Psych Conference II Flashcards
one way to induce a panic attack
give lactate
Someone who is experiencing intense anxiety for 10 years, and now reports worsening depressed mood in response do her symptoms, feels like shes going crazy but denise ay psychotic or manic syptoms, what other dianostic possibilities must you consider?
What medical disorders must you consider?
- Panic disorder
- Panic disorder with agoraphobia
- Major depression
- Alcoholism (in remission) - she stopped drinking alcoholic beverages 5 months ago
- Adjustment disorder
1, Cardiac illness
- Asthma attacks (she has asthma)
- Hyperthyroidism
What is agoraphobia?
Characterized by fear and avoidance of situations in which help might not be available in case of a panic attack or in which escape would be difficult. Avoidance of stiuations that might cauase a panic attack is consistent with agoraphobia.
depressive symptoms could indicate two things
presence of anhedonia suggests what?
Alcoholism is common in what?
depressive symptoms could represent a reaction to the effects that the anxiety has had on her life, or a full episode of major depression
Anhedonia (lack of interest/pleasure) would suggest a major depression.
Alcoholism is common in anxiety disorders (often begins as a self-medication)
What is the pysiology behind the intense physical symptoms such as palpitations, air hunger, and termulousness seen in anxiety disorders?
Mediated by norepinephrine, in the locus coeruleus. Initiator of flight or flight response.
Serotonin is involved in triggering the panic episodes
The gradual linking of certain situations to expectation of panic attacks (agoraphobia) is mediateed by processing that occurs in the prefrontal cortex and is fed back to the components of the anxiety system.
Medication treatment effective for panic disorder. How are they administered?
- Benzodiazepines
- Clonazepam 2x daily (alprazolam had to be taken 4x/day, ugh)
- Several anti-depressants.
- SSRIs are first line treatment
- imipramine was effective but tolerability makes it sucky
Need to be started at lower doses of antidepressants in panic disorder due to side effect sensitivity.Benzos at low-dose will be ueed to brdige the 3-5 week latency of effect of the antidepressants.
pt has retinitis pigmentosa (inhereited degenerative vision disorder), complains of insomina, can’t shut is mind off, and reports frequent stomach discomfort, with alternating gas, diarrhea and constipation. What other information would help distinguish between the diagnostic possiblities (both medical and psychiatric?)
- generalized anxiety disorder
- depression
- OCD
- adjustment disorder
50% of pts presenting with insomina ahve anxiety disorder or depression as the underlying cause.
What does bed time worrying, coupled with insomina and chronic muscle tension suggest? (Also fatigue, irritaibility, concentration difficulty, persistent edginess)
generalized anxiety disorder
How do we draw the line between “normal: and pathologic anxiety?
- persistence and pervasiveness of the anxiety
- worry NORMALLY is supposed to lead to some action on or resolution of a stressor.
- in GAD, the worry persists even when any acute stressors are resolved
- need IMPAIRMENT for it to be pathological: interference with job and fam
For generalized anxiety disorder, which neurotransmitters would be potential targets for phamacological intervention? How long should he continue treatment for his condition?
- GABA receptor was original target: benzodiazepines and barbiturates
- current meds trying to target specific subtypes of GABA receptors that are involved PREFERENTIALLY in the anxiety system and less so in the motor and memroy systems to minimize side effects.
- For continuing treamtnet (which is most of the time): SSRIs (serotenergic antidepressants)
- Paroxetine has just been approved for GAD
- Nefazodone, Mirtazepine may also be effective
- Psychotherapy: Cognitive behavioral and interpersonal therapy effective.
Pt has excessive anxiety in most social situations, wants to get involved but makes him feel so uncomfortable, denied history of persistent depressed mood or substance abuse. What are the diagnostic possibilities?
- Social anxiety disorder
- Panic disorder (episodes of intense physical symptoms)
- Paranoid disorder (delusional disorder, schizophreniform disorder)
- Avoidant personality disorder
What is the relationship between avoidant personality disorder and social anxiety disorder?
30-50% overlap between social anxiety disorder and avoidant personality disorder. In current trials, they now no longer meet criteria for the personality disorder with effective treatment.
What condition do you need to diagnose panic disorder?
Unexpected panic attack
How would you discern between a social anxiety disorder and a paranoid disorder?
pt with social anxiety disorder can experience full-fledged panic attacks in social situations that trigged anxiety. If the patient believes that others actually mean in harm and are watching him, then a paranoid disorder would be supported.
What brings pts with social anxiety disorder to seek treatment? How does this compare to someone with panic disorder?
Up to 1/3 of social anxiety disorder pts suffer atleast one episode of major depression or comorbid alcoholism, and it is often the comorbid disorder that brings them into treatment. The nature of their anxiety prevets them from seeking help.
Pts with panic disorder exhibit the OPPOSITE help-seeking behavior-they often see a number of medical specializsts over the course of their illness and seek out friends and family for assistance frequently.
