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DSM > Week 5 > Flashcards

Week 5 Flashcards

1
Q

Anxiety Disorders

Experience of anxiety: where does it come from?

A
  • Genes & Environment
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2
Q

Anxiety Disorders

Trauma Related (PTSD)

A
  • traumatic events disrupt a person’s homeostasis
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3
Q

Anxiety Disorders

Homeostasis

A
  • 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
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4
Q

Anxiety Disorder

“Fight or flight” response engages these hormones in response to a traumatic event, or for anticipation of one.

A
  • Epinephrine/adrenaline
  • Gluco-cortical/Cortisol
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5
Q

Anxiety Disorders

Anticipatory anxiety

A
  • 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)
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6
Q

Anxiety Disorders

Psychological experience of person in anxiety…

A
  • overestimate the danger; tense
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7
Q

What is the most common of all disorders we deal with?

A
  • Anxiety
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8
Q

Fear

A
  • emotional response to real or perceived effects
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9
Q

Anxiety

A
  • 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)
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10
Q

Panic Attacks

A
  • short periods of intense fear; last approx. 10 minutes
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11
Q

Epidemiology

A
  • 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)
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12
Q

Comorbid Conditions

A
  • 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”)
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13
Q

Onset

A
  • (don’t say “when it started” – use the term “onset”)
  • Often preceded by:
  • Marital disruption
  • Death, crisis
  • Financial upheaval, etc.
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14
Q

Why is anxiety often misdiagnosed?

A
  • it can be overlooked and if you have an addictive behavior also that will be picked up first.
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15
Q

Statement to remember Generalized Anxiety diagnosis

A
  • JJ has all the worries all the time
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16
Q

What is the difference btw fear and anxiety?

A
  • Fear happens when something is imminent or happening
  • anxiety is in anticipation of something
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17
Q

Statement to remember Specific Phobia diagnosis

A
  • Jessica is afraid of the specific thing, spiders
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18
Q

Statement to remember social anxiety diagnosis

A
  • Fear of being in front of people and getting judged
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19
Q

Symptoms of Panic Attack

(Always present with panic disorder)

A
  • 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
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20
Q

Uncued Panic Attack

A
  • nothing is causing panic attack
  • (comes from nowhere)
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21
Q

Cued (or expected) Panic Attack

A
  • developing panic attack in presence of something
  • they are in response to something
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22
Q

Agoraphobia and sentence to remember the diagnosis

A
  • the experience of anxiety in a specific situation from which you do not feel you can escape easily
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23
Q

What are the four types of Specific Phobia?

A
  • Animal
  • natural environment
  • blood/injection/injury
  • situational
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24
Q

Symptoms of Specific Phobia

A
  • 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
25
Q

What needs to be ruled out before diagnosing specific phobia?

A
  • OCD,
  • PTSD,
  • Panic Disorder,
  • Agoraphobia,
  • Social Phobia,
  • Separation Anxiety Disorder
26
Q

Treatment Planning considerations for Specific Phobia

A
  • Anti-depressants
  • Systematic Desensitization
  • Exposure to the object of the phobia or the situation
27
Q

Symptoms of Social Phobia

A
  • 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
28
Q

What needs to be ruled out before diagnosing Social Phobia?

A
  • Medical condition or substance use,
  • Panic Disorder,
  • Agoraphobia,
  • Separation Anxiety Disorder,
  • Eating Disorder,
  • Body Dysmorphic Disorder
29
Q

What does JCAHO stand for and what does it do?

A
30
Q

What do Common Clinic Commitees do?

A
  • Continuous quality improvement
  • utiliztiation review
  • safety
  • infection control
  • clinic privileges and credentialing
31
Q

BPS DD

What is a mental disorder?

A
  • 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
32
Q

What makes something clinically significant?

A
  • Must have some for of physical, social or occupational impairment that causes distress in one’s life
33
Q

DIDU

What are the Features of a Diagnosis?

A
  • Must cause distress, must show impairment in functioning, and must be a clear deviation of usual roles.
34
Q

What does a Master Treatment Plan Consist of?

A
  • A master treatment plan consists of the problem, the goal, and between 8-10 objectives.
35
Q

CS PSO CD

What Three Distinct Features Define Psychopathology?

A
  • Clinically significant impairment of psychological, social or occupational functioning that causes distress to individual.
36
Q

What Three Things are Looked at in order for a Person to Meet the Criteria of a Diagnosis?

A
  • 3 s’s
  • Signs - objective, Symptoms- subjective, Syndromes – combination of the two
37
Q

OCD and Related Disorder

How common is OCD?

A
  • 4th most common disorder in U.S.
38
Q

What are OCD and other Related Disorder?

A
  • 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
39
Q

OCD and Related Disorder

What do we rule out before Diagnoses?

A
  • Eating Disorder,
  • Hypochondriasis,
  • Body Dysmorphic Disorder,
  • Major Depression, and PTSD
40
Q

OCD and Related Disorder

obsessions

A
  • unwanted thoughts that are intrusive and do not seem to want to go away
  • recurrent thoughts
  • they are unwanted and intrusive
41
Q

OCD and Related Disorder

compulsions

A
  • behaviors that a person engages in to manage the anxiety caused by the thoughts
  • compulsive behavior is driven by obsessions
  • the repetitive behaviors
42
Q

Generalized Anxiety Disorder

A
  • 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
43
Q

Generalized Anxiety Disorder

Rule out before diagnosis?

A
  • Panic Disorder,
  • Social Phobia,
  • OCD,
  • Hypochondriasis,
  • PTSD,
  • Eating Disorder
  • Medications
  • medical conditions
44
Q

Acute Stress Disorder

A
  • 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
45
Q

Acute Stress Disorder

Duration of Symptoms

A
  • Two days- four weeks
  • if lasts longer, it’s PTSD
46
Q

Physical disorders that may cause anxiety

A
  • Adrenal tumor (kidney)
  • Alcoholism
  • Coronary insufficiency (inadequate blood flow)
  • Delirium
  • Hypoglycemia [hypo = too little]
  • Hyperthyroidism [hyper = too much]
  • Mitral valve prolapse
47
Q

General Approach to Treatment of Anxiety

A
  • 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”
48
Q

General Treatment Issues with Anxiety

Understand the cause

A
  • 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?
49
Q

General Treatment Issues with Anxiety

Stress management

A
  • manage stress or stress will manage you.
  • Stress exacerbates anxiety
50
Q

General Treatment Issues with Anxiety

Eliminate alcohol

A
  • (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.
51
Q

General Treatment Issues with Anxiety

Self-talk skills,

A
  • “coach” self; track positive self-talk
52
Q

General Treatment Issues with Anxiety

Ego strengthening

A
  • (aka assertiveness training)
  • teaching a sense of possibility. Use ego-strengthening instead because BCBS won’t pay for assertiveness training.
53
Q

General Treatment Issues with Anxiety

Time structuring

A
  • (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.
54
Q

General Treatment Issues with Anxiety

Anger management

A
55
Q

General Treatment Issues with Anxiety

Nutrition and exercise

A
  • (send them to a physician)
  • NEVER tell a client to exercise
    • (you don’t know their cardiac state, physical fitness, etc.)
56
Q

General Treatment Issues with Anxiety

Self-esteem enhancement

A
  • a resulting consequence of the other actions above: don’t start here.
57
Q

Panic Disorder

A
  • 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
58
Q

Panic Disorder: Treatment Planning

Cognitive Behavioral Therapy

A
  • Cognitive
    • Teach about panic itself
    • Learn positive self-talk
  • Behavioral
    • Breathing exercises (teaching them how to relax)
    • Deep muscle relaxation

DSM (7 decks)

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