General for Anxiety Flashcards
Considerations for Mental Health Visits
Assessing for thoughts of self-harm or harming others is the most important part of the visit
Studies show no increase in suicides with providers querying about suicide
You must ask directly, “ have you had thoughts of hurting yourself or someone else?”
“ I know this is hard, but I need to know how you have harmed yourself”
Asking detail, method, action, and plan is important
There is a difference in a fleeting thought and a well thought out plan
Brain functions
-Emotional Processing in the brain occurs in the Limbic system of the brain which is comprised of the hippocampus, amygdala, hypothalamus, and thalamus
It is postulated that people with anxiety have more activity in the limbic system
Neurotransmitters transfer signals in brain:
Serotonin: responsible for mood, sleep, appetite
Norepinephrine: alertness and attention
GABA: slows signals
Anxiety
Epidemiology
Anxiety
Sx
Fear- emotional response to a real or perceived threat
Uncontrollable anxiety- anticipation of a future threat
Can have a unique presentation for individual
Manifests mentally
Fear
Worry
hypervigilance
Manifests physically
Palpitations
Perspiration
Dyspnea
Chest pain
GI upset
Muscle tension
Workup of behavioral disorders
Screen for primary and associated/underlying disorders
Screen for underlying pathology/ medical diagnosis
Screen for current affect on functioning
Medications, recreational drugs, caffeine, tobacco
Relationships, work, academics, recreation, concentration
Anxiety
Screening
0-4: low risk : no intervention
5-9: mild risk: repeat GAD-7, adjust plan if no improvement
10-14: moderate risk: further workup, adjust plan
15+: severe: adjust treatment plan, assessment for safety
Panic disorder
PHQ-PD
Depression
SIGECAPS
Anxiety
BATHE
Background
Affect
Trouble
Handle
Empathy
“what has been going on?”
“how do you feel about that?”
“what troubles you the most?”
“how are you handling that?”
“this must be difficult for you”
Anxiety- Tx
Cognitive Behavioral Therapy
Compressed therapy /limited
Makes connections between thoughts and actions/choices
Change emotions by changing your thinking/behavior; what am I feeling? What are the facts?
Focus is on present not past
Highly structured- clear goals, practical techniques
Homework for patient
Empowers patient to make choices
Less $, goal focused
Anxiety
Psychotherapy/Psychodynamic Therapy
Unlimited-patient determines when to stop
Rooted in Sigmund Freud
Less structure, no homework
Client leads sessions
Transference- what happened in the past and how affecting your present
Explores unconscious thoughts and past experiences to gain insight into present thoughts/emotions
Focus is to have a better understanding of self and health emotional wounds
Anxiety - Tx
Exposure Response Therapy
Use a lot in PTSD and Phobias
Based on habituation
Exposure to fear for a set duration and learning that they are safe- desensitize patient
EMDR
PTSD therapy
Process on the trauma while stimulating different areas of brain with light/vibration/sound- thought to disrupt stored trauma by dual stimulation
Helps people to dissociate from the “feelings” of the event and introduce more logic to the event
Anxiety Disorders
Somatic therapy
Transcranial Magnetic Stimulation
noninvasive procedure that delivers magnetic pulses to the brain to alter nerve cell activity in specific areas of the brain ( usually cerebral cortex) that regulate mood; indicated for anxiety, ocd, ptsd- non painful. Treatment is 4-5 times a week for 4-6 weeks x 40 minutes
Acupuncture
Stimulating specific points seeks to balance energy flow through meridians
Positive data in PTSD and GAD
Genesight
https://genesight.com/wp-content/uploads/GSPS.092.221.Psychotropic4_1.pdf
https://genesight.com/product/
Introduction: Rx for Anxiety Disorders
Other Medications for Anxiety Disorders
