Test 2 Flashcards
mc mental d.o
anxiety
mc anxiety d.o
phobias
50-60% of pt’s w. anxiety also have
dpn
similarities btw anxiety and dpn (3)
egodystonic → defined by negative emotional experience
triggered by stress
respond to SSRIs and CBT
excessive anxiety and worry about a number of events or activities, occurring more days than not for at least 6 mo - that are out of proportion to the likelihood or impact of feared events
gad
diagnostic criteria for gad (5)
meets definition
at least 6 mo
worry is pervasive and difficult to control
at least 3 associated symptoms
anxiety, worry, or fear cause clinically significant distress or impairment in social, occupational, or other important areas of life
associated sx w. gad (pt must meet at least 3)
restlessness or feeling keyed up/on edge
easily fatigued
difficulty concentrating or mind going blank
irritability
muscle tension
sleep disturbance
poorer outcomes/more complicated tx in patients with gad PLUS
mdd
comorbidities make anxiety disorders
harder to treat
common gad comobidities (4)
mdd -> mc
panic d.o
specific phobia
social phobia
FDA approved pharm for gad
1st line: SSRI → Paxil
2nd line: SNRI -> Venlafaxine
types of phobias (3)
agoraphobia
social phobia
specific phobia
mc phobia
specific phobia
which phobia has a focus on social performance and a situation in which a person is exposed to unfamiliar ppl or to scrutiny by others
social phobia
in social phobia, person fears they will act in a __
or __ way
humiliating
embarrassing
social phobia is related to __ anxiety
performance
tx for performance anxiety
beta blockers
is social phobia mc in men or women
men
phobia related to persistent fear that is excessive or unreasonable, and is cued by the presence of anticipation of specific object or situation
specific phobia
specific phobia is associated with an __ anxiety response
and the person recognizes that the fear is __
immediate
excessive/unreasonable
specific phobia is not diagnosable until it
interferes with a persons ADLs
is specific phobia mc in men or women
women
social phobia is mc in __
specific phobia is mc in __
social: men
specific: women
1st line tx for social anxiety and social phobia
SSRIs → Zoloft, Paxil
also: relaxation, CBT, exercise, diet
a pt with one phobia is likely to have
another phobia
phobia involving fear of areas where escape isn’t possible
agoraphobia
agoraphobia has to include 2 or more of the following (5)
using public transportation
open spaces
enclosed spaces
standing in line/being in a crowd
being outside of home alone
why do pt’s avoid certain situations in agoraphobia
fear that escape might be difficult or help might not be available if panic develops
does panic d.o have to be present for agoraphobia dx
no!
in desensitization/exposure behavioral therapy, we tell the pt that we can
unlearn a fear
the idea behind desensitization/exposure therapy is that avoiding a fear
reinforces it
putting pt in situation they fear → keep them from performing rituals/make them experience anxiety
response prevention
exposure therapy PLUS __ has better results than
__ alone
Anafranil (antidepressant ->TCA)
Anafranil
you can use desensitization therapy via __
or __
flooding
gradual
which type of desensitization is used for phobias
gradual → unplug the phobia and plug in positive response
gradual desensitization involves
continuous exposure, over and over
panic d.o reaches peak at __ min
and then starts to __
10 min
alleviate
sudden onset; misinterpretations of symptoms of panic
panic d.o
ex out of breath from running up stairs and think you’re having a heart attack
disorders related to OCD (6)
body dysmorphic
hoarding
hair-pulling → trichotillomania
excoriation → skin picking
substance/medication induced OCD
OCD dt another medical condition
OCD definition
obsessions or compulsions that cause marked distress
in OCD, obsessions or compulsions must: (3)
be time consuming
interfere significantly w. ADLs
create mounting tension that extends to loved ones
OCD is underdiagnosed; one reason for this may be that
pt’s are secretive about symptoms
2 mc comorbidities w. OCD
dpn
anxiety
also: tourettes, panic attacks
OCD and psychosis both involve
violent strange thoughts
differentiation btw OCD and psychosis
psychosis:
egosyntonic
no attempt to resist thoughts
thoughts are consistent w. delusions
OCD:
dystonic
resist OCD thoughts
pt is terrified of committing harm
differentiation btw OCD and OCD Personality Disorder
ODC Personality Disorder is egoSYNtonic
obsessions are __
compulsions are __
thoughts
actions
describe obsessions
thoughts, impulses, images
intrusive, recurrent, persistent
describe compulsions
actions, behaviors:
repetitive, ritualized, purposeful, intentional
obsessions and compulsions are perceived by pt as
irrational
senseless
egodystonic → no pleasure derived
what happens if a pt w. OCD resists compulsions
increases tension → yields to compulsion → tension relief
mc manifestations of OCD (2)
checking
cleaning
“checking” obsession/compulsion is related to
harm and/or aggression → leads to checking and repeating compulsions
“cleaning” obsession/compulsions are related to
contamination obsessions
harm and/or aggression is the __
and checking things is the __
obsession
compulsion
contamination is the __
and cleaning things is the __
obsession
compulsion
OCD has ~50% occurrence with what condition
pregnancy
post partum
screen all pt’s w. anxiety or dpn for
OCD
screening q’s for OCD (4)
repeatedly wash hands?
repeatedly check things?
repetitive thoughts of distress?
repetitive behaviors that are difficult to control?
OCD obsessions/compulsions are classified as __ behaviors
intrusive
1st line tx for OCD
SSRIs → start low go slow!
OCD pt’s may need __ doses
and __ duration of SSRI than dpn pt’s
higher
longer
SSRIs often __ sx for OCD,
but do not __ them
reduce
elliminate
it is rare for a pt to NOT see effect of SSRI w.in
8-12 weeks
what SSRI is not approved in kids/adolscents
paxil
evolutionary theories (2)
preparedness theory of phobias
genetic factors and anxiety d.o
humans are biologically prepared to learn to fear objects and situations that threatened the survival of the species throughout its evolutionary hx
preparedness theory of phobias
social anxiety d.o, panic d.o, and gad are all linked to specific genes
high rate of panic d.o in pt’s w. 1st degree relatives w. panic d.o
genetic factor and anxiety theory
relatives of panic d.o pt’s especially at high risk for __
but NOT __
panic d.o
GAD
-> supports genetic theories
relatives of GAD are at risk for __,
but NOT __
GAD
panic d.o
-> supports genetic theory
relatives of pt’s w. OCD are at risk for __
but not specifically at risk for __
all types of anxiety d.o
OCD
-> supports genetic theories
physical sx of panic d.o
sweating
palpitations
cognitive sx of panic d.o
impending doom
fear of dying
ways to increase a panic attack
CO2
lactate
caffeine
some studies have shown pt’s with panic disorder to have higher serum levels of
lactate
-> supports evolutionary theory
tx for panic d.o (2)
CBT
SSRI
tx for biploar PLUS panic d.o
atypical antipsychotics
mood stabilization BEFORE antidepressants
SSRIs > tricyclics
benzo moa
hyperpolarize the cell → less likely to fire
which mood disorders might benzos be used to treat
anxiety
panic d.o
but not first line
exposure to a traumatic event → numbing/avoidance of stimuli associated w. event; intrusive thoughts and re-experiencing event; hyperarousal
PTSD
5th mc psychiatric illness
PTSD
for dx of PTSD, sx must last at least __
1 month
1st line tx for PTSD
antidepressants
if symptoms of ptsd last < 1 month, the dx is
acute stress
failure to respond to 2 or more antidepressants from different classes w. adequate dose, duration, and compliance
treatment resistant dpn
goal of dpn tx
total remission
4 factors that indicate poor remission
poor work productivity
impaired psycho social fxn’ing
higher level of health care use
higher risk of suicide
causes of treatment resistant dpn
subtherapeutic meds
pt non adherence
intolerable adverse effects
misdiagnosed
mc reason for treatment resistant dpn
pt nonadherence → 40%
best predictor of response to ADM in STAR*D study
early response
in the STAR*D study, higher remission rates seen in
female
caucasian
employed
higher levels of ed and income
shorter current episode
fewer concurrent d.o
do studies show it is better to augment or switch meds w. treatment resistant dpn
augment
what drug in the STAR*D study was associated w. greater reduction in number and severity of sx
bupropion
in the STAR*D study, 25% of pt’s saw remission with __ alone
CBT
