Anxiety ii Flashcards
DSM-V definition of OCD
A: the presence of obsessions and compulsions.
B: these obsessions and compulsions must be either time consuming, cause siginificant distress, are not substance induced, and not better explained as symptoms of something else
what is an obsession?
recurrent/persistent thoughts, urges, or images. Intrusive and unwanted: sometimes called ego dystonic. cause person anxiety and stress. Patient trues to ignore/suppress these thoughts or try to neutrualize them (undoing ego defense mechanism)
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 undoes or reduces anxiety. stopping compulsion often increases anxiety
comorbidities to OCD
1/3 have major depression. up to 2/3rds of people with tourette’s syndrome are diagnosed with OCD. suicide risk is high
treatment for OCD (therapy)
CBT: as effective as pharm therapy, with longer lasting effects. exposure and response prevention. Acceptance and commitment therapy for obsessions.
treatment for OCD (pharm)
1st line: SSRIs ( need higher dose than for MDD)
2nd line: clomipramine (a TCA) (high side effects)
3rd line: antipsychotics, other antidepressants
benzodiazepine sedatives dont work.
differential diagnoses for OCD
tourette’s disorder. temporal lobe epilepsy. OCD personality disorder. these people generally have insight into their behavior.
DSM-V criterion A of PTSD
exposure to actual or threatened traumatic event. must have symptoms for more than 1 month. must cause significant distress/impairment. symptoms must not be the result of a substance or other medical condition.
Modes of exposure in PTSD
directly experiencing events, witnessing events happening to others, learning that a family member/friend experienced such an event, directly experiencing repeated/extreme exposure to horrific details of an event
DSM-V criterion B of PTSD
> 1 intrusion symptom associated with the event. reliving of events. distressing memories or nightmares/dreams of the event. dissociate reactions during which the patient feels and/or acts as if the events are recurring. psychological distress from exposure to internal or external cues that resemble the event. psychological reactions to external cues
DSM-V criterion C of PTSD
avoidance of stimuli associated with the traumatic events. avoid memories/thoughts/feelings. avoid external reminders that may arouse memories. avoid interpersonal connectivity
DSM-V criterion D of PTSD
negative changes in cognition and mood associated with the event. >2 of the following: inability to remember important part of event due to dissociative amnesia or repression. persistent exaggerated beliefs/expectations of oneself, others , the world. distortion of thoughts and memories of the event, causing self blame. negative emotional state, decreased interest in daily activities. feeling of detachment. inability to experience positive emotions
DSM-V criterion E of PTSD
alterations in arousal/reactivity. >2 of the following: irritable behavior/angry outbursts, expressed as verbal or physical aggression towards others. reckless behavior. hypervigilance. exaggerated startle response. problems with concentration, sleep disturbances
Acute stress disorder
criteria B-D must persist for 3 days to 1 month after exposure. a precursor to PTSD. best time to treat!
co-morbidities of PTSD/ASD
depressive disorders, substance related disorders, other anxiety disorders, bipolar disorders, personality disorders.
treatment of PTSD (therapy)
follow model of crisis intervention. initial support, grounding, validation of feelings. seal over and move on.
treatment of PTSD (drugz)
1st line: SSRIs
2nd line: TCAs, atypical antipsychotics
3rd line: MAOi, trazodone, anticonvulsants, clonidine, propanolol.
prazosin for nightmares
