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PSYCH CLERKSHIP > Chapter 5_Anxiety, OCD, Trauma, Stressor Related Disorders > Flashcards

Chapter 5_Anxiety, OCD, Trauma, Stressor Related Disorders Flashcards

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1
Q

General way to treat anxiety?

A

Milder: psychotherapy
Moderate to severe: psychotherapy + combination pharmacotherapy

severity is gauged based on amount of distress/impairment

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2
Q

What medications/substances cause anxiety?

A

alcohol (toxication and withdrawal), sedatives, hypnotics withdrawal, cannabis, hallucinogens, stimulants, caffeine, tobacco, opioid withdrawal

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3
Q

What medical conditions cause anxiety?

A

neuro: epilepsy, migrianes, brain tumors, MS, Huntingons
endocrine: hyperthyroid, thyrotoxicosis, hypoglycemia, pheochromocytoma, carcinoid syndrome
metabolic: vitamin b12 deficiency, electrolyte abnormalities
respiratory: asthma, COPD, hypoxia, PE
CV: CHF, angina, arrhythmia

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4
Q

What NT systems are implicated in anxiety?

A

NE, serotonin, and GABA

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5
Q

First line pharmacotherapy for anxiety?

A

SSRIs (sertraline) and SNRIs (venlafaxine)

low doses for depression
HIGHER DOSES FOR ANXIETY

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6
Q

How are benzodiazepines involved in treatment of anxiety?

A

Enhance GABA activity, but can be ADDICTIVE! Only use this to temporarily bridge patients until long term medication can be used. Avoid in patients with comorbid substance use

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7
Q

What are some nonaddicting PRN anxiolytics?

A

diphenhydramine (benadryl), hydroxyzine (atarax)

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8
Q

Beta-blockers (propanolol) can also be useful in treating anxiety; especially in….?

A

controlling autonomic symptoms (palpitations, tachycardia, sweating)

also for PANIC ATTACKS AND PERFORMANCE ANXIETY

Use B’s to Block P’s (Panic attacks, and Performance anxiet)

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9
Q

When should benzodiazepines be avoided?

A

Patients with comorbid substance use disorder and depression disorder (may worsen depression)

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10
Q

What is the pharmalogic goal of anxiety treatment?

A

achieve symptomatic relief for at least 6 months before tapering off meds, or at least until therapy can be initiated

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11
Q

What two types of therapy are useful for anxiety treatment?

A

CBT (relationship between anxiety driven cognitions/thoughts, emotions, and behavior)
psychodynamic psychotherapy - insight into development of anxiety and increases tolerance

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12
Q

Panic attacks

A

type of fear response involving sudden anxiety surge (spontaneous or from trigger). Peak within minutes and resolve within half an hour.

Symptoms: dizziness, disconnectedness, depersonalization, palpitations, paresthesias, abdominal distress, numbness/nausea, intense fear of dying or losing control, chills, sweating, SOB

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13
Q

DSM criteria for panic disorder

A
  • Recurrent and UNEXPECTED panic attacks without identifiable trigger
  • one or more panic attacks followed by at least one month of continuous worry of FUTURE panic attack
  • not due to substance/medical condition
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14
Q

When patient presents with panic attack, what to rule out?

A

MI, thyrotoxicosis, and thromboembolism

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15
Q

Treatment for panic disorder

A

Pharmacotherapy (first line SSRIs like sertraline (zoloft) citalopram (celexa), or escitalopram (lexapro) then TCAs if not effective or PRN benzos) PLUS CBT

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16
Q

What other psych disorders are often comorbid with anxiety

A

Major depression, other anxiety disorders, bipolar disorder, and alcohol use disorder

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17
Q

DSM criteria for agoraphobia

A
  • Intense fear/anxiety of >2 situations for concern of difficulty escaping/accessing help in case of panic disorder/embarassing situation (i.e. outside of home alone, open spaces, enclosed places, public transport, crowds)
  • fear out of proportion to trigger, usually involving prolonged anxiety, need for companion, or avoidance
  • symptoms last longer than 6 months
  • significant impairment
  • not due to any other disorder/substance
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18
Q

What are some characteristic situations avoided in agoraphobia?

A

Bridges, crowds, buses, trains, open areas outside of home

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19
Q

Treatment of agoraphobia?

A

Same as panic disorder (SSRIs and CBT)

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20
Q

DSM criteria for specific phobia

A
  • Persistent, excessive fear of specific situation or object which is out of proportion
  • exposure to trigger = IMMEDIATE fear response
  • symptoms lasting more than 6 months
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21
Q

What are common situations that people with social phobia avoid?

A

public speaking, eating in public, using public restrooms

fear of scrutiny by others or acting in humiliating/embarassing way

22
Q

How to treat specific phobia?

A

CBT

23
Q

How to treat social anxiety disorder/phobia

A

CBT
SSRIs first line or SNRIs for debilitating symptoms
PRN Benzos
PROPOANOLOL FOR PERFORMANCE ANXIETY/PUBLIC SPEAKING/PANIC ATTACKS

24
Q

DSM criteria for selective mutism

A
  • consistent failure to speak in select social situations (ie school)
  • mutism not due to communication/language difficulty
  • symptoms last for more than 1 month, and impairment
25
Q

Treatment for selective mutism

A

CBT, family therapy

can use SSRIs to help treat (esp with comorbid social anxiety

26
Q

DSM criteria for separation anxiety

A
  • excessive and developmentally inappropriate fear/anxiety regarding separation from attachment figures.
  • excesssive worry about loss/harm to attachment figure or an event that leads to separation
  • reluctance to leave home, school, work
  • physical symptoms to avoid school/work
  • significant impairment
  • symptoms last greater than 4 weeks in children/adolescents and 6 months in adults
27
Q

Treatment for separation anxiety?

A

CBT, family therapy, SSRIs adjunct

28
Q

Symptoms of generalized anxiety disorder (GAD)?

A

Worry WARTS

Worried
Worn out, wound up
Absent minded
Tense (muscles)
Restless
Sleepless/insomnia
29
Q

DSM criteria for generalized anxiety disorder?

A
  • excessive anxiety/worry about various daily activities/events (EVERYTHING) for more than 6 months
  • difficulty controlling anxiety
  • at least three WARTS (worn up/wound out, absent minded, restless, tense (muscle),sleepless
  • no other d/o, impairment
30
Q

T/F: Most patients with GAD are able to attain full remission with CBT

A

False. Remission rates are low.

31
Q

What are two lifestyle modifications that help reduce anxiety?

A
  • reducing/eliminating caffine

- exercise!

32
Q

Treatment for GAD

A

Combined CBT and SSRI/SNRI

May consider short term Benzo or augmentation with buspirone

33
Q

Obsession vs. compulsion

A

Obsessions are recurrent, intrusive thoughts that increase anxiety. Compulsions are attempts to reduce this anxiety via repetitive actions or mental rituals (i.e. repeated checking/counting)

34
Q

DSM criteria for OCD

A

experiencing obsessions and/or compulsions that are time consuming (>1hr daily) or cause significant distress/dysfunction

35
Q

Common obsessions and their compulsions

A

Contamination - cleaning/avoiding contaminant
doubt/harm - checking multiple times to avoid danger (checking oven)
symmetry - lining/ordering things

36
Q

Treatment for OCD

A

Combo high dose SSRI (fluoxetine, sertraline) or clompiramine (most serotonin selective TCA)

can also augment with atypicals

last resort: cingulotomy or ECT (esp of comorbid depression)

37
Q

What does CBT for OCD involve?

A

exposure and response prevention

38
Q

Difference between OCD and OCPD

A

OCPD - obsessed with details, control, perfectionism (not intruded on by thoughts or compelled to do compulsions), EGO-SYNTONIC

OCD - distressed by obsessions and compulsions, EGO-DYSTONIC

39
Q

DSM criteria for body dysmorphic disorder

A
  • preoccupations with one or more perceived physical “flaws” or “defects” that aren’t apparent to others
  • repetitive behaviors in response to this (grooming, make up, comparing self to others)
  • cannot be explained by other disorder (i.e eating disorder)
40
Q

Treatment for body dysmorphic disorder

A

SSRIs/CBT may help in reducing obsessive and compulsive symptoms

41
Q

DSM criteria for hoarding disorder

A
  • persistent difficulty discarding possessions, regardless of value, due to the need to save items and distress associated with discarding them
  • accumulation of possessions that congest/clutter living areas
42
Q

DSM criteria for trichotillomania (hair pulling disorder)

A

recurrent pulling out of one’s hair resulting in hair loss (anywhere on body)
repeated attempts to decrease/stop hair pulling
impairment + no other disorder

43
Q

treatment for trichotillomania

A

SSRIs, atypicals, N-acetylcysteine, or lithium

CBT

44
Q

criteria for excoriation disorder (skin picking)

A

recurrent skin picking resulting in lesions
repeated attempts to stop

treatment same as trichillomania

45
Q

Criteria for PTSD

A
  • exposure to LIFE THREATENING trauma (injury, near death, sexual violence, etc) via witnessing or actually experiencing the trauma
  • recurrent intrusive re-experiencing of event via flashbacks, nightmares, distress @ cues
  • at least two symptoms of negative mood/cognition: anhedonia, feelings of detachment, self blame, negative emotions
  • at least two symptoms of arousal: hypervigilance, exaggerated startle, irritability, impaired concentration, insomnia
46
Q

Difference between PTSD and acute stress disorder

A

Unlike PTSD, acute stress disorder…

  • trauma has occured less than 1 month ago (PTSD trauma can happen any time from past)
  • symptoms last
47
Q

T/F: PTSD symptoms may sometimes be delayed

A

True. usually begins 3 months after trauma, but 50% of patients have complete recovery within 3 months

48
Q

Symptoms of PTSD

A

TRAUMA

traumatic event
re-experience
avoidance
unable to function
month or more of symptoms
arousal increased
49
Q

Treatment for PTSD

A
  • first line SSRIs/SNRIs
  • PRAZOSIN (a1 receptor antagonist) FOR NIGHTMARES :)
  • can augment with atypicals if severe
  • CBT (specialized exposure and cognitive processing)
50
Q

Adjustment disorder criteria

A
  1. development of emotional/behavioral symptoms within 3 months in response to identifiable stressful life event (distress in excess of what is expected/significant impairment
  2. Symptoms not due to normal bereavement
  3. Symptoms resolve within 6 months of stressor terminating
51
Q

Which psychotherapy is most helpful in treating adjustment disorder?

A

supportive psychotherapy

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