Week 5 Flashcards
Anxiety Disorders
Experience of anxiety: where does it come from?
- Genes & Environment
Anxiety Disorders
Trauma Related (PTSD)
- traumatic events disrupt a person’s homeostasis
Anxiety Disorders
Homeostasis
- principle by which our bodies function
- drive to keep in balance
- mechanisms to correct that which goes awry
- when person experiences stress, homeostasis goes out and physical things will change
- heart rate will accelerate, temperature will increase, glucose levels rise, etc.
- Body seeks to re-stabilize and does so by secreting two hormones:
- Epinephrine/adrenaline
- Gluco-cortical/Cortisol
Anxiety Disorder
“Fight or flight” response engages these hormones in response to a traumatic event, or for anticipation of one.
- Epinephrine/adrenaline
- Gluco-cortical/Cortisol
Anxiety Disorders
Anticipatory anxiety
- is most common of all anxiety and releases these hormones
- (adrenaline and Cortisol)
- spilled into the brain without actual danger
- (This is the biological basis of anxiety)
- this anxiety exists in anticipation of an event(s)
- (i.e. anxiety over whether or not my car will start when I leave class even though nothing is wrong with my car at all)
Anxiety Disorders
Psychological experience of person in anxiety…
- overestimate the danger; tense
What is the most common of all disorders we deal with?
- Anxiety
Fear
- emotional response to real or perceived effects
Anxiety
- anticipation of future threats causing you vigilance, caution, hypertension, and the tendency to avoid places where the fear would be even worse
- Runs in families like mood disorders
- Frequently misdiagnosed and/or ignored by physicians (especially in women)
Panic Attacks
- short periods of intense fear; last approx. 10 minutes
Epidemiology
- Up to 3% of the population have a lifetime anxiety
- It is the primary symptom of up to 25% of all psychiatric disorders
- Up to 70% of patients who visit physicians for treatment have anxiety and stress as significant factors (may go for other things but this is something that is going to be a problem)
Comorbid Conditions
- Major depressive disorder (depression often co-occurs with anxiety)
- Substance use disorder (often people attempt to self-medicate)
- Hypertension (common; known as “elevated blood pressure”)
Onset
- (don’t say “when it started” – use the term “onset”)
- Often preceded by:
- Marital disruption
- Death, crisis
- Financial upheaval, etc.
Why is anxiety often misdiagnosed?
- it can be overlooked and if you have an addictive behavior also that will be picked up first.
Statement to remember Generalized Anxiety diagnosis
- JJ has all the worries all the time
What is the difference btw fear and anxiety?
- Fear happens when something is imminent or happening
- anxiety is in anticipation of something
Statement to remember Specific Phobia diagnosis
- Jessica is afraid of the specific thing, spiders
Statement to remember social anxiety diagnosis
- Fear of being in front of people and getting judged
Symptoms of Panic Attack
(Always present with panic disorder)
- Palpitations or racing heart
- Sweating
- Trembling
- Shortness of breath or smothering sensation
- Choking sensation
- Chest pain or discomfort
- Abdominal discomfort
- Dizziness or fainting sensation
- Derealization
- [feeling as though people and world around you are not real or move in slow motion]
- depersonalization
- [see self as outside of your own body; observing self]
- Fear of losing control or “going crazy”
- Fear of dying
- Numbness or tingling sensation
- Chills or hot flashes
Uncued Panic Attack
- nothing is causing panic attack
- (comes from nowhere)
Cued (or expected) Panic Attack
- developing panic attack in presence of something
- they are in response to something
Agoraphobia and sentence to remember the diagnosis
- the experience of anxiety in a specific situation from which you do not feel you can escape easily
What are the four types of Specific Phobia?
- Animal
- natural environment
- blood/injection/injury
- situational
Symptoms of Specific Phobia
- Excessive fear of specific object or situation
- Exposure to stimulus almost invariably causes anxiety
- Person recognizes anxiety is excessive
- could lead to client feeling excessive guilt, or others making that person feel guilty
- Stimulus is avoided or endured with great anxiety
- Avoidance or the distress interferes in functioning
What needs to be ruled out before diagnosing specific phobia?
- OCD,
- PTSD,
- Panic Disorder,
- Agoraphobia,
- Social Phobia,
- Separation Anxiety Disorder
Treatment Planning considerations for Specific Phobia
- Anti-depressants
- Systematic Desensitization
- Exposure to the object of the phobia or the situation
Symptoms of Social Phobia
- Fear of social or performance situations (being evaluated or judged) in which person is exposed to either unfamiliar people or scrutiny of others
- Exposure to social situation almost invariably causes anxiety
- Person recognizes fear is excessive
- Situations are either avoided or endured with great anxiety
- Avoidance or distress interferes in functioning
What needs to be ruled out before diagnosing Social Phobia?
- Medical condition or substance use,
- Panic Disorder,
- Agoraphobia,
- Separation Anxiety Disorder,
- Eating Disorder,
- Body Dysmorphic Disorder
What does JCAHO stand for and what does it do?
What do Common Clinic Commitees do?
- Continuous quality improvement
- utiliztiation review
- safety
- infection control
- clinic privileges and credentialing
BPS DD
What is a mental disorder?
- Clinically significant behavioral or psychological syndrome or pattern that occurs and is associated with present distress or disability in important areas of functioning
- psychological
- social
- occupational
What makes something clinically significant?
- Must have some for of physical, social or occupational impairment that causes distress in one’s life
DIDU
What are the Features of a Diagnosis?
- Must cause distress, must show impairment in functioning, and must be a clear deviation of usual roles.
What does a Master Treatment Plan Consist of?
- A master treatment plan consists of the problem, the goal, and between 8-10 objectives.
CS PSO CD
What Three Distinct Features Define Psychopathology?
- Clinically significant impairment of psychological, social or occupational functioning that causes distress to individual.
What Three Things are Looked at in order for a Person to Meet the Criteria of a Diagnosis?
- 3 s’s
- Signs - objective, Symptoms- subjective, Syndromes – combination of the two
OCD and Related Disorder
How common is OCD?
- 4th most common disorder in U.S.
What are OCD and other Related Disorder?
- Either obsessions or compulsions (cleaning, checking, repeating, organizing)
- At some point the person has recognized that the obsessions or compulsions are excessive
- Symptoms cause marked distress, are time consuming (hour or more per day) or interfere in daily functioning
- Not due to substance or medical condition
OCD and Related Disorder
What do we rule out before Diagnoses?
- Eating Disorder,
- Hypochondriasis,
- Body Dysmorphic Disorder,
- Major Depression, and PTSD
OCD and Related Disorder
obsessions
- unwanted thoughts that are intrusive and do not seem to want to go away
- recurrent thoughts
- they are unwanted and intrusive
OCD and Related Disorder
compulsions
- behaviors that a person engages in to manage the anxiety caused by the thoughts
- compulsive behavior is driven by obsessions
- the repetitive behaviors
Generalized Anxiety Disorder
- Excessive/Over-the-top worry and anxiety over a number of events that persist for at least 6 months (can’t eat, can’t sleep, racing thoughts, etc.)
- Difficulty controlling the worry
- Three or more anxiety symptoms with at least some persisting for at least 6 months (restlessness, fatigue, going “blank,” muscle tension, disturbed sleep…)
- Clinically significant distress or impairment in functioning
Generalized Anxiety Disorder
Rule out before diagnosis?
- Panic Disorder,
- Social Phobia,
- OCD,
- Hypochondriasis,
- PTSD,
- Eating Disorder
- Medications
- medical conditions
Acute Stress Disorder
- Exposed to traumatic event which:
- Involves actual or threatened death or serious injury to self or others
- Is responded to with intense emotion
- Person develops dissociative symptoms (3) during event or immediately after (dissociative symptoms = feeling detached, feeling dazed, depersonalization, derealization etc.)
- Event is persistently re-experienced with all physiological experiences of the actual event (ex. dreams)
- Avoidance of reminders of event
- Overall increased anxiety or arousal
- Causes impairment in social or occupational functioning or impairment in completing necessary tasks
Acute Stress Disorder
Duration of Symptoms
- Two days- four weeks
- if lasts longer, it’s PTSD
Physical disorders that may cause anxiety
- Adrenal tumor (kidney)
- Alcoholism
- Coronary insufficiency (inadequate blood flow)
- Delirium
- Hypoglycemia [hypo = too little]
- Hyperthyroidism [hyper = too much]
- Mitral valve prolapse
General Approach to Treatment of Anxiety
- Behavioral and cognitive approaches preferred
- other approaches can create too much focus on the anxiety
- Rule out (R/O) medical conditions – have a physical exam
- Focus on cognitions – “cognitive restructuring”
General Treatment Issues with Anxiety
Understand the cause
- What is the client telling himself?
- most of the time anxiety comes from the things that you tell yourself
- self-talk is what maintains the tension
- examine what the client is telling themselves
- Is it valid?
General Treatment Issues with Anxiety
Stress management
- manage stress or stress will manage you.
- Stress exacerbates anxiety
General Treatment Issues with Anxiety
Eliminate alcohol
- (also for people with zero problems with alcohol)
- caffeine
- get to a moderated place.
- Make contract with patient about no alcohol or caffeine as part of the treatment process for the duration of therapy.
General Treatment Issues with Anxiety
Self-talk skills,
- “coach” self; track positive self-talk
General Treatment Issues with Anxiety
Ego strengthening
- (aka assertiveness training)
- teaching a sense of possibility. Use ego-strengthening instead because BCBS won’t pay for assertiveness training.
General Treatment Issues with Anxiety
Time structuring
- (big problem for people with anxiety because they are always behind where they are supposed to be)
- set them on a schedule for time management.
General Treatment Issues with Anxiety
Anger management
General Treatment Issues with Anxiety
Nutrition and exercise
- (send them to a physician)
-
NEVER tell a client to exercise
- (you don’t know their cardiac state, physical fitness, etc.)
General Treatment Issues with Anxiety
Self-esteem enhancement
- a resulting consequence of the other actions above: don’t start here.
Panic Disorder
- Must have had panic attacks in order to be diagnosed w/ this disorder
- Treatment Considerations
- Rule out substance abuse- self-medicating
- 33% spontaneously remit - testimonials?
- Deal with the shame
Panic Disorder: Treatment Planning
Cognitive Behavioral Therapy
- Cognitive
- Teach about panic itself
- Learn positive self-talk
- Behavioral
- Breathing exercises (teaching them how to relax)
- Deep muscle relaxation
