Anxiety, OCD, trauma Flashcards
What are some examples of anxiety disorders
Panic disorder
Social anxiety disorder
specific phobia
agoraphobia
generalized anxiety
What disorders do panic attacks occur with
Panic disorder
What symptoms will someone have with a panic attack
Tachycardia
diaphoresis
trembling/shaking
What is the average age of onset for a panic disorder
20-30
What biologically happens in those with a panic disorder
autonomic hyperactivity
heritability
heightened sensitivity for somatic symptoms
What is Locus coeruleus and what is its role
alertness
primary source of Norepi
What is the main DSM-5 criteria for panic disorders
Recurrent unexpected panic attacks
What is Agoraphobia
Fear of leaving the home
What are some treatments for panic disorders
Antidepressants
Benzos
CBT
How long should antidepressants be continued with panic disorders
1-2 years after resolution of symptoms to decrease chance of relapse
What are some first line SSRIs for panic disorders
Paroxetine (not with pregnancy)
Fluoxetine
citalopram
escitalopram
sertraline
What benzos can be used for panic disorders
Alprazolam*
Clonazepam
diazepam
lorazepam
What is the most common anxiety disorder
Phobia
Which gender is more effected by phobias
females
*often run in families
What is the difference between phobias in adolescents vs early adulthood
Before age 12 = specific phobia
Before age 25 = social anxiety disorder
What is a phobia
An irruption fear of specific object / situation / place
What are the three main types of phobias
Specific phobia
social phobia
Agoraphobia
What are some phobia specifiers
Animal
Natural environment
Blood - injection - injury
situational
other
What are some DSM 5 criteria for social anxiety disorder
Social situations related to possible scrutiny
individual fear of embarrassment/humiliations for their actions
not related to medical condition or substance use
What are some DSM 5 criteria for agoraphobia
Individual fears they may not be able to escape or help is unavailable
What are some treatment options for phobias
Desensitization
flooding (rapid / intense exposure)
CBT
Meds
What is the preferred first line pharmacological treatment for phobias
SSRIs
-paroxetine
fluoxetine
sertraline
What would you give someone who does not get relief from SSRIs
MAOIs
Benzos
What can you give someone who has performance anxiety
propanolol
What ethnicity has higher risk for generalized anxiety disorder
African Americans
What is generalized anxiety characterized by
Overwhelming worry
What is one of the main DSM 5 criteria for GAD
Excessive anxiety and worry for >6 months
involves 1 or more areas of life
What is the treatment for GAD
Control symptoms
-CBT
-Meds (antidepressants / anxiolytics)
What is a long acting anxiolytic that can be used for GAD
Buspirone
When does OCD generally present
Usually early teens -20s and generally before age 30
What abnormalities are seen in the brain with OCD
Abnormalities in the basal ganglia and prefrontal cortex
What characteristics are seen with obsessions
Recurrent / intrusive thoughts
cause significant distress
Follow common themes around the world
What are some common obsessions
Germs/contamination
doubting
orderliness
sexual thoughts
somatic
concern about hurting self / others
What are characteristics of compulsions
repetitive intentional behaviors
aimed at relieving obsession
cause significant distress
rigid behavior
What are some common compulsions
hand washing / cleaning
double checking
counting
seeking / demanding reassurance
organizing
following strict routine
What are some DSM 5 writers for OCD
Presence of obsession, compulsion, or both
obsessions / compulsions are time consuming
Not due to substance
What are specifiers of OCD
Good insight
poor insight
absent insight / delusional belief
Tic-related
What is body dysmorphic disorder often associated with
Social phobia
major depression
suicide
What is body dysmorphic disorder generally associated with
Social phobia
major depression
suicide
What is body dysmorphia characterized by
preoccupation with perceived physical flaw
Significant associated embarrassment
appears excessive to those around patient
Often involves facial characteristic
What are common symptoms with body dysmorphia
Compulsive mirror checking
compulsive grooming
comparing to others
soliciting reassurance
What are some DSM 5 criteria for body dysmorphia
Preoccupation with 1+ physical flaw
Preoccupation causes significant distress
no better explained by another disorder (eating disorder)
What are some specifiers for body dysmorphia
good or fair insight
poor insight
absent insight / delusional beliefs
What are some treatment for body dysmorphia
CBT
SSRI
Surgical intervention *NOT RECOMMENDED
What is trichotillomania
Hair pulling disorder
-will sometimes chew and swallow pulled out hair
-Females»_space; males
What are some DSM 5 for trichotillomania
Recurrent hair pulling leading to hair loss
Repeated attempts to quit
no attributable medical condition
**diagnosis of exclusion
What is the treatment for trichotillomania
Habit reversal (Conditioning / barrier)
CBT
Medications (SSRI / TCA)
What are some DSM 5 criteria for hoarding
difficulty getting rid of possessions regardless of value
Associated perceived need to save items
significant distress when getting rid of items
accumulation of stuff impacts living environment
What is some treatment for hoarding
CBT
SSRI
Enlisting personal organizers
What are some stressor related disorders
PTSD
Adjustment disorder
What can trigger an adjustment disorder
Relationship trouble
Health trouble
Financial trouble
Who is at highest risk for adjustment disorders
Single women in their 20s
What are some DSM 5 criteria of Adjustment disorder
Symptoms generally begin within 3 months of stressor onset
NOT part of normal berievment
symptoms resolve within 6 months
What are some specifiers of adjustment disorder
Depressed mood
anxiety
disturbance of conduct (more in kids)
What is the treatment for adjustment disorder
Mainstay is psychotherapy
*can have medication for symptomatic treatment
What are the risk factors for PTSD
Age
History of psych illness
Level of social support
Severity & duration of stressor
Low SES
Family hx of depression
What are some events known to lead to PTSD
Domestic violence
Major incidents
Military
Sexual assault
childhood abuse / neglect
Mass casualty
being threatened w/ weapon
burglary / muggings
events around death of a loved one
What is the etiology of PTSD
Disruption of neurotransmitters (NE/5HT/DA)
other psych disruptions
endocrine dysfunction
What are some characteristics of PTSD
Exposure to significant event that is not part of average human experience
Reliving trauma
emotional changes
hyper-reactivity
What are some DSM 5 criteria of PTSD
Exposure to actual/threatened death, injury, sexual violence
1+ recurrent associated symptoms
Negative changes in cognition and mood
Symptoms for longer than a month
What are some specifiers of PTSD
Dissociative symptoms (depersonalization, derealization)
delayed expression
What is some PTSD treatment
Psychotherapy
medications (SSRI first line)
-prazosin for nightmares
-Benzos for acute anxiety
What is dissociation
response to significant stress
unconscious defense mechanism
What is depersonalization
feeling as though youre looking at yourself from the outside
Feeling like youre living a dream
Feeling like youre not in control of yourself
What is derealization
Feeling disconnected from your environment
feeling completely emotionally cut off
seeing your surrounding differently
distorted perception of time
What is dissociative amnesia
Most common dissociative disorder
patient unable to recall specific memories (usually traumatic)
Symptoms terminate abruptly
*women effected more than men
What is dissociate fugue
Subtype of dissociative amnesia
inability to recall ones past
know what happened pre and post fugue but don’t know what happened during fugue
