psych anxiety Flashcards
neurotransmitters in anxiety
increased norepi, and decreased GABA and serotonin
anxiety develops more freq in higher socioeconomic groups
right
panic attacks
peak within 10 minutes and usually last less than 25 min; four of the listed criteria
criteria for panic attacks
palpitations, sweating, shaking, shortness of breath, choking sensation, chest pain, nausea or abdominal distress, lightheadedness, depersonalization, or derealization, etc.
panic disorder
spontaneos recurrent panic attacks with no obv precipitant; on avg two times per week; can be as infreq as a few times per year
dsm IV criteria for panic disorder- at least one of the attacks must be followed by a min of 1 month of the following
persistent concern about another attack, worry about implications of attack, change in behavior related to attacks
panic disorder you must specify
whether the attack is with or without agoraphobia
panic attacks may be induced by
nicotine, caffeine, hyperventilation
genetics/gender of panic disorder
more common in females; very strong genetic component
onset of panic disorder
late teens to early thirties, but may occur at any age
prognosis of panic disorder
often chronic; relapses common; ten to twenty percent of patients continue to have signif sx that interfere with daily functioning; fifty percent have mild sx; the rest are free of sx after treatment
treatment for panic disorder
SSRI (esp paroxetine and sertraline)
how long does tx take to see results?
2-4 weeks
dose of SSRI in panic disorders
requires higher doses than those needed for depression
length of treatment for panic disorder
8-12 mos as relapse is common after discontinuation of therapy
agoraphobia
the fear of being alone in public places; can be diagnosed alone or as panid disorder with agoraphobia
when agoraphobia is not assoc with a panic disorder
it is usually chronic and debilitating
phobia
patient recognizes that the fear is excessive
length of phobia
if person is under 18, duration must be at least 6 mos
average age of onset for social phobias
mid teens
phobias genders
women are twic as likely to have specific phobia as men, but social phobia occurs equally in men and womne
treatment for specific phobia
meds are not effective; behavioral therapy (systemic desens) is most effective; a short course of benzos may be used during desensitization
treatment for social phobia
Paroxetine (paxol), an SSRI is used for social anxiety disorder; beta blockers are freq used to control sx of performance anxiety
def of obsession
recurrent and intrusive thought, feeling or idea that is egodystonic
def of compulsion
conscious repetitive behavior linked to an obsession that, when performed, functions to relieve anxiety caused by depression
egodystonic
patients wish they could get rid of these symptoms because they cause signif stress in their lives
obsessions
person attempts to suppress the thoughts; person realizes thoughts are a product of his or her own mind
diagnosis of OCD
either obsessions or compulsions; person is aware that they are unrealistic and excessive; obsessions cause marked distres, are time consuming or signif interfere with daily functioning
onset of OCD
early adulthood, and men and women are equally affected
OCD is assoc with what other disorders
MDD, eating disorders, other anxiety disorders, and OC personality disorder
the rate of OCD is hgiehr in patients with first deg relatives who have tourettes syndrome
right
mechanism
assoc with abnormal regulation of serotonin
prognosis of OCD
usually chronic; about 30% of patients show signif improvement with tx
treatment of OCD
SSRIs (higher than normal doses may be required to be effective); TCAs are also effective; behavioral tx is as effective as pharmacotherapy but even better in combo
behav treatment for OCD
exposure and response prevention (ERP); involves prolonged exposure to the ritual-eliciting stumulus and prevention of relieving compulsion
last resort for OCF
ECT or surgery (cingulotomy)
PTSD def
response to a catastrophic (life-threatening) experience in which the patient reexperiences the trauma, avoids reminders of the event, and experiences emotional numbing or hyperarousal
PTSD length
symptoms must be present for at least one month
prognosis for ptsd
half of patients are sx free after 3 mos of treatment
treatment for PTSD
SSRIs, TCAs, MAOIs; anticonvulsants for nightmares and flashbacks
eye movement desens and reprocessing
a non-pharm treatment that can be used for PTSD
difference between PTSD and acute stress disorder
PTSD- the event could have happened any time in the past and the sx last over a monht; for ASD, the event occurred less than 1 mo ago and sx last less than 1 mo
acute stress disorder
patient experiences major traumatic event but has anxiety sx for less than 1 mo; sx are similar to PTSD; treatement is same as for PTSD
Generalized anxiety disorder DSM 4 criteria
excessive worry about daily events and activities (that is difficult to control) for at least 6 mos; must be assoc with at least 3 of the listed criteria
criteria for GAD, at least three of
restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance
GAD epi
45% lifetime prevalence; women twice as likely as men; onset before age 20; most have coexisting mental disorder like MD, phobia, or panic disorder
prognosis for GAD
chronic, with lifelong fluctuating sx in 50% of patientsl the other half will fully recover within a few years of therapy
treatment of GAD
combo of CBT and pharmacotherapy (SSRIs, buspirone, venlafaxine); if benzos are used, they hsould be tapered off
panic attacks are assoc with what med conditions
mitral valve prolapse, asthma, pulm embolus, angina, and anaphylaxis
characteristic situations avoided in agoraphobia include
bridges, crowds, buses, trains,or any open areas outside the home
performance anxiety treatment
beta blockers
systemic desensitization
gradual exposure of a patient to the feared object or situation while teaching relax techniques; the opposite, flooding, would be directly confronting the patient with their fear
seventy five percent of OCSF patients have both obsessions and compulsion
right
difference between OCD and OCPD
in OCPD, patient is excessively preoccupied with details, lists, and organization and OCPD patients don’t perceive a problem with their sx
why should benzos be avoided in the treatment of PTSD
high rate of substance abuse
in GAD, the anxiety is free floating
as opposed to being fixed on a particular person, event, or activity
