PSYCH 2 - ANXIETY DO Flashcards
Patient will present as → a 21-year-old female complaining of poor school performance. She is concerned about her performance despite reassurance from her professors. She tells you that her symptoms occur daily consisting of sleep disturbances, difficulty concentrating, and irritability. She reports her symptoms started around age 16 but have worsened.
GAD
Alternative to SSRI/SNRI tx for GAD
Buspirone/Busbar
Generalized Anxiety Disorder:
Generalized Anxiety Disorder:
→ MC in Females early 20s
Disease Presentation:
Excessive worry > 6 MONTHS (Multifocal Worry) causes distress
3 or more:
Restlessness
Fatigued
Difficulty Concentrating
Irritability
Muscle tension
Sleep disturbances (falling/staying/restlessness)
→ NOT episodic, Not specific (like phobias)
MC psychiatric illness seen by providers
Treatment:
Psychotherapy of choice = CBT
1st Line: SSRIs + CBT!!!!
Or Buspirone (Buspar)
Or SNRIs / Venlafaxine ER
Anxiety Attacks: Lorazepam/Ativan (long-acting Benzo)
Used interim until SSRI response is seen (several weeks)
Herbal: KAVA
Panic Attack:
Panic Attack:
→ Disease Presentation:
- Random burst of panic that peaks within 10 minutes and resolves in 1 hr
- Sympathetic system overdrive (4 or more)
- Dizzy, Trembling, choking, paresthesias, sweating, SOB, Chest pain, chills, hot flash, fear of losing control, fear of dying, palpitations, Nausea, Depersonalization
***(be sure to rule out any life-threatening situation)
→ Treatment:
ACUTE ATTACKS: BENZOS
ALPRAZOLAM (Xanax), Lorazepam (Klonopin), Diazepam
1st line for LONG TERM: SSRI
Patient will present as → a 26-year-old first-year PA student with a medical history significant for GERD comes to your office because of frequent episodes of palpitations. The palpitations are sudden in onset and are accompanied by sweating and a sense that she is going to “pass out.” The episodes typically last no more than 10 minutes, and although the patient feels as if she may pass out, she never has. The episodes first appeared when she started PA school and have increased in frequency to the point where she is afraid to attend lectures out of fear of having an “attack.”
Panic DO
Which benzo has the shortest half-life?
Alprazolam/Xanax
Panic DO
Panic Disorder:
→ Disease Presentation:
** 3 Panic Attacks in 3 weeks **
At least one attack has been followed by ONE MONTH or more of PERSISTENT WORRYING ABOUT HAVING ANOTHER PANIC ATTACK or CHANGE IN BEHAVIOR TO AVOID ATTACKS!!!
→ Tx:
1st Line = SSRI (but treat with Benzos until SSRIs kick in)
Benzos: Alprazolam
CBT + SSRI = best
→ Facts:
MC in females (esp if family)
Associated with MDD
Agoraphobia
Agoraphobia:
→ Fear of being in places you cannot escape/find a way out
→ 6 months
TX:
→ CBT
Social Phobia/Social Anxiety DO
→ Disease Presentation:
-Intense fear of social/performance situations fearing embarrassment/scrutiny by others
-Fear of humiliating or embarrassing themselves: PUBLIC SPEAKING, starting conversation, dating
-Person avoids situations to avoid this feeling
> 6 months
→ Treatment:
EXPOSURE Therapy
SSRI + CBT
→ PERFORMANCE ONLY:
BB or Benzo prior to event
Common with AVOIDANT PERSONALITY DO
Performance Anxiety Tx
PRN BB or Benzos (prior to event)
Specific Phobias:
Specific Phobias:
→ Disease Presentation:
INTENSE FEAR or anxiety over specific SITUATIONS, OBJECTS, or PLACES
>6 Months
Phobias are avoided as much as possible
Heights, spiders, needles, etc.
→ Treatment:
EXPOSURE THERAPY
SSRIs
Patient will present as → a 29-year-old male presents with a recent onset of upsetting dreams, anxiety, and disturbing flashbacks. The patient reports that he returned from active duty in Iraq three months ago and was adjusting to life back at home until about seven weeks ago when he began having an intense fear of loud noises and seeing sudden flashbacks to bombing attacks he endured during his time in Iraq. He had to take a leave from his army instructor duties as he was not able to handle the familiar settings of practice shooting ranges and sudden loud explosions during battalion training. After refusing to leave his house, he was finally persuaded by his wife to visit your clinic.
PTSD
PTSD
Post-Traumatic Stress Disorder:
→ Disease Presentation:
Traumatic event occurring > 1 month
Symptoms > 1 month: intrusions, distressing dreams, nightmares, memories, dissociative reactions + negative mood: can’t remember event, amnesia, anhedonia, guilt, anger, irritability, etc.
Persistent AVOIDANCE of stimuli
Negative alterations in mood/cognition
Alterations in arousal/reactivity
→ Treatment:
Psychotherapy + SSRIs
1st Line: TRAUMA-FOCUSED THERAPY
1st line PHARM: SSRIs or SNRIs
Trazodone = Insomnia
Prazosin: Alpha-1 Agonist = HELPS WITH NIGHTMARES, sleep disturbances, etc.
Acute Stress DO (not on TL)
→ Disease Presentation:
Traumatic event occurring < 1 month ago
Symptoms: intrusive symptoms, avoidance, increased arousal, negative alterations in thoughts and mood
PTSD symptoms (<1 months)
→ Treatment:
Cognitive Behavioral Therapy
Can give benzos immediately after if needed
Adjustment DO (not on TL)
→ Disease Presentation:
Disproportionate reaction to a NON-LIFE THREATENING stressor (loss of job, physical illness) beginning within 3 MONTHS of the stressor and ends within 6 MONTHS after the stressor is resolved
Resolves after patient adapts to the situation
Stressors: Marriage issues, financial, family, school, sexual issues, death in family
→ Treatment:
Psychotherapy
