B7.076 Anxiety Disorders in Psychiatry Flashcards
what
me worry?
adaptive features of normal anxiety
inborn, unlearned response to threat or the absence of people or objects that signify safety
can result in:
-thought processes like worry
-psychical changes like racing heart, sweating, shaking, freezing
how are physical changes stimulated in anxiety
linked to limbic system function (amygdala)
amygdala receives direct input from areas of the sensory cortex
describe general adaptation syndrome
immune system’s adaptive response to stress over time
- stressor onset
- onset shock
- compensation phase
- resistance phase
- decompensation phase
major anxiety disorders
PTSD OCD panic disorder generalized anxiety disorder specific phobia social anxiety disorder anxiety due to a medical condition substance-induced anxiety disorder anxiety disorder NOS
PTSD
exposure to a traumatic event traumatic event is re-experienced avoidance of related stimuli emotional numbness persistent arousal duration is longer than 1 month
acute stress disorder
duration is less than 1 month
obsessions
recurrent thoughts, impulses, and images
- not excessive worries
- attempts at ignoring/reducing/ distracting
- recognized as mental processes (not psychosis)
compulsions
repetitive behaviors
- feels driven to perform
- attempts at reducing distress
- not rationally connected or are excessive
OCD
obsessions recognized as irrational/ excessive/ unreasonable
compulsions
produces dysfunction (personal, social, occupational)
panic disorder
recurrent (non-triggered) panic attacks rapid experience of sudden anxiety (peak < 10 min) frequently with multiple features (4 needed for diagnosis): -chest pain/discomfort -chills or hot flushes -derealization or depersonalization -fear of losing control -feeling dizzy, unsteady, lightheaded, faint -feeling of choking -nausea or abdominal distress -palpitations or tachy -paresthesia -sensations of shortness of breath or smothering -sense of impending doom -sweating -trembling or shaking
agoraphobia
fear of being places where escape may be difficult or a companion is required
generalized anxiety disorder
excessive worry about multiple events or activities
subjective difficulty redirecting worry
> 6 month duration
associated features (3 of 6):
-restlessness or feeling keyed up or on edge
-being easily fatigued
-difficulty concentrating or mind going blank
-irritability
-muscle tension
-sleep disturbance
specific phobia
cued of anticipated fear that is excessive or unreasonable
exposure (cue, situation) provokes immediate anxiety
recognized as unreasonable
prominent avoidance of cue/trigger
associated distress interferes with person’s functional status
social anxiety disorder
fear of one or more social/performance situation perception of scrutiny by others exposure provokes immediate anxiety situations endured with distress recognized as excessive or unreasonable avoidance of social situations can occur
anxiety disorder due to a general medical condition
anxiety is physiologically related to a known medical condition
substance abuse anxiety disorder
anxiety is physiologically related to the effects/withdrawal of a substance or medication
lifetime prevalence of anxiety disorders
anxiety disorders are common and frequently co-morbid with mood disorders phobias 25% social anxiety 13% PTSD 7.8% GAD 5% panic disorder 3.5% OCD 2.5%
other epidemiological characteristics of anxiety disorders
onset frequently in late adolescence and early adulthood
2:1 F:M
variable course over lifetime
some have evidence of genetic/familial basis
can be more prominent/common in some personality disorders
psychiatric interview for anxiety disorders
ask and observe
be aware of comorbidities
patients will typically be cognizant of symptoms and problems (OCD, phobias, panic disorder, GAD)
some patients more avoidant or reluctant to discuss (PTSD)
why use screening questions for psych interviews
anxiety can be difficult and embarrassing to acknowledge
examples of screening questions
have you every experienced and anxiety attack or felt out of control all of a sudden?
do you consider yourself a worrier?
have you ever had anything happen that still haunts you? do you have a lot of bad dreams?
do you get thoughts stuck in your head that really bother you or need to do things over and over like washing your hands, checking things or count?
when you are in a situation where people can observe you do you feel nervous and worry that they will judge you?
criterion referenced psychodiagnostic testing
comparison of participant to particular criteria- assume skewed distribution
goal: determine if a person meets criteria for a psychiatric diagnosis
objective testing for psych diagnosis
restricted response range (yes or no)
