B7-076 Anxiety Disorders Flashcards
differentiate PTSD and acute stress disorder
PTSD: duration greater than 1 month
acute stress disorder: duration less than one month
symptoms of PTSD
Hyperarousal
Avoidance of associated stimuli
Re-experiencing
Distress
PTSD is HARD
experiencing, witnessing, or discovering that a loved one has experienced a life threatening situation
PTSD
recurrent intrusive thoughts or sensations
obsessions
repetitive, often time-consuming actions that may relieve stress
compulsions
obsessions in OCD are recognized are […] by the individual
irrational
(separates it from OCPD, in which actions are rationalized)
recurrent panic attacks involving intense fear and discomfort without a clear trigger
panic disorder
attacks in panic disorder typically peak in […] minutes
10
how many symptoms are needed during an attack to diagnose panic disorder?
4 or more
(palpitations, derealization, paresthesias, abdominal distress, intense fear of dying/losing control, lightheadedness, chest pain, chills, sweating, etc)
differentiate panic disorder and PTSD
PTSD occurs due to a clear trigger
panic disorder does not have a clear trigger
panic disorder patients can develop […] due to fear of recurrent attacks
agoraphobia
diagnosis of panic disorder requires 1 or more month with 1 or more of the following symptoms [3]
persistent concern of additional attacks
worrying about consequences of attacks
behavioral change related to attacks
excessive worry about multiple events or activities
subjective difficulty redirecting worry
generalized anxiety disorder
GAD must have […] months duration
6 or more
associated features of GAD required for diagnosis
Concentration difficulty
Restlessness
Irritability
Muscle tension
Energy low (fatigue)
Sleep distrubances
CRIMES- must have 3 of 6
key question for making diagnosis of GAD
do you feel like you can stop worrying when you need to?
(patients with GAD have trouble redirecting worry)
cued or anticipated fear that is excessive and unreasonable and provokes immediate anxiety
specific phobias
severe, persistent (>6 months) fear/anxiety due to presence or anticipation of a specific object or situation
specific phobia
do people with specific phobias recognize the fear is excessive?
yes
irrational fear/avoidance of leaving comfort zones due to fear that help/escape is unavailable
agoraphobia
exaggerated fear of embarrassment in social situations recognized as excessive/unreasonable
social anxiety disorder
social anxiety disorder is a type of
specific phobia
anxiety is physiologically related to a known medical condition
anxiety disorder due to GMC
anxiety is physiologically related to effects/withdrawal of substance or medication
substance induced anxiety disorder
anxiety is present but does not meet criteria for other anxiety disorders
anxiety disorder NOS
anxiety disorders are often co-morbid with
mood disorders (depression)
what types of anxiety disorders are more prevalent [3]
phobias
social anxiety
PTSD
what types of anxiety disorders are least prevalent [2]
panic disorder
OCD
two or more depressive symptoms lasting two or more years
persistent depressive disorder (dysthmia)
onset of anxiety disorders typically onset in
late adolescence/early adulthood
anxiety disorders with some evidence of genetic components [4]
panic disorder
OCD
GAD
phobias
anxiety disorders can be more prevalent in persons with […] type personality disorders
cluster C
“anxious, avoidant, fearful” cluster
cluster C
diseases falling under cluster C [3]
OCPD
dependent personality disorder
avoidant personality disorder
differentiate social anxiety disorder and avoidant personality disorder
social anxiety disorder: anxiety in response to certain fears like public speaking or performing
avoidant personality disorder: more chronic, lifelong avoidance and anxiety in any setting
differentiate dependent personality disorder and avoidant personality disorder
dependent personality disorder: people pleasing tendencies
avoidant personality disorder: totally avoidant of people
patients with […] will typically be cognizant of symptoms and problems on assessment [4]
OCD
phobias
panic disorder
GAD
patients with […] may be avoidant or reluctant to discuss their symptoms on assessment
PTSD
preoccupation with order, perfectionism, and control
behaviors are consistent with one’s own beliefs
obsessive compulsive personality disorder
(in contrast to OCD, in which patients recognize symptoms are irrational)
excessive need for support, submissive, low self confidence
dependent personality disorder
hypersensitive to rejection and criticism, socially inhibited, timid, feelings of inadequacy
avoidant personality disorder
anxiety disorders are ego […]
dystonic
(aware of problem)
personality disorders are ego […]
syntonic
(not aware of problem)
make screening questions […] to make patients more comfortable sharing symptoms
conversational
goal of testing is to determine if a person meets criteria for a psychiatric diagnosis
psychodiagnostic testing
criterion referenced testing
psychodiagnostic testing
testing with a restricted response range with yes/no response to each symptom
objective testing
testing with open response range, like asking the patient to interpret finding
(analyzes themes)
projective testing
treatment for anxiety disorders with […] can also treat co-morbid depressive features
SSRIs
patients with anxiety disorders often have […] insight and can engage in coping strategies
good
used in acute depression
rapid response
can help with comorbid anxiety
electroconvulsive therapy
rapid-acting method to treat refractory depression
induces tonic-clonic seizure under anesthesia and neuromuscular blockade
electroconvulsive therapy
systematic exposure/dose of related but incrementally threatening triggers/situations
graded exposure therapy
direct exposure to an intense/threatening stimulus without option of avoidance to produce desensitization
flooding exposure therapy
systematic desensitization via discussion, imagery, and planned exposure
slow and systematic
systematic desensitization via conditioning resulting in “extinction”
counter conditioning
(anxiety typically peaks before extinction- just be aware because patient may want to d/c treatment)
psychological approach that works especially well in children or patients with diminished cognitive capacity
token economy
(exposure earns tokens, maladaptive behaviors loose tokens)
characterized by chronic worry and physical complaints
GAD
panic attacks provoked by social situations
social anxiety disorder
panic attacks come unreliably in multiple situations
panic disorder
chronic disorder associated with trauma, intrusive recollections of trauma, avoidance, and physiological arousal
PTSD
perceptions of […] by others are typical of social anxiety disorder
scrutiny
fear of places where escape may be difficult, often due to fear of having additional panic attacks
agoraphobia
(panic disorder with agoraphobia)
chronic worry and anxiety with somatic complaints
problems controlling/redirecting the worry
GAD
occurs in social situation with others which can be provoked by fears of scrutiny of others
social anxiety disorder
characterized by intrusive obsessions, followed by behavioral compulsions that reduce subjective anxiety
obsessive-compulsive disorder
exposure technique in which a patient is exposed directly to their feared stimulus without options to avoid
flooding
[…] and […] involve gradual systematic exposure to a feared stimulus over time to reduce anxiety symptoms
graded exposure
systematic desensitization
[…] medications have potential for dependency/abuse
anxiolytics
first line treatment in anxiety disorders
antidepressants
trauma and associated symptoms occurring less than one month
acute distress disorder
trauma and associated symptoms occurring greater than one month
PTSD
patients with […] may be avoidant or reluctant to discuss their history and symptoms
PTSD
responsible for cortisol release
adrenal gland
what brain structure initiates the events of the HPA axis
amygdala
describe the sequence of the HPA axis
amygdala –> hypothalamus –> pituitary –> adrenal gland
