Anxiety/Stress Disoders Flashcards
Define:
Fear
Anxiety
Fear: a response to a real or preceived immediate threat
Anxiety: expectation of future threat, feeling of fear, worry, and uneasiness to an overreaction to a situation that is only subjectively seen as menacing.
*under-activation of serotonin and over-activation of NE
Anxiety
- when does this become a problem?
- sx
- causes
- risk factors
- experiencing anxiety has what 2 components?
becomes a disorder when sx interfere with a persons daily life or ability to function
Sx:
- muscle tension
- poor memory
- sweaty hands
- fear or confusion
- constant worry
- feeling tense
- trouble concentrating
- palpitations
- upset stomach
- frequent urination
- SOB
Cause:
- heart disease
- diabetes
- thyroid problems
Risk factors:
- being female
- trauma
- stress d/t illness
Components:
- awareness of physiological sensations (sweating and palpitations)
- awareness of being nervous or frightened
Anxiety:
-tx
-CBT
- Exposure therapy:
- -desensitization: combines relaxation with gradual exposure to whatever provokes the anxiety
- -flooding: involves intense and prolonged exposure to the feared stimulus
- -modeling: involves the witnessing of another handle and feared stimulus without anxiety
-Meds: SSRI, SNRI, Benzo, TCA
- alternatives:
- -meditation, yoga, acupuncture, kava
What are the 3 categories of anxiety disorders? what disorders encompass each category
Anxiety Disorders: separation anxiety disorder, specific phobia, social phobia, panic disorder, agoraphobia, and generalized anxiety disorder.
Obsessive-Compulsive Disorder: hoarding, trichotillomania, excoriation
Trauma and Stressor-related disorders: PTSD, disinhibited social engagement disorder, acute stress disorder.
PTSD:
- what is this?
- sx
- what does TRAUMA stand for?
debilitating condition that can occur in people who have experienced or witnessed a natural disaster, serious accident, terrorist incident, sudden death or a loved one, war, violent personal assault such as rape.
Sx:
- intrusive thoughts, nightmares or flashbacks of the event.
- social, occupational, and personal dysfunction.
- anhedonia
- emotionally numb
- guilt, depression, worry
- hyperarousal sx:
- -easily startled, tense, diff sleeping, angry outburst
- -in children, enuresis, forgetting how to talk, unusually clingy
TRAUMA:
- Traumatic event
- re-experience
- avoidance
- unable to function
- month long or more duration of sx
- arousal is increased
PTSD
- dx
- Tx
Dx:
- sx begin within 3mo of incident and last more than 1 mo.
- must have ALL of the following for at least 1mo:
- -one re-experiencing sx
- -3 avoidance sx
- -two hyperarousal sx
Tx:
-Psychotherapy(CBT) monotherapy or in combo w/ meds.
meds = SSRI, SNRI
*may use benzo short term until SSRI kicks in.
Acute Distress DIsorder:
- what is this?
- tx
What: PTSD on a short vacation. Lasts minimum of 3 days and a maximum of 4wks. Must occur within 4 wks of the traumatic event.
Tx:
- CBT
- Benzos (Clonazepam)
General Anxiety Disorder:
- what is this?
- sx
- dx
- Tx
What: worried or anxious about almost everything, think things will always go badly. WOrrying causes impaired functioning.
Sx:
- cant relax
- startle easily
- have diff concentrating
- trembling
- irritability
- sweating
- fatigue, HA, nausea, lightheadedness, SOB, hot flashes
Dx:
- GAD -7; scoring:
- -5-9 = mild anxiety
- -10-14 = moderate anxiety
- -15-21 = sever anxiety
Tx: First line = Combo/Mono -Psychotherapy (CBT) -SSRI (paroxetine, sertraline, citalopram -SNRI (alternative to SSRI)
Second line:
- TCA (imipramine)
- Benzos
Panic Disorder
- characterized by?
- signs and sx
- dx
- Tx
Characterized by sudden and repeated attacks of fear that last for several minutes, fear of disaster or of losing control even when there is no real danger.
Signs and sx:
- sudden and repeated attacks of fear
- feeling of being out of control during a panic attack
- pounding or racing heart
- sweating
- weakness/dizziness
Dx:
-interferes with daily tasks. 1/3 of people become housebound of are able to confront a feared situation only with a spouse or trusted person.
Tx:
- CBT
- Meds:
- -SSRI first line (Fluoxetine/Prozac, Paroxetine/paxil, Escitalopram/lexapro, Citalopram/celexa, Sertraline/zoloft)
–SNRI second line (Effexor/Venlafaxine)
–TCA (impiramine & Clomipramine) or Benzos are 3rd line
Agoraphobia
- what is this?
- examples
- signs and sx
- Tx
What: feels fear and often avoid place or situations that might cause you to panic and make you feel trapped, helpless, or embarrassed
Examples: fear of an actual anticipated situation:
- use of public transport
- open or closed spaces
- standing in line or being in a crowd
Signs and sx:
- fear of leaving the house
- dependence on others
- fear of being alone
- fear of being in places that would be difficult to escape
- sx of panic attack
Tx:
- CBT
- Meds (SSRI, SNRI, TCA, Benzo)
Specific Phobia:
- what are the 5 most common?
- signs and sx
Social Phobia
- what is this?
- signs and sx
Tx of both social and specific phobia
Specific phobia;
- 5MC types:
- -Animal
- -Natural Environment (heights, storms, water)
- -BLood-injection-injury
- -Situational (airplanes, elevators)
- -Other (loud sounds, costume characters, etc)
SIgns and Sx:
- persistent fear that is excessive or unreasonable
- exposure to the phobia provokes immediate anxiety response
- fear and anxiety is out of proportion to the actual danger posed
Social phobia:
-what: intense fear, anxiety, and avoidance of social situations where there is potential of being scruitinized or negatively judged by others.
- signs and sx:
- -anxious about being with other people and have hard time talking to them
- self-conscious and embarrassed
- afraid other people will judge them (blush, sweat, and nausea)
Tx:
- Specific phobias = CBT is 1st line
- Social phobias = CBT (mono or combo w/ meds)
Meds:
- Specific phobias:
- -BEnzos (2nd line)
- -SSRI (3rd line)
- Social phobia:
- -SSRI and SNRI (combo/mono 1st line)
- -Beta-blocker (performance anxiety)
- -benzos (2nd line)
Obsessive Compulsive Disorder:
- what is this?
- Tx
What; intrusive thoughts that produce uneasiness, apprehension, fear or worry (obsession), repetitive behaviors the person feels driven to perform aimed at reducing the associated anxiety (compulsions) or a combination of such obsessions and compulsions.
Tx:
- CBT 1st line
- MEds:
- -SSRI: alternative 1st line
- -TCA 2nd line
- -SNRI (venlafaxine 3rd line)
Anxiety Disorder d/t a medical condition
- what is this?
- dx
- examples
- Tx
WHat: fear and anxiety sx are the direct effect of a medical condition.
Dx:
-careful and thorough medical evaluation must be done to determine the presence of the medical condition that leads to the anxiety
Examples:
- endocrine conditions (pheochromocytoma, hyper/hypothyroidism)
- CV conditions
- Resp conditions
- Metabolic conditions (Vit B12 deficiency)
- Neurological conditions
Tx:
- treat the medical condition
- short acting BENZO until SSRI begins working.
