week 2;anxiety disorders,, trauma and stress related disorders, and Obsessive Compulsive and related disorders, Flashcards
define the terms anxiety, fear, and panic;
ANXIETY=a negative mood with physical tension,apprehension re future, possible worry behaviours such as fidgeting.
FEAR=an immediate alarm to danger, with increased heart rate and blood pressure etc.
PANIC=sense of overwhelming fear. Panic attack is acute intense fear, usually with heart palpitations, chest pain, shortness of breath, sometimes dizziness.
describe the biological, psychological, and social contributions to anxiety, obsessive-compulsive and related disorder, and trauma and stressor related disorders, and their integration;
CONTRIBUTORS TO ANXIETY;inherited tendency to be tense/anxious, specific brain circuits , depleted GABA, switching on of Corticotropin-releasing-factor (possibly genetic influence), limbic system involved, BIS(behavioural Inhibition System) and the Fight/Flight System involved. A general feeling of Üncontrollability(possible parental actions big impact on whether or not occurs), proness to “änxiety
sensitivity” (personality trait), stressful life events
CONTRIBUTORS TO PANIC; conditioned response, genetics, anxiety tendency increases liklihood of panic
TRIPLE VULNERABILITY THEORY-states a mix of contributors to anxiety, involving generalised biological vulnerability, generalised psychological vulnerability (ie disbelief in control) and specific psychological vulnerability (eg learn to be afraid of dogs for whatever reason)
discuss the issue of comorbidity in anxiety and related disorders;
high rate of comorbidity b/n anxiety and depression. Shared vulnerabilities to anxiety, depression, panic. Many with anxiety or depresssion, have elements of more than 1 anxiety or depressive related disorder. Risks for anxiety and depresion partially mediated by low self esteem and childhood sexual abuse. Anxiety also often comorbid with gi disease, resp dz, allergy. Where both exist, level of suffering/disability is greater.. Panic attacks often comirbid with cardiac issues, inner ear disorder, gi dz, resp dz.
20% of those with Panic Disorder, attempt suicide.. Same for Depression.PTST also high risk suicide. Increased suicide risk if anxious.
name the major anxiety, obsessive-compulsive and related disorders, and trauma and stressor-related disorders listed in the DSM-5 and their distinctive features;
ANXIETY DISORDERS; typically signs of anxiety or panic. 1. Generalised Anxiety Disorder 2. Agoraphobia 3.Other-Specific Anxiety Disorder 4 Panic Disorder 5. Nocturnal Panic 6.Specific Phobia 7. Separation Anxiety Disorder 8. Social Anxiety Disorder 9. Selective Mutism TRAUMA AND STRESS RELATED DISORDERS after a stressful life event 1. Post-Traumatic Stress Disorder 2.Attachment Disorders 3. Adjustment Disorders OBSESSIVE COMPULSIVE AND RELATED DISORDERS-driven repetitive behaviours 1. Obsessive Compulsive Disorder 2.Tic Disorder 3. Body Dysmorphic Disorder
describe the clinical features, causes, and treatment of panic disorder and of agoraphobia;
PANIC DISORDER;severe unexpected panic attacks, often copresenting with agoraphobia.Develops profound anxiety re possibly having another panic attack (minimum 1 month),attempts to cope with the possible panic inlude avoidance (agoraphobia), and substance abuse, sometimes situations are endured with intense fear. Many also have some degree of interoceptive avoidance (avoidance of bodily sensations such as sweat etc).2/3rds are women.Usual onset is early adult (teen-40’s), rare in children.in US whites more likely than asian or african.Biological and psychological causes interacting.8-12% of population will experience a panic attack yet not develop panic disorder.Tx;benzodiazepine (eg xanax),SSRI,(eg prozac), serotonin norepinephrine reuptake inhibitor (SNRI)(eg venlafaxine).SSRI possibly best med, but high rate sexual dysfn side effect.benzodiazepenes most commonly used but addictive and impairs motor/cognition.Exposure Therapy as psychological tx is quite effective.drug and psychological tx equally effective, as is combined tx but combined or cbt lasted longer.Benzodiazepenes likely interfere with cbt.Meds usually respond quicker but don’t last as well as cbt.
AGORAPHOBIA-fear/avoidance of a situation as feel unssfe or unable to escape to safety (often fearing what would happen if have a panic attack or something else eg loss of bladder control away from home).Tx with anxiety reducing exercises, gradual exposure therapy.Panic control tx is a specific exposure therapy focussing on building tolerance to interoceptive sensations.
describe the clinical features and subtypes, causes, and treatment of specific phobia;
Irrational fear of object/situation markedly interfering with ability to fn.The object/situation provokes immediate fear/anxiety.The fear response is out of proportion.persists for 6 months+
Specific subtypes include:Animal, Natural/environmental, blood-injection injury, Situational, Other.Under most situations of experiencing phobia, there is increased heartrate and blood pressure and feel like fainting, but do not. In Blood injection phobia, there is also an excessive vasovagal response, and they do faint.Situational phobias tend to develop in teens or 20’s.
Note that situational phobia is experience only in the situation whereas panic disorder can have a panic attack unexpectedly.
Natural environmental phobia often onset when very young.Aniamal and environmental phobias peak at 7 years of age.Phobias tend to last a lifetime.
Phobias may occur through direct experience of an adverse event, or by hearing/observing about others, or being told re danger etc.May have a generalised vulnerability.Usually combination of a fearful event or being told about danger, and a predisposition to be fearful and to be anxious.Blood phobia highly inheritable.Others seem to be too.Social factors re whether can report the phobia or not.
Tx is Exposure Therapy.
describe the clinical features, causes, and treatment of post-traumatic stress disorder;
PTSD;features; at least 1 month of symptoms, which started after a very stressful event involving threat of death/severe harm or sexual violence or witnessed.Symptoms of avoiding memory triggers, difficculty sleeping, bad thoughts, irritability, interfering with fn, intrusive memories, negative cognition alterations, sometimes dissociated responses. Sometimes onset can be delayed by months or years after the event.
ACUTE STRESS DISORDER-similar to ptsd but has occurred for less than 1 month.
Causes;biological vulnerability, and having experienced a traumatic event. The closer to the centre of the event, or if of a repeated nature, the higher the risk of developing disorder.
Treatment;psychological recommended. need to revisit the trauma and be able to process the emotion, and put aside eg feelings of guilt. often in format such as Prolonged exposure therapy where repeatedly revisit an imagined version of the trauma. Counselling sessions to process trauamas are ideal for ASD and means less likely to go into PTSD. SSRI’s can be useful for PTSD too. d-cycloserine (DCS) is a newer drug which may be of benefit in PTSD.
Fear Memory Consolidation is a process where fear memory is re-activated, then returned to long term memory
describe the clinical features, causes, and treatment of obsessive-compulsive disorder;
related to anxiety disorder, driven repetitive behaviours,despeately trying to gain some control, try to avoid certain thoughts, images or impulses. Having either obsessions (intrusive, mostly non sensical thoughts), and or compulsions (thoughts or actions used to suppress the obsessions).Such compulsions are excessive and time consuming, cause dysfn.
Subtypes: Symmetry obsessions, forbidden thoughts/actions, cleaning/decontamination, hoarding.
10-40% with OCD also have a tic disorder.
M:F 1:1. Onset ranges from childhood to mid 30’s.
Thought-action fusion-the idea that to think a thought is to be responsible for it happening in action. This tendency seems far worse in those with OCD of strong religious background.Possibly enhanced by excessive feelings of responsibility developed in childhood.There may be a paricular individual level of vulnerability to believing some thoughts are unacceptable and must be suppressed, which leads to OCD.
Clomipramine or SSRI’s help 60% of OCD patients. Psychological tx is better, but they are not readily available. Best tx is psychological and called Exposure and Ritual Prevention (ERP)-rituals prevented and patient gradually exposed to the feared thought/situation.CBT can also be beneficial. Surgeries of cingulotomy or capsulotomy have been used in extreme cases with approx 33% success.Deep brain simulation may also be beneficial as a last resort and is reversible, unlike surgery.
describe the clinical features, causes, and treatment of social anxiety disorder;
SAD (also known as social phobia), is more severe than shyness.Marked fear/anxiety re social situations and possible scrutiny by others.the fear is disproportionate. . Persistent, minimum 6 months duration.causes impaired fn.Predisposed to remember critical or angry faces, possible greater amygdala activity, and less cortical regulation.Possible excessive BIS activation.Biological vulnerability to anxiety.Possible psychological belief that stressful events are uncontrollable.May have had traumatic /upsetting social experiences. Most report having experienced severe bullying in childhood.Parents possibly more socially fearful.
Tx is CBT, family based therapy better for children. Beta blockers (tried b/c reduce heartrate) proven ineffective, but SSRI’s are beneficial.CBT best.Seems CBT may be more effective if patient has a dose of DCS prior to session.
describe the clinical features, causes, and treatment of generalized anxiety disorder;
Generalised worry re many different things, usually minor everyday things. Unable to stop worrying.6 months minimum duration.More days spent worrying than not.Muscle tension and mental agitation.Fatigue, irritability and difficulty sleeping.Mind wanders from one impeding crisis to the next.Causing dysfn.M:F, 1:2.Usually starts early adult and as result of a particular life stressor.Onset often more gradual than other anxiety disorders.Is chronic.Higher prevalence in older adults.
General biological vulnerability, anxiety sensitivity is inheritable. Compared to other anxiety or panic disorders though GAD sufferers tend to respond to stress with less cardiac vagal tone, (autonomic inflexibility) but far more muscle tension.Generally highly sensitive to potential threat, with intense cognitive processing.They avoid images of potential threat but successful therapy requires confronting them, which would facilitate working through pronlems.ie thought the worry is similar to the avoidance shown by phobics.
Benzodiazepenes work quite well but are short term.CBT is moderately effective.Antidepressants quite good.CBT has longer effect.Relaxation techniques also beneficial.Meditation and mindfulness also help.Train patients to increase their tolerance to an uncertain future.
describe the clinical features, causes, and treatment of body dysmorphic disorder
Preoccupation with one or more tiny or non existent appearance flaws.Repetitive actions of mirror checking, excessive grooming, reassurance seeking.Causing distress or dysfn.Related to OCD.Persistent intrusive thoughts re appearance.Occasionally complete phobic avoidance of mirrors. Frequently have suicidal thoughts.Have “ideas of reference”meaning think everything relates to them (specifically to their imagined defect).Many become housebound.Less likely to recognise their irrationality than those with OCD.Men tend to focus on body build, genitals and thinning hair, women more likely to have a concurrent eating disorder. Age of onset teens-20’s.Chronic..One of the more depressive and serious disorders. few marry. many seek cosmetic surgery or dermatologists. Few will ever be satisfied by the end result.May attempt to alter their appearance themselves eg put staples in face to make skin taut etc.No familial information.15% comorbid with an eating disorder. Also Social Anxiety Disorder often comorbid.
Some aided by SSRI’s (clomipramine or fluvoxamine) or fluoxetine.Or exposure and response CBT. CBT benefit (if responds) tends to last longer than drugs.
describe the core clinical features of the other disorders within these categories – namely separation anxiety disorder; selective mutism, adjustment disorders, attachment disorders, hoarding disorder, trichotillomania (hair pulling disorder), and excoriation (skin picking disorder).
SEPARATION ANXIETY DISORDER;developmentally inappropriate excessive fear of being separated from loved ones, fearing something will happen to self or loved ones.Can occur in adults also, and may arise de novo or be a continuation of childhood. SAD. Persists minimum 1 month in children and 6 months in adults.
SELECTIVE MUTISM; consistent failure to speak in certain circumstances lasting at least 1 month (but not simply the first month of school).Interferes with education/occupation.
ADJUSTMENT DISORDERS; behavioural or emotional symptoms developing within 3 months of having experienced a stressor. Causing marked distress or impairment. Not considered eg “normal bereavement”.. Cause impairment but concerned less severe than PTST. Not supposed to continue for longer than 6 month (as otherwise needs to be classified as something else???)
HOARDING DISORDER; persistent difficulty parting from possessions irrespective of if worthless.Perceived need to keep them and distress at thought of discarding.Results in excessive clutter, and if living area s are clear of clutter it is only because of the intervention of other family members or agents. Causes distress and impairment.
TRITRICHOTILLOMANIA; repeated hairpulling causing alopecia, with attempts to stop having failed.Causing distress/impairmt.
SKIN PICKING DISORDER; (excoriation). excessive recurrent skin picking which creates lesions. Causes distress/impairment.
