Day 11-13 - Substance Use and Anxiety Disorders Flashcards
Substance Use disorders are defined as a ______ of substance use leading to clinically significant impairment or distress as manifested by at least ___ symptoms occurring within a ___-month period
problematic pattern; at least 2 symptoms in 12mo
What are the severity specifiers for substance use disorders?
- mild: 2-3 symptoms
- moderate: 4-5 symptoms
- severe: 6+ symptoms
Define early remission and sustained remission in the context of substance use disorders
- early: <2 symptoms for 3-12mo (excluding cravings)
- sustained: same but for 12+mo
(T/F) to be considered in remission for a substance use disorder, you have to be sober
FALSE
What are the 4 categories of symptoms for substance use disorders?
- physical dependence
- risky use
- social problems
- impaired control
____% of kids who start drinking by 14 develop alcohol use disorder, compared to __% of those who start @ 21+
15%; 2%
Early onset of drinking is a risk (marker/factor) for alcohol use disorder
Unclear as of yet (maker=associated; factor=causal)
Substance use in teens is ass w 3 leading causes of death for teens: ___, ___, and ___
accidents/injuries, suicide/self-harm, and interpersonal violence
In US, ___ of students in gr 12 and ___ of students in gr 10 report drinking in past year
2/3 gr12; 1/2 gr10
What is the lifetime prevalence of any substance use disorder for:
- teens 13-18
- 13-14y
- 15-16y
- 17-18y
- teens 13-18: 11%
- 13-14y: 4%
- 15-16y: 12%
- 17-18y: 22%
Substance use in teens (increased/decreased) during the pandemic
DECREASED
What is an example of an early, brief intervention for SUD?
- norm-based intervention for college students
- ppl overestimate how much their peers drink, so show them the reality to set more healthy norms
- changes in perceived norms can mediate tx effects
- these programs work well!!
What is multidimensional family therapy for SUD?
- similar to MST used for conduct disorders
- involve parents to help with monitoring
- works well, often better than group therapy or CBT
What is Alcoholics Anonymous for SUD?
- most popular treatment
- peer support
- recommends abstinence
- very easily accessible
- ass w less alcohol consumption and fewer substance related problems
What are the 3 hypotheses for the link between AA and lower alcohol consumption and related problems? Which is/are supported by research?
- attendance itself leads to using less
- lower alc use ass w going to more meetings, these ppl are more likely to get better anyways
- ppl w good prognosis (motivated + less comorbidities) use less and are more likely to go to meetings (so have less risk and more protective factors
- evidence for #1 only (attendance leads to lower use)
- study of veterans found AA involvement @1y post-tx predicted less use @2y post-tx (no evidence for other hypotheses)
What does research say about the efficacy of inpatient tx for SUD?
- not enough research to say
There is (high/low) service utilization for kids w anxiety disorders
LOW
What groups are most likely to receive MH services for anxiety disorders?
girls and older kids/teens
About ___ of kids 6-12 have 7 or more fears
half
How does anxiety differ from fear?
- anxiety is future-oriented (anxious apprehension)
- fear is present-oriented
(T/F) anxiety disorders and OCD now fall under the same DSM category
FALSE, used to but now separate (some related features)
When is the typical onset of specific phobia?
middle childhood (7-9y)
What are the 5 diagnostic specifiers for specific phobias?
- animal
- natural environment (heights, storms, water)
- blood, injection, injury
- situational (e.g. planes, elevators, small spaces)
- other (choking/vomiting, sounds, costumed characters)
Separation anxiety occurs in ___% of children and is more prevalent in (boys/girls)
4-10%; girls
In children diagnosed w separation anxiety, ____ have another anxiety disorder and ___ have a depressive disorder
2/3 anxiety; 1/2 depressive
What are the key features of GAD?
- excessive, uncontrollable anxiety or worry
- somatic (physical symptoms as well!)
When is the typical onset of GAD? What is the gender ratio?
- onset in adolescence and beyond (older kids have more symptoms)
- similar levels in boys and girls
A panic attack is a period of intense ____ that develops abruptly and is accompanied by at least ___ symptoms
intense fear or discomfort; at least 4 symptoms
DSM5 criteria for panic disorder:
- recurrent, ____ panic attacks
- at least one attack followed by ___mo+ of one of: _____, _____, _____
- recurrent, unexpected panic attacks
- 1mo+ of one of: persistent concern of having more attacks, worry ab consequences of attack, significant change in behaviour related to attacks
(T/F) you can have panic attacks without having panic disorder
TRUE
What are obsessions?(4 points)
- obsessions: recurrent/persistent thoughts, impulses, or images that cause anxiety or distress
- not just excessive worrying ab real life problems
- attempts to ignore/suppress w another thought or action
- person recognizes thoughts as product of own mind
What are compulsions?
- repetitive behaviours/mental acts that the person feels driven to perform in response to obsession
- aimed at preventing distress but not connected in a realistic way to the problem or are clearly excessive
What is the lifetime prevalence in kids/teens for:
- any anxiety disorder
- specific phobia
- separation anxiety
- social phobia
- GAD
- panic disorder
- OCD
- selective mutism
- any anxiety disorder: 32%
- specific phobia: 19%
- separation anxiety: 8%
- social phobia: 9%
- GAD: 2%
- panic disorder: 2%
- OCD: 1-2%
- selective mutism: 0.7%
What is the girl:boy ratio for anxiety and OCD?
- anxiety 2:1
- OCD 1:2
(T/F) lower SES and single parent household are linked to greater likelihood of anxiety disorder
TRUE
Anxiety disorders are more common in (Black/white) youth, and (Black/white) youth receive more services for anxiety
Black; white
(T/F) anxiety disorders are often comorbid w other anxiety disorders
TRUE
Diagnostic comorbidity btw anxiety and depression can be as high as ____%
75-80%
Often, (anxiety/depression) preceeds (anxiety/depression)
anxiety preceeds depression
What 5 symptoms overlap between GAD and MDD?
- fatigue
- sleep disturbance
- irritability
- concentration difficulties
- negative affectivity
What is the typical age of onset for:
- separation anxiety
- OCD
- GAD
- social phobia
- panic disorder
- separation anxiety: 7-8y
- OCD: 9-12y
- GAD: 10-14y
- social phobia: teens
- panic disorder: teens
Long term outcomes of anxiety disorders are (homotypic/heterotypic)
not sure yet (homotypic = disorder predicting itself over time, heterotypic = predicting other, related disorder)
Children of parents w anxiety disorder are __x more likely to have an anxiety disorder
5x
__% of variability in anxiety is heritable
33%
What is the 2-stage model of fear acquisition
- stage 1: fear develops through classical conditioning
- stage 2: avoidance behavior maintained through operant conditioning
(T/F) compulsions can be cognitive, not just physical
TRUE (eg counting)
What are the 5 steps of social information processing?
- encoding (what you pay attention to)
- interpretation
- response search
- response decision
- enactment
How does anxiety impact social information processing?
- encoding: attention to threat
- interpretation: negative bias, catastrophizing
What are 4 environmental (family) factors in pediatric anxiety
- modeling (parents demonstrate anxious response)
- information transmission
- low expectations (expect child won’t be able to cope)
- parental reinforcement of problematic behavior (eg avoidance)
(T/F) research has found that parents of anxious kids tend to talk them into engaging in avoidant responses
TRUE
SSRIs can be used to treat what 4 anxiety/related disorders?
- OCD
- GAD
- SAD
- social anxiety disorder
What is the effectiveness of SSRIs for youth w anxiety disorders?
- not much research
- some evidence, but not large effect
What are the 3 core components of effective anxiety interventions?
- reduce cognitive biases
- reduce bodily tension
- exposure and habituation
What are 2 ways to reduce cognitive biases in anxiety?
- coping self-talk (identify and challenge negative thoughts)
- retraining attention to threat bias
How is attention re-training done for threat bias?
- dot-probe task
- trained to look away from angry face
- found decrease in threat bias! (AND number and severity of symptoms)
What is flooding?
- exposure technique involving intense exposure to highest level of fear (can lead to quick improvement but can also be traumatic)
What were the main findings of the CAMS (child/adolescent anxiety multimodal study)?
- major RCT for youth anxiety treatments
- combined SSRI + CBT worked best
- CBT and SSRI equal ish and both better than placebo
- SSRI better than CBT for social anxiety disorder
- CBT better than SSRI for GAD
- results maintained at 3mo and 6mo
- improvements related to long-term outcomes 3-11y later!
What were the main findings of the POTS (pediatric OCD treatment study)?
- combined was best
- CBT and SSRI equal ish and both better than placebo
- BUT effect of CBT and SSRI varied across tx sites
