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Psychiatric Principles > Exam 2 anxiety disorders > Flashcards

Exam 2 anxiety disorders Flashcards

1
Q

what are the various anxiety disorders

A
  1. GAD
  2. Panic disorder (with or without agoraphobia)
  3. Phobia (specific/social)
  4. OCD
  5. Acute stress disorder
  6. PTSD
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2
Q

What is the dx criteria for GAD (e-f criteria)

A

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

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3
Q

Tx of GAD without comorbid major depression

A

Pharmacotherapy OR CBT

  • SSRI/SNRI
  • other option: anxiolytics ie BuSpar or BZs
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4
Q

Tx of GAD with comorbid major depression

A

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

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5
Q

What is CBT and what can it be used for

A

psychotherapy focused on teaching specific skills to identify negative thoughts and behaviors; replace with positive ones

*can be used in GAD tx etc

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6
Q

Definition of Panic

A

Acute episodic, intense attack of anxiety assoc with overwhelming feelings of dread and autonomic discharge

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7
Q

Definition of Agoraphobia

A

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

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8
Q

Define phobia

A

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

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9
Q

Panic disorder is subcategorized into

A

with agoraphobia

without agoraphobia

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10
Q

etiology of panic disorder

A
  1. Genetic
  2. Environmental- hx of unpredictable and uncontrollable life stressors (grew up in chaotic house)
  3. Psych: temperament/anxious type
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11
Q

Define panic attack

A

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

  1. palpitations/tachy
  2. sweating
  3. Trembling/shaking
  4. Feel SOB/smothered
  5. Feel choking sensation
  6. Chest pain/discomfort
  7. Nausea/abd distress
  8. Feel dizzy/unsteady/faint
  9. Derealization or depersonalization
  10. Fear of losing control or going crazy
  11. Fear of dying
  12. Paresthesias (numbness or tingling sensation)
  13. Chills or hot flushes
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12
Q

Criteria for Panic disorder (with or without agoraphobia)

A

[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

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13
Q

What are the primary Goal in the tx of panic disorder

A
  1. Reduce intensity, freq, duration
  2. Reduce avoidance behavior
  3. Limit over reliance on safety cues
  4. Improve functional capacity
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14
Q

How should you approach tx/relapse in regards to tx of panic disorder

A

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)

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15
Q

What are the tx options for Panic disorder (non pharm and pharm)

A
  1. CBT: education, self monitoring, relaxation training, challenging neg thinking, exposure,

Pharm: SSRI, SNRI, maybe BZ (clonazepam and alprazolam) and/or Beta blocker

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16
Q

What is a phobia (specific)

A

Cued by presence or anticipation of a specific object or situation

Types: animal, natural environment, blood/inj, situational, other

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17
Q

How do you dx phobia *criteria

A
  1. marked/persistent excessive/unreasonable fear of presence or anticipation or specific object/situation
  2. exposure provokes immediate anxiety response (may be panic attack)
  3. Excessive or unreasonable
  4. Avoided or endured with intense anxiety/distress
  5. Significant interference with functioning
  6. If <18yo, must last 6 mth
  7. Not better attributed to another disorder (OCD, PTSD)
18
Q

How do you treat Specific Phobias

A

CBT (short term tx, sig improvement in 1-5 session; one session with systematic exposure)

Meds: short term BZ

19
Q

How do you define social phobias

A

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

20
Q

Dx of Social phobia (a thru g)

A

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

21
Q

Tx approach (4 primary goals) for social phobias

A
  1. Reduce phobic/social anxiety
  2. Eliminate avoidance and excess safety behaviors
  3. Improve functional capacities
  4. Treat co-morbid condition (social)
22
Q

Tx of Social Phobia without co-morbid condition

A

SSRI/SNRI or CBT

–>short term BZ

23
Q

Tx of Social phobia with comorbid depression

A

SSRI/SNRI & CBT

24
Q

Tx of social phobia with comorbid anxiety

A

SSRI/SNRI & CBT

25
Q

Dx of Obsessions

A

Defined by 1, 2, 3 and 4
1) Recurrent and PERSISTENT thoughts, impulses or images experiences as intrusive and inappropriate and cause marked anxiety or distress

2) Thoughts, impulses, images not just excessive worries about real life problems
3. Attempts to ignore or suppress the thoughts or to neutralize them with other thought/action
4. Recognizes that obsessional thoughts are product of their own mind (NOT IMPOSED as in thought insertion)

26
Q

Dx of Compulsions

A

Defined by 1 & 2

1) Repetitive BEHAVIORS or mental acts, driven to perform in response to obsession or according to RIGID rules
2) Aimed at PREVENTING/REDUCING distress, preventing dreaded event; however NOT connected in a REALISTIC way or are clearly EXCESSIVE

27
Q

Dx of OCPD

A

A. Either Obsessions or compulsions (see previous for definition cx)

B. Recognized as unreasonable/excessive

C. Cause marked distress, are consuming, or significantly interfere with functioning

D. Not restricted to other Axis I (eating disorder, trichotillomania, hypochondriasis)

E. Not due to drug or GMC

28
Q

Tx of OCPD mild to moderate sx w/o comorbid personality disorders or dissociative sx

A

1st line: CBT with pharm adjunct.. OR

1st line: Pharm with CBT adjunct

2nd line: increase dose of current med or consider combo drug tx with CBT adjunct

29
Q

Tx of OCPD with severe sx or comorbid personality disorders or dissociative sx

A

1st line: CBT with Pharm

2nd line: increase dose of current med or consider Combo

30
Q

70-80% of people with acute stress disorder go on to…

A

develop PTSD

*MVA, mild TBI, assault, burn, industrial accident, witness mass shooting

31
Q

dx of ASD (A thru H)

A

A) Exposed to traumatic event with both:

  1. experienced or witness event that involved ACTUAL OR THREATENED DEATH OR SERIOUS INJURY, or threat to physical integrity of self or others
  2. Response involved intense fear, helplessness or horror

B. During or after event, 3+ present:

  1. Subjective numbing, detachment, absence of emotional responsiveness
  2. Reduced awareness of surroundings
  3. De-realization
  4. Depersonalization
  5. Dissociative amnesia (unable to recall important aspect of trauma)

C. Trauma persistently RE-EXPERIENCED in 1+ way: recurrent images, thoughts, dreams, illusions, flashbacks, distress on exposure to reminders

D. AVOIDANCE of stimuli/reminders

E. Marked sx of ANXIETY or increased arousal

F. Clinically sig DISTRESS/impairment

G. Lasts at least TWO DAYs but NO more than FOUR WKs; occurs WITHIN 3 wks of trauma

H. Not secondary to drug, GMC, brief psychotic d/o, exacerbation of axis 1 dx

32
Q

Key factors to PTSD

A 
Key:
- exposure and response to trauma
- re-experiencing sx
- avoidance sx
- hyper arousal sx
OTHER
- depression
- alcohol or substance misuse
33
Q

How is PTSD classified (axis?)

A

Axis I: clinical disorders: anxiety disorders: PTSD

  • acute: sx < 3 mth
  • chronic sx >3 mth
  • with delayed onset: onset of sx is at least 6 mth after stressor

sx severity: mild, moderate, severe

34
Q

How should you approach dx of PTSD

A

a) re experiencing (flashbacks, nightmares)
b) Avoidance (people, situations)
c) hyperarousal (irritability, sleep problems)

35
Q

What is the dx criteria for PTSD

A 
ALL must be met:
A) Exposure to stressor
B) Re-experiencing sx
C) Avoidance and numbing sx
D) Sx of increased arousal
E) duration at least 1 mth
F) significant distress or impairment of funcitoning
36
Q

Goals of treatment of PTSD?

A
  1. Reduce severity of sx
  2. Prevent of treat trauma related comorbid conditions
  3. Improve adaptive functioning
  4. Restore sense of safety and trust
  5. Prevent relapse
  6. Limit generalization of danger experienced
37
Q

Tx options for PTSD (sx <3 mth, mild)

*note: not pregnant or breast feeding

A

1st line: watchful waiting and follow-up in 1 mth

38
Q

Tx options for PTSD sx <3 mth, moderate

A

1st line: watchful waiting and follow-up in 1 mth

39
Q

Tx options for PTSD sx <3 mth, severe

A

First line: trauma focused CBT (TFCBT), adjunt is pharmacotherapy

40
Q

Tx options for PTSD sx >3 mth

A

1st line: trauma focused CBT
adjunct: pharmacotherapy

2nd line: alt trauma psych therapy
adjunct: pharm

41
Q

Psychological vs Pharmacological tx for PTSD

A

Psych:

a) TFCBT or EMDR (severe sx)
b) CBT: for those not ready for trauma focused work

Pharm

a) antidepressants 1st line - Paroxetine (Paxil)
b) off label atypical neuroleptics

Psychiatric Principles (9 decks)

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