PTSD, OCD, and anxiety disorder Flashcards
PTSD DSM Criteria
A: Someone who experienced real/threatened trauma/ a close family member or friend experienced trauma
Symptoms:
Simplified Diagnosis of PTSD (for ages older than 6 years)
1. Re-experiencing of intrusion symptoms
Dreams, flashbacks, spontaneous memories
2. Avoidance
External and internal reminders
3. Negative Cognitions and Mood
Self-blame, estrangement, amnesia, reduced interest
4. Arousal
Fight: aggressive, reckless or self-destructive behavior
Flight: Sleep disturbance, hypervigilance, startle
5. Clinically significant distress or impairment in relationships, work, general functioning
6. Not result of another medical condition or substances
7. Duration of the disturbance is more than 1 month
8. Specify if:
With dissociative symptoms i.e. experiencing either depersonalization or derealization
With delayed expression: If the full criteria are not met until at least 6 months after
event
Differential diagnosis for PTSD
Bipolar, BPD, Acute stressor, adjustment disorder
What are the three stages of PTSD therapy
- Safety- working on coping skills, feeling safer, medications, substance use
- Working through past memories. NOTE: patient needs to accomplish 1 to move on.
- Reconnections and future orientation
What are the first line medications for PTSD
First line: Fluoxetine, paroxetine, Venflaxine, Sertraline
Others: Can use benzo for short periods of time. Prazosin for nightmares (second line)
DSM Criteria for Acute Stressor Disorder
Considered a pre-cursor to PTSD
o Dissociative symptoms immediately after a traumatic event are predictive of PTSD
Occurs in people who have experienced real or threatened trauma
o Can still occur if event is witnessed or if experienced by close family member or friend
Symptoms must cause clinically significant difficulties in functioning
Symptoms last from 3 days – 1 month after trauma exposure
Required 9+/14 symptoms from 5 categories:
o Intrusion Symptoms
o NegativeMood
o Dissociative Symptoms o AvoidanceSymptoms o Arousal Symptoms
Adjustment Disorder
Occurs when an everyday stressful (non-life threatening) event causes a person to feel
overwhelmed and develops symptoms of emotional distress
Emotional distress includes: depression, anxiety or impaired work ability
Episodes can be so severe as to require psychiatric care over a short term period
typically as an out-patient
Examples: adultery in relationship, failed exam, lost employment, etc.
Emotional or behavioural symptoms must arise within 3 months of stressors and must
be clinically significant
Symptoms cannot merely represent an exacerbation of a pre-existing disorder, or
normal bereavement and does not meet criteria for any other mental disorder
Maladaptive reaction cannot persist for more than 6 months after the
termination of the stressor/event consequence
Subtypes of adjustment disorder
Subtypes:
1. With depressed moodlow mood, tearfulness, or feelings of hopelessness and predominant 2. With anxietynervousness, worry, jitteriness, hyperventilation, or separation anxiety is predominant
3. With mixed anxiety and depressed mooda combination of depression and anxiety predominant
4. With disturbance of conductdisturbance of conduct is predominant (i.e. violating the rights of others or disregarding age appropriate societal norms and rules)
5. With mixed disturbance of emotions and conductboth emotional symptoms (i.e. depression, anxiety) and a disturbance of conduct are predominant
6. UnspecifiedFor maladaptive reactions and issues with function that are not classifiable as one of the specific subtypes of adjustment disorder
DSM Criteria for OCD
A. Presence of obsessions, compulsions or both Obsessions defined by 1 and 2:
1. Recurrent persistent thoughts, urges, or images that are experienced, as intrusive and unwanted, that in most individuals cause marked anxiety or distress
2. Individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e. compulsion)
Compulsions are defined by 1 and 2”:
1. Repetitive behaviours (e.g. hand washing, ordering, checking) or mental acts (e.g.
praying, counting, repeating words silently) that the individual feels driven to perform in
response to an obsession or according to rules that must be applied rigidly
2. The behaviours or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviours or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent,
or are clearly excessive
B. Obsessions or compulsions are time-consuming( e.g. take more than 1 hour per day) or
cause clinically significant distress or impairment in social, occupational, or other important
areas of functioning.
C. Symptoms are not attributable to physiological effects of a substance or another medical
condition
D. Disturbance not better explained by symptoms of another mental disorder
Specifiers: good insight, poor insight and absent insight/delusional beliefs (a spectrum of delusional disorder)), tic related
what are examples of ocd symptoms
OCD medication tx and non-medical and surgicaql
Can use adjunctive medications
addition of an atypical antipsychotic - risperidone, aripiprazole are first line adjuncts
+CBT exposure and response prevention
Monitor response with scale
Surgical: anterior cingulotomy using gamma knife or thermolesions
First-line therapy for GAD (pharm and non pharm
CBT is gold standard non-pharm (other: psychodynamic)
Meds: SSRI, SNRI, pregabalin, buspirone
DSM Criteria for GAD
DSM Criteria for Panic Disorder
Agoraphobia DSM Diagnosis
Social anxiety disorder diagnosis
DSM Specific phobia
