First Aid CH5 Anxiety/OCD/Trauma & Stressors Flashcards
define anxiety
emotional and physical fear response to a perceived threat, causes significant distress or impairment in social/occupational situations
major neurotransmitter systems implicated in anxiety
NE, 5HT, GABA
tx guidelines
begin with psychotherapy for mild cases, combo pharm + therapy for moderate-severe cases
late onset anxiety? what’s your suspicion
if there’s no personal or fam psychiatric history, consider medical condition or substance use
what part of caffeine intake involves anxiety?
intoxication
what three substances can cause anxiety throughout their use cycle?
ETOH, stimulants, tobacco
first-line tx for anxiety
SSRIs or SNRIs, Benzos (avoid in pts w/ h/o substance abuse), Buspirone (often low efficacy, Propranolol (performance anxiety)
TCAs = second-line d/t risk profile
define CBT
explores relationship between anxiety-provoking thoughts, emotions, and behaviors
define psychodynamic psychotherapy
facilitates understanding and insight into dev of anxiety, helps to increase anxiety tolerance
define panic attack
fear response involving abrupt surge in intense anxiety that peaks within minutes and usually resolve within 30 min
- can occur outside panic disorder
benzo use for anxiety
prn or as bridge medication
symptoms of panic attacks
Da PANICS dizziness, derealization, depersonalization palpitations, paresthesias abd distress numbness, nausea intense fear of dying, losing control chills, chest pain sweating, shaking, SOB
is smoking a risk for panic attacks?
yes
what group is clozapine in?
SGAP
define panic disorder
recurrent panic attacks that occur spontaneously (out of the blue), can also have clear trigger, can lead to agoraphobia
are relapses of panic disorder common with med cessation?
yes
MC co-morbidity with panic disorder
depression
first-line tx for panic disorder
SSRI
how long must agoraphobia sxs be present for for diagnosis?
at least 6 months
tx for agoraphobia
therapy, SSRIs
define phobia
irrational fear that leads to endurance of the anxiety and/or avoidance of the feared object or situation
define social anxiety
fear of social situations d/t fear of judgment by others.. fear of possibly acting in a humiliating/embarrassing way, this fear then impairs academic or occupational efficacy
how long must phobia-like sxs last before official diagnosis?
at least 6 months
treatment for performance anxiety
propranolol (beta-blocker)
selective mutism can’t be due to what?
language difficulty or communication disorder
how long must selective mutism sxs last prior to diagnosis?
greater than one month
tx for selective mutism
CTB, SSRIs
stranger anxiety vs separation anxiety
stranger = 6-9 months old separation = 1 year - 18 months old
separation anxiety may manifest as what in kids?
somatic sxs to avoid school/work
separation anxiety sxs must occur for how long for diagnosis?
at least 4 weeks in kids
at least 6 months in adults
separation anxiety tx
SSRIs + CBT
GAD Mnemonic
Worry WARTS worried wound up, worn-out absent-minded restless tense sleepless
for patients with anxiety, consider suggesting eliminating what? consider suggesting adding what?
caffeine!
exercise (low-impact, inc HR can exacerbate anxiety)
define general anxiety disorder
persistent and excessive anxiety (fear/worry out of proportion) about many aspects of daily lives, can manifest as physical sxs
how long must someone be consistently anxious to have GAD?
at least 6 months
long-term prognosis of GAD?
few pts fully remit, waxes and wanes, can be well-controlled
GAD tx
CTB + SSRI
What is OCD?
obsessions and/or compulsions that are time consuming, distressing, and impairing
obsessions: intrusive, undesired thoughts that inc anxiety
compulsions: the attempt to relieve anxiety, repetitive behaviors or mental rituals
DSM5 of OCD
o/c’s that are time consuming (>1hr per day) or cause sig distress/dysfunction
OCD co-morbidities
SI (50%) and attempts (25%), other anxiety disorders (75%), mood disorders (60%), OCPD (30%), tics (30%)
OCD tx
pharm (SSRI) + CBT
- second-line pharm = Clomipramine (TCA)
define body dysmorphic disorder
pt preoccupied w/ body parts they perceive as flawed or defective, believe they’re unattractive, imperfections are minimal but perceived as severe/grotesque
- pt tries to correct w/ makeup, derm procedures, plastic surg
what body perception disorders are in each eithers ddx?
body dysmorphic disorder, eating disorder, concerns w/ body fat/wt
what population does body dysmorphic disorder persist in?
F, those w/ childhood abuse and neglect
high risk of what in those w/ body dysmorphic disorder?
suicidal ideation and attempts
tx for body dysmorphic disorder?
SSRIs + CBT
define hoarding disorder
difficulty discarding possessions regardless of value leading to congestion of living spaces
is hoarding genetic?
often yes
hoarding tx
specialized CBT (difficult to tx overall)
What areas are involved w/ trichotillomania? what’s typically the initiating event?
scalp, eyebrows and lashes, facial hair, axillary hair, pubic hair
stress/trauma
tx for trichotillomania?
SSRIs, SGAPs, lithium, CBT
define excoriation disorder
recurrent skin picking resulting in lesions
define PTSD
exposure to traumatic event causes nightmares, flashbacks, avoidance of triggering stimuli, depressed mood, negative thoughts, increased arousal (fight or flight), sxs occur for at least one month
acute stress disorder vs ptsd
ASD = less than 1 month of sxs, trauma occurred less than 1 month ago PTSD = sxs for at least 1 month, trauma occurrred at any time in past
PTSD tx
prazosin to stop dreams
how long can it take to recover from PTSD?
complete recovery within 3 months
PTSD tx
SSRI or SNRI, prazosin (a-1 antagonist), CBT
what’s a high-prevalence risk in PTSD? what’s a tx that should be avoided
substance abuse, benzos (etc)
adjustment disorder
when behavioral or emotional sxs develop after a stressful life event (within 3 months) that cause distress in excess of what’s expected and/or sig impairment
how long until sxs resolve?
6 months
