Anxiety, OCD, Trauma Flashcards
what are the three D’s of psych disorders?
deviance, discomfort, dysfunction
anxiety disorders must significantly impact at least _____ area of functioning to be considered a disorder
one
what % of Americans 18 yrs and older have anxiety annually
18%
anxiety is a response to what two things
danger or threat
what body response is activated for anxiety?
fight/flight (sympathetic)
most anxiety disorders will present with what symptoms?
physical
what three things can be a comorbid condition with anxiety?
depression, substance abuse, another anxiety disorder
differential diagnoses for anxiety? (4)
1) . substance intoxication (stimulants) /withdrawal (CNS depressants)
2) . Caffeine
3) . Medical conditions (endocrine disorders, cardiovascular problems, arrhythmias)
4) . Psych disorders (depression, mania, obsessive disorders)
psychotherapy options for anxiety? (3)
Cognitive-behavioral
Supportive with problem-solving
Structured relaxation and stress management
psychopharmacology options for anxiety? when is this used?
When symptoms significantly interfere with functioning
1). Antidepressant and antianxiety medications
(SSRIs or Buspirone)
2). Benzodiazepines (limited basis only- addictive and pt develops tolerance)
3). Herbal remedies (passiflora, valerian) – mixed results
five types of anxiety disorders
1) . panic disorder
2) . panic attack
3) . generalized anxiety disorder
4) . phobia (specific phobia)
5) . social anxiety disorder
panic disorders are more common in what sex?
female (2-3x)
what % of primary care patients have a panic disorder?
7%
to be diagnosed with a panic disorder, you need to have what 4 things?
1) . recurrent unexpected panic attacks
2) . at least 1 attack has been followed by 1 month or more of persistent worry about having another attack or significant change in behavior related to attack (avoidance)
3) . not direct effects of substance or medical condition
4) . not better accounted for by another mental disorder
panic attack: abrupt surge of ______ _______, symptoms develop ______ and reach peak within a few ______
intense fear; abruptly; minutes
panic attack: must have at least 4 of what symptoms to develop abruptly
SYMPATHETIC OVERDRIVE:
Palpitations, pounding heart, accelerated heart rate
Sweating
Trembling or shaking
Sensations of shortness of breath or smothering
Feeling of choking
Chest pain or discomfort
Nausea or abdominal distress
Feeling dizzy, unsteady, lightheaded, or faint
Derealization (feelings of unreality) or depersonalization (being detached from oneself)
Fear of losing control or going crazy
Fear of dying
Parasthesias (numbness or tingling sensations)
Chills or hot flushes
what is agoraphobia?
marked fear or anxiety about situation/place where escape might be difficult: Using public transportation Being in open spaces Being in enclosed spaces Standing in line or being in a crowd Being outside of the home alone
7 criteria for agoraphobia
1) . fear or anxiety about a specific situation
2) . individual fears or avoids these situations bc escape might be difficult
3) . situations provoke FEAR or ANXIETY
4) . situations are ACTIVELY avoided
5) . fear or anxiety is OUT OF PROPORTION to actual danger
6) . persistent fear/anxiety, lasts 6 months or more
7) . causes significant distress or impairment in functioning
how can panic attacks be debilitating?
the person usually stops going to the place where attacks occur or avoid anything associated with the attack
prevalence and more frequent gender for generalized anxiety disorder (GAD)
3 percent and 2/3 female
generalized anxiety disorder: ______ comorbidity with other psychiatric disorders
high
GAD age of onset
about 20
GAD: patient worries about what two things?
rational AND irrational things
GAD criteria (6)
1) excessive anxiety and worry occurring more days than not for at least SIX months, VARYING ASPECTS of life
2) . out of proportion to event
3) . anxiety and worry associated with three or more of the following
- restlessness
- being easily fatigued
- difficulty concentrating
- irritability
- muscle tension
- sleep disturbance
4) . NOT episodic NOR situational
5) . cause significant impairment in functioning
6) . disturbance not due to direct effects of a substance or general medical condition
treatment of GAD (therapy and meds)
1) . psychotherapy- supportive, cognitive behavioral, biofeedback and relaxation
2) . SSRIs- FIRST LINE (paroxetine, venlafaxine, escitalopram); can add buspirone
what is the hallmark symptom of GAD?
excessive anxiety about many events including those that are unrealistic
phobias: most _________ but ________ disabling psychological disorder
common; least
specific phobia: gender prevalence and tends to run in __________
females are twice as likely to have it; runs in families
social phobia: gender prevalence and some evidence of ________ factors
more common among women; genetic
specific phobia is the only psych disorder that can be _______
cured
specific phobia criteria (6)
1) . persistent fear or anxiety about a specific object or situation FOR AT LEAST 6 MONTHS
2) . exposure to the phobic situation provokes immediate fear/anxiety
3) . phobic situation is avoided or endured with intense anxiety
4) . fear or anxiety is out of proportion to the actual danger
5) . causes impairment in functioning
6) . not due to substance use or other medical condition
social phobia criteria (6)
1) . persistent fear or anxiety about one or more social situations in which person is exposed to possible scrutiny by others FOR AT LEAST 6 MONTHS
2) . fear of showing anxiety symptoms that will be negatively evaluated
3) . social situations are avoided or endured with intense anxiety
4) . fear or anxiety is out of proportion to actual threat
5) . causes impairment in functioning
6) . not due to another substance
treatment for specific phobias (therapy and meds)
therapy- exposure and desensitization therapy tx of choice for specific phobias
meds- short term benzos or BBs for some pts
a). paroxetine for social phobia
b). BB’s for performance situations
c). benzos for infrequent events
are phobias are always caused by a negative prior experience with the feared object?
no
what are the five obsessive-compulsive related disorders?
1) . obsessive compulsive disorder
2) . body dysmorphic disorder
3) . Hoarding disorder
4) . trichotillomania
5) . Excoriation
Obsessive-Compulsive and Related Disorders: common pattern of ___________ or driven ________ behaviors
compulsive; repetitive
obsessive-compulsive DO: average age of onset and 3 comorbid conditions
20 yo, early adulthood
-eating DOs, anxiety DOs, depression
what is a rumination? it occurs frequently in what psych condition?
persistent thought in a patient’s mind that they can’t get rid of; depression
obsessions are defined by what three things?
1) . Recurrent and persistent thoughts, urges, or images that are intrusive/unwanted **cause marked anxiety or distress
2) . The person attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e. by performing a compulsion)
3) . usually EGO-DYSTONIC: inconsistent with one’s own personal beliefs
compulsions are defined by what three things?
1) . repetitive behaviors that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly
2) . the behaviors or mental acts are aimed at preventing or reducing distress or anxiety, or preventing some dreaded event or situation (but not connected in a realistic way)
3) . Cause distress, impairment in functioning or time consuming
three criteria of OC disorder
1) . presence of either obsessions or compulsions or both
2) . impairment in functioning
3) . not due to effects of a substance or other medical condition
management of OCD (therapy and meds)
1) . FIRST LINE = Cognitive behavioral psychotherapy (exposure with response prevention)
2) . meds- SSRIs (sertraline) and clomipramine (TCA)
OC disorder: rates of full remission after therapy & meds ___-____%
6-43%
what is body dysmorphic disorder?
preoccupied with imagined or exaggerated physical defect in appearance AND becomes obsessed with perceived defect
body dysmorphic disorder criteria (4)
1) . Preoccupation with AT LEAST ONE or more perceived defects or flaws in physical appearance that are not observable
2) . causes person to be ashamed or feel self-conscious = leading to functional impairment
3) . the individual has performed repetitive behaviors or mental acts in response to the appearance concerns (i.e. mirror checking, excessive grooming, skin picking)
4) . Not better explained by concerns with body fat or weight in an individual whose symptoms meet dx criteria for an eating disorder
treatment of BDD
SSRIs and/or CBT
1) . CBT: exposure with response prevention and cognitive restructuring
2) . SSRIs and clomipramine
what treatment should be discouraged in BDD?
surgical and cosmetic tx bc patient is rarely satisfied with the results and keeps undergoing surgery
hoarding disorder criteria (4)
1) . persistent difficulty discarding or parting with possessions (regardless of value)
2) . difficulty is due to a perceived need to save the items
3) . results in accumulation of possessions that clutter living areas
4) . causes impairment in functioning
treatment of hoarding disorder
CBT: helping change the maladaptive beliefs about the need to retain possessions
HARD TO TX
little data on med use
what is trichotillomania? what is it used as a coping response for?
Recurrent pulling out of one’s hair, resulting in hair loss, with repeated attempts to stop; coping response to deal with stress or anxiety
what is the first line tx of trichotillomania?
habit reversal therapy: self-monitoring, awareness training, stimulus control, counter-conditioning
what is excoriation? treatment?
compulsive or repetitive picking of the skin, resulting in skin lesions or sores that don’t heal; repeated attempts to stop; tx is behavioral therapy
what are the five trauma and stressor related disorders? (2 peds)
pediatrics:
1) . reactive attachment disorder
2) . disinhibited social engagement disorder
3) . PTSD
4) . acute stress disorder
5) . adjustment disorder
what is important about the onset of trauma and stressor related disorders?
the patient must have an event to cause/trigger these disorders
PTSD has high comorbidity with what three disorders?
depression, substance abuse, panic disorder
PTSD: has to inflict feeling of ___________ in a person
helplessness
PTSD criteria (8)
1) . traumatic event: exposure to actual threat or threatened death, sexual violence
- experienced it
- witnessed it in person on others
- learned that it occurred to close family member or friend
- experienced repeated exposure to aversive details of the event
2) . presence of 1 or more intrusion symptom
- distressing memories
- distressing dreams
- dissociative reactions (if the event were recurring)
- intense psychological distress
- physiological reactivity on exposure to something that resembles an aspect of the event
3) . persistent avoidance of stimuli by 1 or both
- avoidance of distressing memories, thoughts, or feelings about the event
- avoidance of external reminders (people, places, activities)
4) . negative alterations in cognition and mood (2 or more)
- psychogenic amnesia
- persistent negative beliefs about oneself, others, world
- distorted cognitions that blame oneself or others
- persistent negative emotional state
- diminished interest
- feelings of detachment or estrangement from others
- persistent inability to experience positive emotions
5) . alterations in arousal and reactivity (hyperarousal), 2 or more
- irritable behavior and angry
- reckless or self destructive behavior
- hypervigilance
- startle response
- problems with concentration
- sleep disturbance
6) . duration is MORE THAN ONE MONTH
7) . significant impairment in functioning
8) . not attributable to effects of a substance or other medical condition
what is a flashback?
similar to a hallucination but specific ONLY to PTSD
what is psychogenic amnesia?
inability to remember an important aspect of the trauma
Management of PTSD (therapy, meds)
1) . multidisciplinary team- psychotherapist, psychiatrist, substance abuse counselor, peer groups, family therapy
2) . Meds- SSRIs first line, trazodone maybe for insomnia, prazosin for nightmares
3) . Cognitive behavioral treatment- prolonged exposure therapy, coping strategies
what is acute stress disorder?
same symptoms as PTSD (need 9 of them) but traumatic event occurred LESS THAN ONE MONTH AGO and symptoms resolve within THOSE 4 WEEKS, lasting AT LEAST THREE DAYS (if symptoms last longer than one month, then PTSD diagnosis is given)
how to treat acute stress DO
counseling and psychotherapy first line
tx for agoraphobia?
CBT and SSRIs
tx for panic disorder
SSRIs- first line
**may start with benzos too and taper benzos once SSRIs effective
CBT + Meds = IDEAL
how to treat acute panic attacks
BENZOs (Xanax or klonopin)
*watch for dependence
treatment for social anxiety disorder
psychotherapy FIRST LINE (CBT- desensitization)
SSRIs- fluoxetine, sertraline
**meds and psychotherapy
4 major patterns of OCD
1) . contamination: compulsion may include hand washing or cleaning
2) . pathologic doubt: forgetting to unplug iron to avoid potential danger
3) . symmetry/precision: ordering or counting
4) . intrusive obsessive thoughts without compulsions
