Anxiety/Stress Disorders Flashcards
Define Fear
Response to a real or perceived immediate threat
Define Anxiety
Expectation of future threat, feeling of fear, worry, and uneasiness to an overreaction to a situation that is only subjectively seen as menacing
When does anxiety become a disorder?
When symptoms interfere with a persons daily life or ability to function
Symptoms of Anxiety Disorder
Muscle tension Poor memory Sweaty hands Fear or confusion Constant worry
Causes of Anxiety
Heart disease DM Thyroid problems Asthma Drug use/withdrawal Tumors
Risk Factors for Anxiety
Female Trauma Stress due to illness Personality disorders Depression Blood relative with anxiety disorder Drugs/alcohol
2 Components of Anxiety
Awareness of physiological sensations
Awareness of being nervous or frightened
Emotional Symptoms of Anxiety
Excessive fear & worry Feelings of apprehension Trouble concentrating Feeling tense Anticipating the worse possible outcome
Physical Symptoms of Anxiety
Pounding heart Sweating Stomach ache Frequent urination SOB Muscle twitches Headache Fatigue
Major Neurotransmitters in Anxiety
Norepinephrine: over activation
Serotonin: under activation
Dopamine
GABA
Treatment of Anxiety
CBT
Exposure Therapy
Medication
Alternative Treatment
Desensitization Exposure Therapy for Anxiety
Combines relaxation with a gradual exposure to whatever provokes the anxiety
Flooding Exposure Therapy for Anxiety
Involves intense and prolonged exposure to the feared stimulus
Modeling Exposure Therapy for Anxiety
Involves the witnessing of another handle a feared stimulus without anxiety
Medication Treatment for Anxiety
SSRIs
SNRIs
Benzodiazepines
TCAs
SE of SSRIs
Insomnia
Weight gain
Sexual dysfunction
SE of SNRIs
Upset stomach
Sexual dysfunction
Increase in BP
Insomnia
SE of TCAs
HTN
Urinary retention
Constipation
Alternative Treatment for Anxiety
Stress & relaxation techniques Meditation Yoga Acupuncture Kava: improves mood; OTC or herbal places
3 Categories of Anxiety
Anxiety Disorders
OCD
Trauma & stress-related disorders
Examples of Anxiety Disorders
Separation anxiety disorder Selective mutism Specific phobia Social phobia Panic disorder Agoraphobia GAD
Examples of OCD
OCD Body dysmorphic disorder Hoarding disorder Trichotillomania: pull out & eat hair Excoriation disorder
Examples of Trauma & Stressor-Related Disorders
Reactive attachment disorder Disinhibited social engagement disorder PTSD Acute stress disorder Adjustment disorder
Define PTSD
Debilitating condition that can occur in people who have experienced or witnessed a natural disaster, serious accident, terrorist incident, sudden death of a loved one, war, violent personal assault such as rape, or other life-threatening events
4 Types of Symptoms of PTSD
Re-experiencing symptoms
Avoidance symptoms
Hyperarousal symptoms
Children
Re-experiencing Symptoms
Flashbacks
Bad dreams
Frightening thoughts
Avoidance Symptoms
Staying away from events, places, objects
Feeling emotional numb
Feeling strong guilt, depression, worry
Losing interest in activities
Having trouble remembering the dangerous event
Hyperarousal Symptoms
Being easily startled
Feeling tense
Difficulty sleeping
Having angry outburst
Symptoms in Children
Bedwetting
Forgetting how or being able to talk
Acting out event during playtime
Being unusually clingy
Clinical Presentation of PTSD
T: traumatic event R: re-experience A: avoidance U: unable to function M: month long or more duration of symptoms A: arousal is increased
Diagnosis of PTSD
Symptoms begin within 3 months and last more than a month
At least 1 re-experiencing symptoms, 3 avoidance symptoms, 2 hyperarousal symptoms
Treatment for PTSD
Psychotherapy
Medications
Psychotherapy for PTSD
CBT
Exposure therapy
Cognitive restructuring
Stress inoculation training
Medications for PTSD
1st: SSRI, SNRI
2nd: TCA
Benz’s short term
Define Acute Stress Disorder
Minimum of 3 days & maximum of 4 weeks
Treatment of Acute Stress Disorder
CBT
Benzodiazepines: clonazepam
Define General Anxiety Disorder
Applies to people who are worried or anxious about almost everything
Think things will always go bad
The worrying causes impaired functioning
Epidemiology of General Anxiety Disorder
Average onset: 31 year old
Women > Men
Signs/Symptoms of General Anxiety Disorder
Can't relax Startle easily Have difficulty concentrating Trembling Irritability Sweating Fatigue Headaches Light headedness Hot flashes SOB
Diagnosis of General Anxiety Disorder
Worries excessive about a variety of everyday problems for at least 6 months
GAD-7
Treatment of General Anxiety Disorder
1st: CBT, SSRI, SNRI
2nd: TCAs, Benzo’s
Examples of SSRI for General Anxiety Disorder
Paroxetine
Sertraline
Citalopram
TCA for General Anxiety Disorder
Imipramine
Short Acting Benzodiazepines for General Anxiety Disorder
Alprazolam
Lorazepam
Long Acting Benzodiazepines for General Anxiety Disorder
Diazepam
Flurazepam
Define Panic Disorder
Sudden & repeated attacks of fear that last for several minutes
Define Panic Attacks
Characterized by a fear of disaster or of losing control even when there is no real danger
Epidemiology of Panic Disorder
Women > Men
Late adolescence or early adulthood
Signs/Symptoms of Panic Disorder
Sudden & repeated attacks of fear
Feeling being out of control during a panic attack
Signs/Symptoms During a Panic Attack
Pounding or racing heart Sweating Weakness or dizziness Hot/cold Chest pain Tingling/numb Abdominal pain
Diagnosis of Panic Disorder
Attacks occur any time
Attack will peak in 10 minutes
1/3 of people become housebound
Treatment of Panic Disorder
CBT
Medication
Types of CBT for Panic Disorder
Education Self-monitoring Breathing retraining Muscle relaxation Cognitive restructing Exposure Relapse prevention
Medications for Panic Disorder
1st: SSRIs
2nd: another SSRI or SNRI
3rd: TCAs, Benzodiazepines
Examples of SSRIs for Panic Disorder
Fluoxetine Paroxetine Sertraline Fluvoxamine Citalopram Escitalopram
SNRI for Panic Disorder
Venlafaxine ER
Examples of TCAs for Panic Disorder
Imipramine
Clomipramine
Examples of Benzodiazepines for Panic Disorder
Alprazolam
Clonazepam
Define Agoraphobia
Person feels fear and often avoid places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed
Epidemiology of Agoraphobia
Onset: Men
Risk of Developing Agoraphobia
Tendency to be nervous or anxious
Experiencing stressful life events
Having a blood relative with agoraphobia
Signs/Symptoms of Agoraphobia
Fear of leaving the house
Dependence on others
Fear of being alone
Fear of being in places that would be difficult to escape
Symptoms of a panic attack: helpless, anger, feel like body isn’t real
Treatment of Agoraphobia
CBT: exposure therapy, service animals
Medications: SSRIs, SNRIs, TCAs, benzodiazepines
Define Specific Phobia
Intense fear, anxiety, & avoidance of specific object or situation
Define Social Phobia
Intense fear, anxiety & avoidance of social situations where there is the potential of being scrutinized or negatively judge by others
5 Major Specific Phobias
Animal
Natural environment: storms, heights
Blood-injection-injury
Situational: airplane, elevators, closed spaces
Other: chocking, vomiting, clowns, costume characters (clowns)
Epidemiology of Specific Phobias
Females > Males
Run in families
Appear in adolescence or adulthood
Symptoms of Specific Phobia
Persistent fear that is excessive or unreasonable
Exposure provokes immediate anxiety response
Fear or anxiety is out of proportion to the actual danger posed
Epidemiology of Social Phobias
Women = Men
Onset in childhood or early adolescence
Signs/Symptoms of Social Phobia
Anxious about being with other people
Have hard time talking to other people
Self-conscious & feel embarrassed
Afraid other people with judge them
Treatment of Phobias
CBT
Medications
1st Line Treatment for Specific Phobias
CBT
1st Line Treatment for Social Phobia
Group & individual CBT
Medications for Specific Phobias
2nd: benzodiazepines
3rd: SSRI
Medications for Social Phobias
1st: SSRIs & SNRIs
2nd: benzodiazepines
Performance: beta-blockers
Define Obsessive-Compulsive Disorder
Characterized by intrusive thoughts that produce uneasiness, apprehension, fear or worry (obsessions), repetitive behaviors aimed at reducing the associated anxiety (compulsions), or a combination of obsessions & compulsions
Epidemiology of Obsessive- Compulsive Disorder
Average onset: 19
Men = Women
Define Obsessions
Recurrent & persistent thoughts, impulses, or images that cause distressing emotions such as anxiety or disgust
Define Compulsions
Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession
Treatment of Obsessive-Compulsion Disorder
1st: CBT, SSRI
2nd: TCAs
3rd: SNRI
Examples of SSRIs for Obsessive Compulsive Disorder
Fluoxetine
Sertraline
Paroxetine
TCA for Obsessive Compulsive Disorder
Clomipramine
SNRI for Obsessive Compulsive Disorder
Venlafaxine
Define Anxiety Disorder due to a Medical Condition
Fear & anxiety symptoms are the direct effect of a medical condition
Associated General Medical Conditions that Lead to Anxiety
Endocrine conditions (thyroid) CV conditions Respiratory conditions Metabolic conditions Neurological conditions
Treatment of Anxiety Disorder due to a Medical Condition
Treat the medical condition
Short acting benzodiazepines
SSRIs