PTSD is when symptoms are present for at least a month. Therefore, it’s a precursor to PTSD
Do men or women have higher prevalences of PTSD?
women
What’s the psychotherapy treatment for PTSD?
Follow model of crisis intervention:
- initial support, grounding, validation of feelings
- CBT, eye-movement desensitization and reprocessing (EMDR)
- psychodynamic, psychotherapy, support groups and family therapy
What can you give pts who are having nightmares due to PTSD?
prazosin (a1 receptor antagonist)
Whats the first line pharmacotherapy for PTSD?
- SSRIs
- TCAs (amitryptiyline & imipramine)
- Maoi, trazodone, anticonvulsants, clonidine, propanolol.
Listed are some obsessions, state their assoc compulsion: contamination symmetry, precision sexuality, aggressiveness doubts discarding something valuable
contamination -washing hands, cleaning house
symmetry, precision -arranging, organizing, cataloging
sexuality, aggressiveness -praying
doubts -checking (lock, gas jets)
discarding something valuable -hoarding
What’s an adjustment disorder?
emotional symptoms that cause social, school or work impairment occurring w/in 3 months and lasting less than 6 months after the stressor is terminated
What are risk factors that increase the duration of PTSD?
- alcohol abuse
- childhood trauma
What’s the emergency treatment for panic disorder? What about long-term treatment?
emergency –> fast-acting benzos
long-term –> SSRI
Why is buspirone a better long-term pharmacotherapy for GAD than benzos?
buspirone is a non-benzo anti-anxiety med that has low abuse potential, making it a useful long-term maintenance therapy for pts with chronic anxiety like GAD
