Streyffeler 3

Question 1

BATHE MODEL

Answer 1

Response to worried patients

• B = background
  
  • what is going on in your life… tell me about the stressors in life
• A = Affect (how do you feel about it?)
• T = Trouble (what troubles you most about it)
• H = handling (how are you handling or coping iwth it)
• E = empathy (that must be very difficult)

Question 2

define anxiety

Answer 2

• A response to a threat that is sometimes known, but may also be unknwon, internal, vague or conflictual

Question 3

anxiety disorders

Answer 3

• anxiety that is severe, persistent and disabling and persists beyond developmentally appropriate periods of time

Question 4

Key features of anxiety disorders

Answer 4

• Physical (somatic) symptoms = tachycardia, lightheaded
• Affective symtpoms = uneasiness ———-> panic
• Behavioral symptoms = avoidance ———–> compulsions
• Cognitive symtpoms = apprehension —-> worry —–> obsessions

3 A’s

• Anticipation/appraisal ( cognitive, cortical)
• Arousal (physiological-subcortical including limbic)
• avoidance (behavioral)

Question 5

Separation anxiety

Answer 5

• Developmentally inappropriate, excessive and recurring fear relation to separation from home and/or attachment figures (duration: adult - 6months; child - 4 weeks)
  
  • can include
    
    • fear of losing them in some way
    • fear of experiencing an even tthat takes one away from significant others
    • fear of being alone or sleeping without another
    • repeated nightmares of separation

Question 6

Panic attacks

Answer 6

• normally reach a peak within 10 mins and resolve itself in 20-30mins
• WITH ASSIsTANCE, patients can learn to “ride out” attacks
• GOALS:
  
  • resolve panic attacks
  • reduce general and anticipatory anxiety
  • minimize avoidance behaviors

Question 7

PANIC DISORDER

Answer 7

• recurrent, unexpected panic attacks evidenced by at least 4 of the following
  
  • heart disturbances (racing, palpitations
  • Shortness of breath
  • chest pain
  • dizzy, lightheaded
  • fear of dying
  • paresthesias
  • lots of others***

Question 8

agoraphobia

Answer 8

• sources of fear/anxiety (need 2 or more)
  
  • public transportation (bus, train, plane)
  • open spaces
  • enclosed spaces (elevator, theatre)
  • being caught in a crowd or line
  • being outside the home alone
• 80% of diagnosed pts are female
• ETIOLOGY
  
  • panic attack –> feat of panic attack –> hypersensitivity –> avoidance –> stay in safe splaces

Question 9

Specific phobia

Answer 9

• marked fear or anxiety about a SPECIFIC OBJECT or SITUATION
  
  • animal type, natural enviornment type, blood injection, situational type, etc
• Predisposing factors
  
  • traumatic event involving the feared object or situation
  • observing others in a fearful situation (MODELING)
  • panic attack in particular situation

Question 10

Social anxiety disorder

Answer 10

• Marked fear/anxiety of SOCIAL SITUATIONS INVOLVING EXPOSURE to the possible scrutiny of others; concerns for acting in a way that is HUMILIATING or EMBARRESSING
  
  • onset
    
    • often mid-teens or late childhood
    • can be in response to humiliating or stressful event
  • Common situations feared include
    
    • socail events, meeting new people, public speaking, performing in some way, eating in public etc
  • Duration is often life-long

Question 11

Generalized anxiety disorder

Answer 11

• Excessive anxiety/worry about a number of events or activityes
• Difficulty controling the worry/anxiety
• including at least 3 of the following
  
  • restlesness, on edge
  • easily fatigues
  • diffiuclty concentration or mind goes blank
  • irritability
  • muscle tension
  • sleep disturbance

Question 12

Common clincial features of GAD

Answer 12

• motor tension = headache, shakiness, restless
• autonomic hyperactivity = shortness of breath, sweating, palpitaitons, GI symtpoms
• Cognitive vigilance = increased irritbaility and startle reactivity

HIGH INCIDENCE OF CORMORBID SUBSTANCE ABUSE

Question 13

Anxiety related to medical conditions

suspicious indicators

Answer 13

• onset of symptom after age 35
• lack of psychosocial history of anxiety
• no childhood issues realted to anxiety
• lack of exacerbating life events
• lack of avoidance behaviors
• poor resposne to antianxiety medications

COMMON CONDITIONS related toa nxiety symptoms

• endocrine, CV, respiratory, metabolic neruolgoical illnesses