Stress, Anxiety, and Somatic Disorders Flashcards
1
Q
Theories of Stress
A
- Diathesis Model: Individual heritable vulnerability that when acted on by a stressor produces disease/dysfunction
- Hans Selye’s General Adaptation Syndrome (GAS) An emotional or physiological change due to a perceived event or stressor
2
Q
Flight or Fight
A
- Hypothalamus stimulates the sympathetic nervous system
- SNS stimulates the adrenal medulla
- Adrenal medulla releases epinephrine and norepinephrine
3
Q
Sustained Stress
A
- Adrenocorticotropic hormone (ACTH) stimulates the adrenal cortex
- Release of mineralcorticoids
- Vasopressin
- Growth Hormone
- TSH stimulates the thyroid gland
- Gonadotropins
4
Q
Generalized Anxiety Disorder
A
- At least three symptoms
* Symptoms present more days than not over the course of six months
5
Q
GAD: Short term pharmacotherapy
A
- Benzodiazepines
- Clonazepam for social phobia
- Alprazolam for phobia
6
Q
GAD Long Term Pharmacotherapies SSRIs/SNRIs
A
- Fluoxetine (SSRI) for OCD, 20-80 mg/day
- Paroxetine (SSRI) for panic, OCD, social anxiety, 40-60 mg/day
- Sertraline (SSRI) for panic, OCD, PTSD, 50 -200 mg/day
- Vilazodone (5-HT1A receptor partial agonist)
- Effexor (SNRI) efficacy comparable to SSRI
7
Q
GAD Long term Pharmacotherapy
A
- Oxcarbazepine (Trileptal)
- Divalproex sodium (Depakote)
- Buspirone (Buspar)
- Beta blockers
- Chlorodiazepoxide (Librium) for substance withdrawal
- Tricyclic Antidepressants
- Clomipramine (Anafranil) for OCD
- Amitriptyline and Tazodone for agoraphobia
8
Q
Panic Disorder
A
- At least four symptoms
- Panic disorder includes recurrent unexpected attacks; Attacks are then followed by at least one month of one of both
- Persistent concern/worry about future attacks
- Significant maladaptive change in behavior
9
Q
Panic Attack treatment
A
- Anxiolytics
- Antidepressants
- CBT
10
Q
Phobias
A
- Fear/anxiety/avoidance lasting at least 6 months
- Out of proportion to actual danger
- Causes clinically significant stress
11
Q
Phobias: Etiology
A
- Specific phobias: increased amygdala activation; conditioning, modeling, traumatic experience
- Social phobia: increased activity in the limbic and paralimbic regions; traumatic social experience
12
Q
Phobias Treatment
A
- Benzos when phobic stimuli is unavoidable
- SSRIs when repeated exposure is expected
- Desensitization
- Flooding (implosive therapy)
13
Q
Obsessive Compulsive Disorder
A
- Presence of obsessions, compulsions, or both
- Obsessions/compulsions are time consuming or cause clinically significant distress
- DSM 5 Specifiers: with good/fair insight, with poor insight, with absent insight/delusional beliefs
- tic-related
14
Q
OCD Assessment
A
- Yale-Brown obsessive Compulsive Scale
15
Q
OCD Management
A
- Allow time for rituals
- Assist with the development of more adaptive methods of coping
- Behavior therapy
Meditation and relaxation techniques - SSRIs: Fluoxetine, setraline, paroxetine, citalopram, escitalopram
- Clomipramine (Anafranil)
16
Q
Body Dysmorphic Disorder
A
- Preoccupation with at least one perceived defect/flaw
- Individual has performed repetitive acts in response
- Preoccupation causes clinically significant distress
- Not better explained by an eating disorder
- DSM 5 specifiers: good/fair insight, poor insight, absent insight/delusional beliefs, muscle dysphoria
17
Q
Body Dysmorphic Disorder Assessment
A
- Body Dysmorphic Disorder Questionnaire-Dermatology version
- Dysmorphic Concern Questionnaire
- Body Dysmorphic Disorder Symptom Scale
- SSRIs
- Tricyclic when SSRIs not effective
- Neuroleptic agents to reduce psychotic symptoms
- CBT
18
Q
PTSD
A
- Exposure to a threat
- Intrusive symptoms; one or more symptoms
- Persistent avoidance of stimuli
- Negative alterations in cognition/mood: at least two symptoms
- Marked alterations in arousal.reactivity: at least two symptoms
- Disturbances longer than a month
- Disturbances cause clinically significant distress
- Disturbance longer than a month differentiates from Acute Stress Disorder
19
Q
PTSD: Etiology
A
- Exposure to traumatic events activates the amygdala
* The orbitoprefrontal cortex is less capable of inhibiting activation
20
Q
PTSD: Screening Tools
A
- PTSD checklist
* Clinician Administered PTSD scale
21
Q
PTSD: Pharmacologic Interventions
A
- SSRIs: Sertraline
- SNRIs: Venlafaxine
- Alph adrenergic receptor blocker: Prazosin
- Benzodiazepines
22
Q
PTSD: Non-Pharmacologic Interventions
A
- Individual therapy
- Cognitive therapy
- Behavior therapy
- Group/family therapy
23
Q
Adjustment Disorder
A
- Emotional or Behavioral symptoms in response to an identifiable stressor within 3 months of stressor
- Symptoms do not persist more than six months post stressor
- Categorized with Trauma/Stressor related disorders: Adjustment disorder, Acute Stress Disorder, PTSD
24
Q
Adjustment Disorder: Management
A
- Crisis Intervention
- Brief therapy
- Supportive techniques
- Pharmacotherapy for target symptoms
25
Q
Somatic Symptom Disorder
A
- One or more somatic symptoms that are distressing
- Excessive thoughts, feelings or behaviors related to the somatic symptoms
- State of being somatic lasts more than 6 months
- Medically unexplained symptoms
- Chronic use of health resources
26
Q
Somatic Symtom Disorder: Management
A
- Tricyclic antidepressants: first line
- SSRI for treating anxiety
- CBT
- Relaxation therapy
- Family Therapy
- Psychoeducation
27
Q
Conversion Disorder
A
- Loss/change in physiologic function without medical cause
- Symptoms of altered voluntary motor or sensory function
- Neurologic symptoms inconsistent with neurological disease
28
Q
Conversion Disorder: Etiology
A
- Hypofunction of the dominant hemisphere and over activity of the non-dominant side
- Decreased rCBF in the left temporal region
- Activation of the orbitofrontal cortex and the anterior cingulate gyrus
- Repression of unconscious intrapsychic conflicts and conversion of anxiety into physical symptoms
- Classical conditioning
29
Q
Conversion disorder: Management
A
- Education
- CBT
- Physical therapy
- Antidepressants, hypnosis, psychodynamic psychotherapy for refractory cases
30
Q
Dissociative Amnesia
A
- Sudden inability to recall important personal information: simple or fugue (new identity)
- Localized: No memory of details associated with traumatic event
- Selective: Remembers selective details
- Generalized: Recall of past life and identity lost
- Continuous: Unable to recall events after a specific time
- Use Dissociative Experiences Scale Revised
31
Q
Management
A
- Most resolve spontaneously
- Supportive psychotherapy
- Hypnosis
- Assist patient in learning adaptive coping skills
- Amobarbital for guided interview
32
Q
Dissociative Identity Disorder
A
- Formerly known as Multiple Personality Disorder
- Disruption of identity characterized by two or more distinct personalities
- Related alterations in affect, behavior, perceptions, memory, cognition
- Gaps in personal information recall
- Usually precipitated by stress
33
Q
Dissociative Disorder: Etiology
A
- Hx of early, on-going abuse
- Inborn tendency to dissociate
- Poor mother-infant attachment
34
Q
Dissociative Disorder: Management
A
- Psychotherapy
- Hypnosis
- Impress the importance of merging personalities
- Safety
- Antidepressants, anti-anxiety meds, antipsychotics for target symptoms.
35
Q
Depersonalization/Derealization Disorder
A
- Depersonalization: Experiences of unreality, detachment, or being an outside observer to one’s thoughts, feelings, sensations
- Derealization: Experiences of unreality or detachment with respect to surroundings
- During the episode, reality testing remains intact
- Transient symptoms are common, approximately 50% adult population
36
Q
Depersonalization/Derealization Treatment
A
- Promote accurate perception of self and environment
- Assist patient with responding to stress
- No particularly theory more helpful
- Hypnosis
- Benzos for anxiety
- SSRIs, SNRIs for anxiety and depressive symptoms
