Anxiety + Trauma-Related Disorders Flashcards
Anxiety Disorder List
- Generalized Anxiety Disorder
- Panic Disorder
- Agoraphobia
- Simple Phobia
- Social Phobia
- PTSD
- OCD (trochotillomania, hoarding, body dysmorphia
- anxiety 2ndary to GMC/Substance
- Separation anxiety
- Readiness to take defensive action
- Hardwired response to theat/acute stress (MOA NTs, in CNS/PNS)
- conditioned learning
S/s?
Paroxysmal anxiety
Cognitive element
- Anticipatory anxiety (fear of fear),
- misinterpretation of body sensations
- belief = avoidance is protective
Panic disorder
Cognitive Elements
- negative social expectations
- Distorted interpretations of others’ responses (fear of judgment)
- belief that avoidance is protective
Social phobia
Cognitive elements
- contents of memory
- belief self unable to withstand
- overestimation of risk
- repition of traumatic experiences
PTSD
Physiological base anxiety
Stress = HPA cortisol NEG FEEDBACK SHUT DOWN
Fight or flight = locus ceruleus (NE), medial raphe (5-HT=Serotonin)
- bladder inhibition = pee self
- HR up
- –>BODY MISINTERPRETS PHYSICAL S/S = self-feeds
Central NTs (gaba glutamate)
Stress response pathway
*Hypothalamus –> Anterior Pituitary –> Adrenal Cortex
Shallow breathing effect
Low CO2, trigger chemoreceptor response –> anxiety
TX: DEEP CONTROLLED BREATHING
Behavioral aspect
Agoraphobia
Panic disorder
Behavioral aspect
Avoiding social situations
Social phobia
Behavioral Aspect
- Avoid internal cues (numbing/forgetting)
- Avoid situations resembling trauma
- Using Substance to avoid feelings
PTSD
Behavioral aspect
*avoiding trigger, regardless of intellectual reasoning ability
Simple phobia
Connected anxiety circle
*Threat
*anticipation/prediction
*Arousal
*Avoidance (rewarding)
*Risk factors (genetic, sensitizing experience)
THEN START AGAIN
Avoidance
what promotes?
Leads to?
Reward promotes
Leads to MORE DYSFUNCTION
Anxiety Tx
- Benzo
- ADD
- other serotonin agents : Buspar
- Anticonvulsant/Atypical Antipsycs
- Cognitive Behavioral therapies (exposure, systematic desensitization, flooding)
Other causes of Anxiety
Meds
- Amphetamines
- Thyroid- Synthroid
- Steroids - prednisone
Choosing Benzos for acute treatment
- INTERMEDIATE T1/2 - LESS ABUSE
- ANTICIPATORY WORRY for KNOWN TRIGGER EVENT - even just relief of thought of having dose nearby
*Clonazepam
PUTS OUT FIRE, DOESN’T TURN DOWN GENERATOR
Long term Pharm Tx - anxiety
*SSRI
TURN DOWN GENERATOR
Psychotherapeutic Tx - Anxiety disorder
(Don’t know trigger)
- Breathing exercises
- Mindfullness (name sensations of item in hand)
- Muscle release/tension exercises
Behavioral Tx
Work on not avoiding
Social phobia
possible Tx
Propranolol
Simple phobia
Tx
- Systematic desensitization
- Deep breathing/Mindfulness
Not much pharm - Benzo for specific trigger events
OCD
Tx
SSRI
(High-dose)
*CBT = Exposure/response Therapy (do thing they try to avoid, stop compulsive behavior)
- Disordered Sleep
- Muscle pain
- Worry
- (others!)
Min 3 needed to Dx:
Generalized Anxiety Disorder
Generalized Anxiety Disorder
Tx
Rx: SSRI
*CBT = Cognitive distortions (about Diabetic)
*Fear of body symptom/sensation
*Panic
*Agoraphobia
Before 30 y/o
Panic Disorder
*Fear of scrutiny/humilation
*Panic, blushing, tremor
*social isolation
Before 25
Social phobia
Anxiety in childhood?
Less common
*fear of natural environment, blood, idiosyncratic
*Panic
*Avoidance of stimulus
Before 12 y/o
Simple Phobia
*Memory of trauma, related strong unpleasant emotion
*Panic, Tonic, Persistent tension
*Dissociation / Amnesia
All Ages
ASD/PTSD
- Fear over money, health, safety, failure
- Tonic, persistent tension, H/A, insomnia
- General constriction of life
*GAD
- Obsession - contamination, fear of offending/sex/violence
- Panic, intense distress if cannot nullify
- compulsive behavior
OCD
3+ *Distress w/ separation from attachment *Worry about losing attachment *fear of being alone *repeated nightmares about separation *refusal to sleep away from attachment *Physical symptoms w/ separation Kids = 4 weeks+ Adults = 6 months +
Separation Anxiety Disorder
- Palpitations
- Sweating
- Shaking
- SOB
- Choking
- chest pain
- discomfort
- Nausea/ GI pain
- chills
- Derealization/dying fear
+ 1 month worrying about attacks
AND/OR +behavior mod (avoidance)
Panic disorder
Depression w/ anxiety
Classification
If anxiety = clinical issue,
Becomes GAD comorbidity
*Exposure to actual death threat/serious injury
*intrusion s/s involving event (worries, nightmares, flashbacks, triggers)
*Avoidance
*negative s/s + pessimistic interpretation
*Hypervigilance, arousal
*not due to substance
1+ months
PTSD
- w/ dissociative s/s? (Depersonalization/derealization
- w/ delayed expression? (6 months after event dx
*developmentally inappropriate excessive fear of separation w/ physical s/s
*4+ weeks in child
6+ months in adult
Separation anxiety
- Women>more
- Isolated, irrational fear
- > 6 months
- onset age 12, resolve in adulthood
Specific phobia
- humiliation or embarassment in social settings
- > 6 months
- women>men
Social anxiety disorder
- Fear/avoidance of places or situations that are difficult to escape in the event of panic attack
- > 6 months
- Women>men
- occurs as consequences of panic d/o
Agorophobia
- attack = abrupt surge of intense fear/ discomfort w/ 4 of 12 symptoms
- disorder = 1 attack followed by maladaptive change in behavior w/ persistent worry
- > 1 month
- possible ER = chest pain
- onset = mid 20s
Panic d/o
- excessive worry about life circumstances
- 3 of 6 s/s
- intermittent >6 months
- Women>men
- Blacks>
- <30 y/o
- FH
Generalized Anxiety Disorder
- > 1 month
- Reexperiencing trauma in dreams
- avoidance of associated stimuli
- Negative mood
- outbursts
- subtype : dissociative + delayed expression (>6 months after trauma)
- post-rape, post-combat
PTSD
- precursor to PTSD
* >3 days to <1 month
Acute stress d/o
- develop clinically significant emotional or behavioral sx in response to non-life threatening stressor (divorce, etc)
- <3 months onset, 6 month termination
- Women, unmarried, young
Adjustment d/o
Agoraphobia Tx
SSRI + exposure therapy
Adjustment D/o
Tx
- therapy
* Rx for symptoms (insomnia, anxiety)
