Exam 2 anxiety disorders Flashcards
what are the various anxiety disorders
- GAD
- Panic disorder (with or without agoraphobia)
- Phobia (specific/social)
- OCD
- Acute stress disorder
- PTSD
What is the dx criteria for GAD (e-f criteria)
a) 6 mth with prominent tension, worry and apprehension
b) Difficulty controlling sx
c) at least THREE (Restless, easy fatigability, poor concentration, irritability, muscle tension, sleep disturbance) - [RFCIMS]
d) does not meet criteria for another disorder
e) Clinically significant distress
f) not due to medical issue
Tx of GAD without comorbid major depression
Pharmacotherapy OR CBT
- SSRI/SNRI
- other option: anxiolytics ie BuSpar or BZs
Tx of GAD with comorbid major depression
Same as GAD w/o MDD (ie SSRI/SNRI or CBT) and may require hospitalization for suidical ideation
**consider combing 2 meds from different classes (ie one SSRI (Quetiapine/Seroquel) and a TCA (imipramine/Tofranil)
*other options: anxiolytics ie BuSpar or BZ
What is CBT and what can it be used for
psychotherapy focused on teaching specific skills to identify negative thoughts and behaviors; replace with positive ones
*can be used in GAD tx etc
Definition of Panic
Acute episodic, intense attack of anxiety assoc with overwhelming feelings of dread and autonomic discharge
Definition of Agoraphobia
anxiety disorder defined as a morbid fear or having a panic attack or panic like sx in a situation that is perceived to be difficult (or embarrassing) from which to escape
Define phobia
Persistent fear of an object or situation in which the sufferer commits to great lengths in avoiding, typically disproportional to the actual danger posed, often being recognized as irrational
Panic disorder is subcategorized into
with agoraphobia
without agoraphobia
etiology of panic disorder
- Genetic
- Environmental- hx of unpredictable and uncontrollable life stressors (grew up in chaotic house)
- Psych: temperament/anxious type
Define panic attack
Discrete period of intense fear or discomfort in which at least FOUR of the following sx (autonomic discharge) developed ABRUPTLY and reached PEAK in 10 min
- palpitations/tachy
- sweating
- Trembling/shaking
- Feel SOB/smothered
- Feel choking sensation
- Chest pain/discomfort
- Nausea/abd distress
- Feel dizzy/unsteady/faint
- Derealization or depersonalization
- Fear of losing control or going crazy
- Fear of dying
- Paresthesias (numbness or tingling sensation)
- Chills or hot flushes
Criteria for Panic disorder (with or without agoraphobia)
[A] Both 1 & 2:
(1) Recurrent unexpected Panic Attacks (4 sx, abrupt, peak in 10 min)
(2) Followed by at least ONE MONTH of ONE or more:
- -> persistent concern about having additional attacks {CONCERN}
- -> worry about implications of attack or it’s consequences (eg losing control, having heart attack, gong crazy) {CONSEQUENCE}
- -> significant change in behavior related to attacks {CHANGE}
[B] Presence or absence of agoraphobia
What are the primary Goal in the tx of panic disorder
- Reduce intensity, freq, duration
- Reduce avoidance behavior
- Limit over reliance on safety cues
- Improve functional capacity
How should you approach tx/relapse in regards to tx of panic disorder
know there is a high rate of relapse
**attain max functioning before stopping meds (ie treat for year with pt not having any sx before stopping)
What are the tx options for Panic disorder (non pharm and pharm)
- CBT: education, self monitoring, relaxation training, challenging neg thinking, exposure,
Pharm: SSRI, SNRI, maybe BZ (clonazepam and alprazolam) and/or Beta blocker
What is a phobia (specific)
Cued by presence or anticipation of a specific object or situation
Types: animal, natural environment, blood/inj, situational, other
How do you dx phobia *criteria
- marked/persistent excessive/unreasonable fear of presence or anticipation or specific object/situation
- exposure provokes immediate anxiety response (may be panic attack)
- Excessive or unreasonable
- Avoided or endured with intense anxiety/distress
- Significant interference with functioning
- If <18yo, must last 6 mth
- Not better attributed to another disorder (OCD, PTSD)
How do you treat Specific Phobias
CBT (short term tx, sig improvement in 1-5 session; one session with systematic exposure)
Meds: short term BZ
How do you define social phobias
Marked and persistent fear of social or performance situations where person exposure to unfamiliar people or t possible scrutiny by others. Fears that he/she will act in way that will be humiliating or embarrassing
Dx of Social phobia (a thru g)
a) Marked/persistent fear of 1+ social/performance situations with unfamiliar people or scrutiny by others. Fear of humiliation (or showing anxiety sx)
b) Exposure provokes anxiety response/panic attack
c) Recognized as excessive/unreasonable
d) avoided or endured with intense anxiety/distress
e) significant interference with functioning
f) if <18yo, must last 6 mth
g) not due to drug, GMC or other Axis 1 disorder
Tx approach (4 primary goals) for social phobias
- Reduce phobic/social anxiety
- Eliminate avoidance and excess safety behaviors
- Improve functional capacities
- Treat co-morbid condition (social)
Tx of Social Phobia without co-morbid condition
SSRI/SNRI or CBT
–>short term BZ
Tx of Social phobia with comorbid depression
SSRI/SNRI & CBT
Tx of social phobia with comorbid anxiety
SSRI/SNRI & CBT
