Session-8 The Anxiety Disorders Flashcards
What is the single most common psychiatric condition?
Anxiety disorders
Anxiety disorders posses a vulnerability to..?
Persons possess a vulnerability to anxiety that can be genetically inherited or acquired through traumatic experience
What is the formation of anxiety-producing cognitive schemas?
Formation of anxiety-producing cognitive schemas: stressful life events; triggers for subsequent activation of anxiety: stressful life events.
Once schemas are formed and activated, they can produce negative misinterpretations in cognition, thus structuring a normal or less serious situation as something catastrophic, life threatening, or seriously embarrassing
What are DSM-IV-TR Anxiety Disorders?
Panic Attack, Agoraphobia, Panic Disorder with our without Agoraphobia, Agoraphobia without History of Panic Disorder, Specific Phobia, Social Phobia, Obsessive-Compulsive Disorder, Posttraumatic Stress Disorder, Acute Stress Disorder, Generalized Anxiety Disorder, Anxiety Disorder Due to a General Medical Condition, Substance-Induced Anxiety Disorder, Anxiety Disorder NOS
What is a Panic Attack?
See pg. 432 of DSM-IV-TR: not a codable disorder. Need to code specific diagnosis in which the Panic Attack occurs (e.g., Panic Disorder with Agoraphobia).
Period of intense fear or discomfort, in which 4 symptoms developed abruptly and peaked within 10 minutes.
Intense fear or discomfort in the absence of real danger (symptoms can be cognitive and/or somatic, but there is a large somatic component of onset including sweating, shaking, trembling, etc.
Once a person develops anxiety related to panic attacks, various other symptoms and disorders can develop (specific phobias, agoraphobia, OCD, and major depressive episodes).
What is Agoraphobia?
see p. 433 of DSM-IV-TR: not a codable disorder. Code the specific disorder in which the Agoraphobia occurs (e.g., Panic Disorder with Agoraphobia).
Anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having a Panic Attack or panic-like symptoms, resulting in avoidance.
Avoidance typically causes social or occupational impairment.
You always diagnose “Agoraphobia with or without History of Panic Disorder.”
“Agoraphobia Without History of Panic Disorder”: see p. 441: this diagnosis is very similar to Panic Disorder with Agoraphobia but criteria not met for Panic Disorder and focus of fear is on the occurrence of incapacitating or extremely embarrassing panic-like symptoms or limited-symptom attacks (dizziness or diarrhea) rather than full Panic Attacks
More than 95% of patients with Agoraphobia also have a current diagnosis or history of Panic Disorder.
What are the Agoraphobia Without History of Panic Disorder Differentials?
Panic Disorder with Agoraphobia: diagnose if there is a history of recurrent unexpected Panic Attacks, and fear of a full Panic Attack; Panic attacks may go into remission, but there is still Agoraphobia.
Social Phobia: diagnose if avoidance of social or performance situations is due to fear the person may act in a way that is humiliating or embarrassing.
Specific Phobia: diagnose is a specific feared object or situation is avoided.
Major Depressive Disorder: diagnose if avoidance of leaving home is due to apathy, loss of energy, or anhedonia.
What is Panic Disorder?
Diagnose either “Panic Disorder without Agoraphobia” (p. 440) or “Panic Disorder with Agoraphobia” (p. 441).
Main feature is criteria met for Panic Attacks (p. 432): the panic attack is extremely frightening, person may feel he or she is either going crazy or dying; the panic attack is usually traumatic, leaving the person with an intense fear of having another one in the future (i.e., may lead to phobia).
Presence of recurrent, unexpected Panic Attacks followed by at least 1 month of persistent concerns about having another Panic Attack.
Panic Attacks may eventually lead to a sense of demoralization and symptoms of major depression; especially true when individuals cognitively construct the problem as something INTERNAL, STABLE, and GENERAL.
High rate of comorbidity re: Panic Disorder and MDD.
What are Panic Disorder Differentials?
Anxiety Disorder Due to a General Medical Condition: diagnose if panic attacks are the direct physiological consequence of a general medical condition (e.g., hyperthyroidism).
Substance-Induced Anxiety Disorder: diagnose if panic attacks are the direct physiological consequence of a substance.
If panic symptoms occur in the context of situationally-bound or situationally-prediosposed conditions (Social Phobia, Specific Phobia, etc. – see p. 438), diagnose the other anxiety disorders
What is Specific Phobia?
Marked and persistent fear of clearly discernible, circumscribed objects or situations; exposure to these objects provokes an immediate anxiety response. Adults typically recognize the fear is excessive or unreasonable, but they are unable to control their cognitive processes/emotions.
5 subtypes (p. 445): Animal, Natural Environment, Blood-Injection-Injury, Situational, and Other.
First symptoms of a Specific Phobia usually occur in childhood or early adolescence and may occur at a younger age for women than for men.
There is an increased risk for Specific Phobias in family members of those with the diagnosis
What are Specific Phobia Differentials?
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Panic Disorder With Agoraphobia: diagnose if repetitive Panic Attacks in which there is pervasive anxiety not limited to a specific, circumscribed object or situation.
Social Phobia: diagnose if avoidance is based on concerns about negative evaluation from others.
What is Social Phobia (Social Anxiety Disorder)?
Marked and persistent fear of social or performance situations in which embarrassment or humiliation may occur; exposure to the social or performance situation provokes an immediate anxiety response.
There is frequently a circular pattern of conditioning: fear of a social situation provokes an anxiety response which then results in embarrassment and further anxiety. This results in more fear of similar situations.
For Social Phobia (Social Anxiety Disorder), when may you use the specifier “Generalized”?
May use the specifier “Generalized” when fears are related to most social situations (fear both public performances and social interactional situations).
What are the Social Phobia Differentials?
Differentials are very complex – Social Phobia is highly associated with Panic Disorder, OCD, Mood Disorders, and Somatization Disorder, and usually precedes these disorders.
Keep in mind: a person with Social Phobia fears/avoids situations limited to those involving scrutiny by others.
Panic Disorder with Agoraphobia: typically characterized by the initial onset of unexpected Panic Attacks and the subsequent avoidance of multiple situations thought to trigger Panic Attacks (Panic Attacks usually not limited to social situations).
Separation Anxiety Disorder: diagnose if avoidance of social situations are due to concerns about being separated from caretaker, concerns about being embarrassed by needing to leave prematurely to return home, or concerns about requiring the presence of a parent.
GAD: diagnose when concerns are about the quality of one’s performance, even when the concerns occur when the person is not being evaluated by others.
Avoidant Personality Disorder: seems to overlap with Social Phobia, Generalized. Some view Avoidant PD to be a more severe variant of Social Phobia, Generalized, and not qualitatively distinct (see p. 455).
What is Obsessive-Compulsive Disorder (OCD)?
Recurrent and persistent obsessions (impulses/thoughts) or compulsions (behaviors) that are time-consuming or cause marked distress or significant impairment.
Adults: recognize that the obsessions or compulsions are excessive, unreasonable, intrusive or inappropriate (not apply to children).
May use the specifier “With Poor Insight.”
