BH Pathologies Flashcards
Physical manifestations of anxiety
Fatigue Restlessness Sleep disturbance Muscle tension Difficulty concentrating Irritability Shakiness HA
GAD is excessive anxiety/worry for a majority of days over the course of at least ___ month(s)
6
1st line tx of GAD
SSRIs
What medication can be added to augment GAD tx?
Buspirone
What is arguably the best tx for anxiety (best tx for kids!)
CBT
Difference b/w anxiety and panic disorder
Anxiety is chronic, insidious, low level + constant
Panic disorder is acute, overt, and catastrophic
Patient attacks consist of at least 4 symptoms of sympathetic system overdrive which affects what 6 bodily systems
Cardiac Pulmonary GI Neuro Psychology Autonomic
Define panic attack
Abrupt surge of intense fear or intense discomfort that reaches a peak within minutes
13 sx of panic disorder
*STUDENTS PANIC* SOB Trembling Unsteady Depersonalize Excessive HR Numbness Tingling Sweating Palpitations Abd pain Nausea Intense fear (of dying, losing control) Chest pain
1st line tx for panic disorder maintenance? What can you use to tx panic disorders before the 1st line tx takes affect?
Maintenance: SSRI (+ CBT = best tx)
Bridge: BZDs (hydroxyzine?)
What other anxiety disorder is closely associated with panic disorder?
Agoraphobia
What is agoraphobia?
Type of anxiety disorder characterized by fear fear and avoidance of places and situations that might cause feelings of panic, entrapment, helplessness, or embarrassment x 6 mo!!!
What age group(s) do phobias usually affect?
Bimodal distribution: childhood, mid-20s
Define phobia
Fear OUT OF PROPORTION to real danger (usually assoc. w/ active avoidance of object/situation = impaired ADLs)
How long do sx have to occur in order to diagnose a phobia?
6 months
1st line treatment for specific phobias
Exposure therapy (BZDs and bblocker appropriate for acute disorders)
What medication can be used to treat social phobia in an “on demand” setting?
Beta blocker (propranolol)
What is the most common mental health problem in the US?
Anxiety disorders
Generally, what percent of patients with anxiety have a somatic complaint?
90%
Generally, what percent of patients with panic disorder have another comorbid psychiatric condition?
90%
What defines the diagnosis of panic disorder vs. panic attack?
Attacks are recurrent + unexpected and are followed by at least 1 month of….[concern for future attack], [worry about losing control], [change in behavior r/t attacks]
Diagnostic criteria for agoraphobia
At least 2 of the following…
- Use of public transportation
- Being in open OR enclosed spaces
- Standing in line or being in a crowd
- Being outside of the home alone
Anxiety and worry assoc. w/ GAD is associated with at least 3 of the following additional sx
- Restlessness
- Easy fatiguability
- Difficulty concentrating
- Irritability
- Muscle tension
- Sleep disturbance
Acute stress disorder is the short version of what other psychological disorder?
PTSD
What separates acute stress disorder and PTSD?
<1mo = acute stress disorder (>3 days) >1mo = PTSD
What are some situations that lead to acute stress disorder/PTSD?
Exposure to actual or threatened death, serious injury, or sexual violations
Acute stress disorder/PTSD clinical manifestations
Presence of at least 9 sx from any of the following categories:
- Intrusion sx
- Negative mood
- Dissociative sx
- Avoidance sx
- Arousal sx
T or F: people can only experience PTSD if they experience an event themselves
FALSE
PTSD can result from experiencing, witnessing, or learning of a traumatic event
What are intrusion sx? (assoc. w/ panic disorder)
Memories, flashbacks
What are avoidance sx? (assoc. w/ panic disorder)
Avoidance or efforts to avoid distressing memories, thoughts, feelings or external reminders assoc. w/ the inciting event
What is negative alterations? (assoc. w/ panic disorder)
Inability to remember an important aspect of traumatic event (or persistent negative emotional state)
What are arousal and reactivity sx? (assoc. w/ panic disorder)
Irritable behavior, angry outbursts, hypervigilance and/or exaggerated startle response, sleep disturbance, reckless or self-destructive behavior
Treatment for PTSD
Psychotherapy (exposure-based CBT)
SSRIs for sx reduction
Define social phobia
A persistent fear or one or more social or performance situations in which the person is exposed to possible scrutiny by others
1st line therapy for social phobia
CBT (SSRIs for comorbid depression)
T or F: both obsessions and compulsions must be present for the diagnosis of OCD
False.
Can be either or or both
Typical ratio between obsessions and compulsions
1:1
Define obsessions
Recurrent thoughts, impulses, or images that cause marked anxiety or distress
Define compulsions
Ritualistic behaviors or mental acts performed in response to an obsession (relieve anxiety assoc. w/ obsession HOWEVER can be disconnected from the obsession itself)
Compulsions usually take up how much of a patients day
1hr/d
OCD tx
SSRIs (higher dose than depression)
CBT
Adjustment disorder diagnostic criteria
- Development of emotional or behavioral sx in r/t identifiable stressor occurring w/in 3 months of onset of stressor
- Does NOT meet criteria for other disorder/is not an exacerbation
- Once stressor has terminated, sx do not persist for more than an addition 6 mo
- *if criteria for another disorder are met, it takes precedent**
Examples of positive dissociative sx
Fragmentation of identity
Depersonalization (from oneself)
Derealization (from surroundings)
Example of negative dissociative sx
Amnesia (localized, selective, generalized)
*most pt. unaware
Cluster A personality disorders
“Weird”
Schizoid
Schizotypal
Paranoid
Cluster B personality disorders
"Wild" Antisocial Borderline Histrionic Narcissistic
Cluster C personality disorders
“Worried”/”Weak”
Avoidant
Dependent
Obsessive-compulsive (OCPD)
Name that personality disorder:
- Voluntary social withdrawal (hermit)
- No desire for relationships
- Absence of psychotic sx
Schizoid
Name that personality disorder:
- Odd, eccentric behavior
- “Magical thinking”
- Social anxiety, family and few friends ok
- Absence of psychotic sx
Schizotypal
Name that personality disorder:
- Distrustful, suspicious
- Easily insulted, bears grudges
- Questions loyalty of others
Paranoid
Name that personality disorder:
- Noncomformity to social norms, laws
- Disregard for and violation of the rights of others
- Irritable, deceitful
- No empathy or remorse
- Aggressive
Antisocial
Name that personality disorder:
- Unstable relationships
- Impulsivity x2 (sex, spending, substances)
- Recurrent suicidal behavior/threats
- Mood swings
- Chronic feeling of emptiness
- Splitting
- Projection
Borderline
Treatment for borderline personality disorder (in addition to psychotherapy)
DBT
Name that personality disorder:
- Overly emotional and dramatic
- Attention seeking
- Sexually provocative, uses physical appearance to draw attention to self
- May believe relationships are more intimate than they are
Histrionic
Name that personality disorder:
- Grandiosity, inflated self image
- Considers her/himself entitled (in reality, afraid and profoundly insecure)
- Fragile self-esteem
- Needs praise and admiration
Narcissistic
Name that personality disorder:
- Low self-esteem, shy, feelings of inadequacy
- Desire for friends, but fear of rejection
- Hypersensitive to criticism
Avoidant
Name that personality disorder:
- Constantly needing reassurance
- Lacks self confidence
- Relies on others for decision-making
- Intense discomfort when alone
Dependent
Name that personality disorder:
- Rigid adherence to routine (routine change -> anxiety)
- Hesitates to delegate tasks to others
- Makes moral judgements on others
- Preoccupied with minor details
- Rigid and stubborn
- Unable to discard worn-out or worthless objects
Obsessive-compulsive (OCPD)
Treatment for all personality disorders
Psychotherapy
