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Behavioral Science > Anxiety > Flashcards

Flashcards in Anxiety Deck (20):
1

DD for anxiety?

1. Think organic (med) causes: caffeine, substance abuse (stimulants), withdrawal, hyperthyroidism, arrythmia, vit B12 deficiency, hypoglycemia, pheochromocytoma
2. usually seen in ED setting (acute MI, PE, COPD, asthma); take a HISTORY about med and psych components, do physical, and send labs to rule out med causes if needed
3. Psych disorder associated with anxiety: depression, schizo, eating disorders, personality disorders, substance dependence

2

To diagnose anxiety, symptoms must

1. be persistent (usually at least 6 months, but shorter for kids)
2. Interfere with normal functioning (work, job, marriage, etc.)
3. Cause significant distress

3

Etiology of anxiety: biopsychosocial associations

1. Psychosocial factors: traumatic events or extreme stressors (PTSD, panic attack); maladaptive coping skills/personality traits can make people vulnerable to increased stress levels; learned?
2. Biologic factors: greater prevalence in populations of family members with anxiety disorders (genetics possibly, less so than bipolar, ADHD, schizo); also gender bias with women>men except OCD
3. Neurobiological factors (less serotonin, GABA; more NE and glutamate)

4

GAD:

1. Excessive anxiety/worry, occurring more days than not for > or = 6 months, about > or = 1 event/activity
2. Difficult to control worry
3. Associated with at least 3 of these symptoms: restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance
4. Causes significant impairment
5. No other explanation for symptoms

5

Occurrence for GAD:

1. 3-5% of general pop
2. Women > men
3. About 50% begin prior to adulthood
4. May have had generally anxious parents
5. Self-med (booze);
prgonosis: without treatment, tends to worsen over time!! Think especially STRESSFUL times

6

Treat GAD?

1. Therapy (CBT or psychodynamic)
2. Meds (antidepressants that increase SR or NE or both, downregulate or desens receptors; use 5HT1a receptor agonist like buspirone; benzos, but second line because of risk of addiction, falls, apnea; beta blockers, more for symp relief of performance anxiety, NOT GAD!!!!!!)

7

For panic disorder, look out for

panic attack: abrupt surge of intense fear or discomfort, peaking within minutes that is UNEXPECTED, with at least four of the symptoms in the slide

8

Panic disorder: how to diagnose

1. Recurrent unexpected PANIC ATTACKS
2. At least one attack followed by at least 1 month of at least one of the following: concern about additional panic attacks or consequences; significant maladaptive change in behavior related to attacks
3. No other explanation for symptoms

9

For panic disorder with agoraphobia, what is needed to diagnose?

1. Fear/anxiety about at least 2 of the in the slide
2. Fear of not being able to escape situation
3. Situation almost always causes fear/anxiety
4. Avoids situations
5. Fear/anxiety out of proportion to actual danger
6. At least 6 months
7. Causes significant impairment
8. No other explanation for symptoms

10

Occurrence, prognosis, treatment of panic disorder

Occurrence: 1.5-3.5%, F>M;
Prognosis: chronic, recurring, increased risk of depression and suicide
Treatment: therapy is CBT with SYSTEMATIC DESENS preferred or flooding, or psychodynamic therapy; meds are fast-acting benzos like alprazolam, SSRI/SNRI (long term first-line), intermediate or long-acting benzos (2nd line because of addiction potential); COMBO treatments

11

For specific phobia, how to diagnose?

At least
1. 6 months or more
2. Cause significant impairment
3. Marked fear/anxiety about a specific object/situation
4. Object/situation almost always provokes fear/anxiety
5. Actively avoid object/situation
6. Fear/anxiety out of proportion to actual danger
7. No other explanation for symptoms

12

For social anxiety phobia, how different than specific?

Change object/situation to social situation specifically; also fear of acting in ways that will be negatively scrutinized;
if PERFORMANCE only, then fear is restricted to public speaking or performing and won't generalize to other social aspects of life

13

Occurrence, comorbidities, treatment of phobias?

O: 5% men, 10% women (usually women > men)
C: other anxiety disorders and depression
T: specific phobia: think therapy first with flooding, systematic desens (CBT!!!!); meds likes sedatives?
for social phobia: do therapy with CBT, assertiveness training, group therapy; meds include SSRI/SNRI (first-line), MAOI's (after you've given SSRI's and benzos), then beta blockers (best for PERFORMANCE ONLY variant)

14

Physical and Psychological manifestations of anxiety?

Physical: 1. symp NS (diaphoresis, mydriasis, tachy, and TREMOR) 2. GI/GU symptoms (diarrhea, increased urinary freq) 3. Hyperventilation (dizziness, syncope, PARESTHESIA) 4. Numbness and tingling in extremities and around mouth

Psychological: Restlessness, irritability, trouble concentrating, worry

15

Fear of clowns

coulrophobia

16

Fear of snakes

ophidiophobia

17

Aerophobia

fear of airplanes

18

Aerophidiophobia

fear of snakes on a plane

19

Fear of bald people

peladophobia

20

iatrophobia

fear of going to doctor or of doctors