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MHD > Psych 3- Anxiety > Flashcards

Psych 3- Anxiety Flashcards

1
Q

What is the difference b/w fear and anxiety?

A
  • Fear: emotional response to real or perceived imminent threat; autonomic behavior surges for fight of flight, thoughts of immediate danger and/or escape
  • Anxiety: anticipation of future threat; Muscle tension and vigilance in preparation for future danger and cautious or avoidant behavior

(Different anxiety disorders often have both, but may have more of one than the other)

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2
Q

Anxiety can be a normal reaction to identifiable stressors that society considers understandable. Anxiety becomes pathological when any of the following happens: (4)

A
  1. Autonomy: anxiety without obvious reason
  2. Intensity: out of proportion response, causes dysfunction and/or is not bearable
  3. Duration: lasts longer than expected
  4. Behavior: coping mechanisms are not enough and/or patient displays other dysfunctional (usually avoidance) behaviors
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3
Q

List the 4 ‘domains’ of anxiety.

A

Physical
Affective
Cognitive
Behavioral

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4
Q

List the sx in the physical domain of anxiety.

A
  • Constitutional: Diaphoresis, fatigue
  • Skin: Flushing, pallor
  • HEENT: Dry mouth
  • Cardiac: Palpitations, tachycardia, chest pain, HTN
  • Pulmonary: SOB, choking sensation, Hyperventilation
  • GI: N/V, diarrhea, constipation, anorexia, abdominal pain
  • GU: Increased urinary frequency, Sexual dysfunction
  • Musculoskeletal: Muscle tension
  • Neurologic: Lightheadedness, vertigo, hyperreflexia, mydriasis, tremors, paresthesias
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5
Q

What are sx of the affective domain of anxiety?

A

Ranges from edginess to terror & panic; often viewed as irritability or restlessness

  • irritability is the one that seems to be least likely to be thought of as being anxiety
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6
Q

What are sx of the cognitive domain of anxiety?

A

Worry, apprehension, poor concentration, feeling your mind has gone blank, feeling tense/jumpy, anticipating the worst

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7
Q

What are sx of the behavioral domain of anxiety?

A

Changes made in an effort to diminish or avoid the distress; responses can be checking behaviors, rituals, avoidance

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8
Q

What anatomic system is most responsible for anxiety?

What brain structures/areas are involved?

A
  • Autonomic system, mostly sympathetic: Locus coeruleus (LC)

- Amygdala, Hippocampus, Hypothalamus

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9
Q

According to Stahl, what are the 2 major anxiety circuits?

A
  1. Fear (panic, phobia)

2. Worry (anxious misery, apprehension, expectation, obsession)

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10
Q

What is the DSM 5 criteria for panic attack? (include time frame)

A

An abrupt surge of intense fear or discomfort that peaks within 10 minutes and has 4 or more of the following symptoms:

PANICS

  • Palpitations, Pounding heart, Paresthesias
  • Abdominal distress
  • Nausea, Numbness
  • Intense fear of dying or losing control, LIghtheadedness
  • Chest pain, Chills, Choking, DisConnectedness
  • Sweating, Shaking, Shortness of breath, Smothering sensation
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11
Q

What is the DSM 5 criteria for panic disorder? (include time frame)

A

Recurrent, unexpected panic attacks without an identifiable trigger. At least one attack has been followed by a month or more of the following:

  • Anticipatory anxiety
  • Significant, maladaptive change in behavior
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12
Q

Panic disorder:

  • Typical age of onset?
  • What is the course if treated?
  • How big is the genetic component?
  • What 2 anxiety-related disorders is it most often co-morbid w/?
    • What non-anxiety disorder is it most often co-morbid w/?
A
  • Late teens to early 20s; median age 24
  • Course: untreated, waxes and wanes over time
  • Moderate genetic component
  • Usually co-morbid: 1st-Agoraphobia; 2nd GAD
    MDD most common non-anxiety disorder
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13
Q

What 3 NT’s are implicated in panic disorder? (not sure if important)

A

GABA, serotonin, NE

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14
Q 
Tx for panic disorder:
1st-line?
2nd-line?
What can you give while waiting for the 1st-line meds to take effect?
What should you NOT use?
A

1st line: *SSRIs, SNRIs
2nd line TCAs, MAOIs
- Benzo’s while waiting
- Do not use Bupropion (Wellbutrin)

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15
Q

What is the ddx for someone who is having a panic attack? (ie list many causes of panic attacks)

A

Panic attacks can occur in any anxiety disorder, not just Panic Disorder. Panic attacks may be due to:
- Specific Phobia, Social Phobia, GAD

Panic attacks are also commonly due to:

  • PTSD, OCD
  • The effects of a Substance (Intoxication or withdrawal)
  • A general medical condition (Ex. Angina, asthma)
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16
Q

What substance use disorder is most likely to be comorbid w/panic disorder?
What personality cluster?

A
  • Alcohol

- Especially Cluster C (Avoidant, Dependent, Obsessive-Compulsive)

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17
Q

What is the DSM 5 criteria for agoraphobia? (include time frame)

A

Fear, anxiety, and/or avoidance > 6 months; marked fear or anxiety about at least 2 of the following situations:

1) Using public transportation
2) Being in open spaces
3) Being in enclosed places
4) Standing in line or being in a crowd
5) Being outside of the home alone

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18
Q

Typical onset of agoraphobia?

How common is complete remission?

A

Onset late teens; late 20’s if no panic attacks/disorder chronic course; majority have co-morbid mental illness dx

  • Course tends to be persistent and chronic; complete remission is rare (10%) unless condition is treated.
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19
Q

Tx for agoraphobia?

A
  • Systematic desensitization (controlled repeated exposure to inciting event);
  • Antidepressants: SSRIs/SNRIs/TCA’s; +/- short term BDZ use
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20
Q

What is the DSM 5 criteria for GAD? (include time frame)

A

Excessive anxiety and worry about a number of events and activities occurring most days for at least 6 months. Unrelated to a specific person/event/situation.

This worry is accompanied by 3 or more somatic symptoms (first aid doesn’t say it needs 3, though):
CRIMES
- Concentrating (difficulty), or mind going blank
- Restlessness, feeling keyed up, on edge
- Irritability
- Muscle tension
- Energy (easily fatigued)
- Sleep disturbance (insomnia)

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21
Q

What is the median age of onset for GAD?

A

30 y/o (later than other anxiety disorders)

Prevalence: Specific > Social > GAD

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22
Q

What are the ages of onset for the following: specific, social, and GAD.

A

Specific ( children), Social (teens), GAD (adults)

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23
Q

Does GAD get better or worse later in life?

A

Some waxing and waning, less than Panic Disorder;
- May worsen later in life, especially
in women; rates of full remission are very low

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24
Q

Describe the tx options in the following: panic disorders, agoraphobia, GAD, social phobia, and specific phobia.

A
  • Panic disorders: Antidepressants, CBT, Benzos
  • Agoraphobia: Antidepressants, CBT*, Benzos
  • GAD: Antidepressants, CBT, Benzos, busprione
  • Social phobia: Antidepressants, CBT, propranolol
  • Specific phobia: Usually no meds, CBT*
  • = systemic desensitization
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25
Q

Tx for GAD:
1st-line?
2nd-line?

A
  • 1st line: SSRI’s, SNRI’s; CBT
  • 2nd/3rd line: TCA’s, MAO-I’s
  • Benzodiazepines, Buspirone (tends to work best in pts not exposed to benzos)
26
Q

What is specific phobia?

Time range?

A
  • Fear/anxiety about a specific object or situation

- > 6 months

27
Q

Do pts w/specific phobia have 1 phobia, or can they have more?

A

Is common for a patient to have multiple specific phobias; about 75% have >1 phobia;
Average patient has 3 phobic objects and/or situations

28
Q

Most specific phobias are F > M. What are some that are F = M?

A

Blood/Injection/Injury

29
Q

When do specific phobias usually develop?

What is the 1 exception?

A
  • Early childhood

- Situational (eg tunnels, flying)

30
Q

What is social anxiety disorder?
What is a hallmark symptom of this disorder?
Time range?

A

fear/anxiety from social situations where one is exposed to scrutiny/judgment by others

Blushing is considered a hallmark symptom of this disorder.

Time: > 6 months

31
Q

What is separation anxiety disorder?

Age of onset?

A
  • Concerning separation from home or attachment figure (parent). > expected for developmental level
  • < 12 years
32
Q

What is selective mutism?

Age of onset?

A
  • Failure to speak in specific social situations in which there is an expectation for speaking (school)
  • < age 5
33
Q

Which is rarer, selective mutism or separation anxiety disorder?

A

Mutism

34
Q

Which is M = F, selective mutism or separation anxiety disorder?

A

selective mutism

35
Q

Is separation anxiety disorder a precursor for other future anxiety disorders?

A

No

36
Q

For separation anxiety disorder, Meet three of the following: Persistent and excessive distress/worry
(just read for a general feel)

A
  1. When anticipating or experiencing separation from home or attachment figures
  2. When separated that attachment figure’s well being. (will need to know whereabouts and stay in touch)
  3. About something happening to them that would result in separation (getting lost, kidnapping)
  4. About going out due to separation fears—will show reluctance or refusal to go out
  5. About being alone or without attachment figure even if at home (leads to clinging or shadowing behavior)
  6. That leads to reluctance/refusal to go to sleep without being near attachment figure (may insist someone stay with them until they fall asleep; refuse to do a sleepover at friends; or go on errands)
  7. With repeated nightmares involving theme of separation
  8. With physical complaints (headaches, stomach aches, etc)
37
Q

What is the time course for separation anxiety disorder in children/teens? Adults?

A

Time: > 4 weeks for children/teens; > 6 months for adults

38
Q

How long is the duration of selective mutism?

A

Duration is > 1 month and not attributable to lack of knowledge or speech/language barriers or due to a communication disorder

39
Q

What are the general rules for diagnosing an anxiety disorder?

A
  • Step 1. r/o substance induced causes
  • Step 2. r/o medical conditions
  • Step 3. characterize the anxiety disorder
40
Q

What is the w/u for ruling out substance induced causes of anxiety disorders?

A

Urine drug screen, BAL, drug levels

41
Q

What is the w/u for ruling out medical condition causes of anxiety disorders?

A

Accucheck, UA, CBC, CMP, ammonia, TSH, B12/folate, RPR, EKG

42
Q

What are the “big 3” co-morbidities w/anxiety disorders?

A
  1. Other anxiety disorders
  2. Depression
  3. Substance abuse
43
Q

Anxiety disorders (precede/follow) agoraphobia; depression/substance (precede/follow) agoraphobia

A
  • precede

- follow

44
Q

What anxiety follows (rather than precedes) the big 3 (anxiety, depression, substance abuse)?

A

Social phobia

45
Q

Name 3 trauma and stressor-related disorders.

A
  • Adjustment Disorder
  • Acute Stress Disorder
  • Post Traumatic Stress Disorder
46
Q

What is adjustment disorder? (give time range)

Once the stressor has terminated, symptoms do not persist for more than _________.

A

Development of emotional or behavioral symptoms in response to an identifiable stressor occurring within 3 months.

Sx are clinically significant as evidenced by either:

  1. Marked distress that is out of proportion to severity of stressor
  2. Significant impairment in social, occupational, or other area of functioning

Once the stressor has terminated, symptoms do not persist for more than 6 months

47
Q

What is acute stress disorder?

What is the time range?

A

Exposure to actual or threatened death, serious injury, or sexual violation by experiencing the event, witnessing the event in person, learning the event(s) occurred to a close family member or close friend, or experienced repeated /extreme exposure to aversive details of traumatic events

Time: 3 days to 1 month after trauma exposure

48
Q

What is PTSD?

What is the time range?

A

Exposure to actual or threatened death, serious injury, or sexual violation by experiencing the event, witnessing the event in person, learning the event(s) occurred to a close family member or close friend, or experienced repeated /extreme exposure to aversive details of traumatic events.

Time: > 1 month

49
Q

Presence of what sx must be present to dx acute stress disorder and PTSD?

A
  • Intrusion Symptoms
  • Negative Mood
  • Dissociative Symptoms
  • Avoidance Symptoms
  • Arousal Symptoms
50
Q

What are some co-morbidities for PTSD?

A

Mood disorders, anxiety disorder, substance use disorder (M>F for substance use disorder)

51
Q

Tx for PTSD?

*What should NOT be used?

A
  • 1st: CBT; SSRI’s, SNRI’s (eg venlafaxine)
  • 2nd: TCA, MAO-I’s
  • Adjunctive treatment: olanzapine, Risperdal, Mirtazapine; Prazosin- for nightmares

*No benzos

52
Q

What defines OCD? How long must they last each day?

A

Recurrent obsessions and/or compulsions that are severe enough to be time consuming (>1 hour/day). Person understands that the obsessions or compulsions are unreasonable or excessive but they “just have to do it”.

53
Q

What are eg’s of “obsessions”?

A

Recurrent & persistent thoughts, images, or urges
Intrusive & unwanted, causing anxiety/distress
- Dirt/contamination
- Doubts
- Disorder/Symmetry
- Dangerous thoughts (aggressive, going to hell)
- Disgusting thoughts (aggressive, sexual)

54
Q

What are eg’s of “compulsions”?

A 
Repetitive behaviors or mental acts 
Usually done in response to an obsession to reduce distress or prevent a feared event
- Cleaning
- Checking, re-checking
- Counting, repeating, ordering
- Console self
- Confession/rituals
55
Q

Mean age of onset of OCD?

A

25

56
Q

Co-morbidities for people w/OCD?

A
  • 75% have an anxiety disorder-usually anxiety disorder then OCD
  • 60% have mood disorder-usually OCD then mood disorder
  • Tic disorder (especially if OCD childhood onset)

OCD is more common in patients with various mental disorders than what would be expected based on its prevalence in the general population:
Schizophrenia, schizoaffective disorder, bipolar disorder, eating disorders (anorexia and bulimia) and Tourette’s disorder

57
Q

Tx for OCD?

A
  • 1st line: SSRIs (high doses); CBT: specifically Exposure Therapy
  • 2nd line: Venlafaxine (Effexor. 1st aid say it’s also 1st-line), Clomipramine (Anafranil)
  • Augmentation: Risperdal (Risperidone)
58
Q

Name some OCD-related disorders.

A
  • Body Dysmorphic Disorder: preoccupied with minor or imagined defect in appearance leading to significant emotional distress
  • Hoarding Disorder: persistent difficulty parting with possessions, perceived need to save items, and hoarding causes clinically significant distress
  • Trichotillomania (hair pulling disorder)
  • Excoriation Disorder (skin picking disorder)
  • Substance/Medication-Induced Obsessive-Compulsive Disorder
  • Obsessive-Compulsive Disorder Due to Medical Condition
59
Q

What is exposure therapy?

A

Exposure to treat anxiety?

60
Q

Tx for body dysmorphic disorder?

A

CBT

61
Q

Propranolol can be used for which d/o?

A

Social phobia (not 1st-line)

62
Q

Buspirone can be used for which d/o?

A

GAD (not 1st-line)

MHD (20 decks)

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