Test 2 Flashcards by Alice Richards

mc mental d.o

anxiety

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mc anxiety d.o

phobias

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50-60% of pt’s w. anxiety also have

dpn

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similarities btw anxiety and dpn (3)

egodystonic → defined by negative emotional experience

triggered by stress

respond to SSRIs and CBT

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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

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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

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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

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poorer outcomes/more complicated tx in patients with gad PLUS

mdd

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comorbidities make anxiety disorders

harder to treat

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common gad comobidities (4)

mdd -> mc

panic d.o

specific phobia

social phobia

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FDA approved pharm for gad

1st line: SSRI → Paxil

2nd line: SNRI -> Venlafaxine

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types of phobias (3)

agoraphobia

social phobia

specific phobia

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mc phobia

specific phobia

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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

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in social phobia, person fears they will act in a __

or __ way

humiliating

embarrassing

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social phobia is related to __ anxiety

performance

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tx for performance anxiety

beta blockers

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is social phobia mc in men or women

men

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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

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specific phobia is associated with an __ anxiety response

and the person recognizes that the fear is __

immediate

excessive/unreasonable

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specific phobia is not diagnosable until it

interferes with a persons ADLs

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is specific phobia mc in men or women

women

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social phobia is mc in __

specific phobia is mc in __

social: men
specific: women

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1st line tx for social anxiety and social phobia

SSRIs → Zoloft, Paxil

also: relaxation, CBT, exercise, diet

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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