Flashcards in ANXIETY Deck (43):
If someone comes to the ER with a panic attack, what must we do?
we MUST work it up!!
What type of drug is not found on a drug tox screen?
If a patient has anxiety due to a medical condition, how do you document it?
Anxiety disorder due to [hypothyroidism]
10-yr-old boy with previous interpersonal issues refuses to attend a 2-week summer camp away from home with his peers, but he is forced by his parents to go; it is the first time he has been away from home. After the first day, a staff member calls and tells the parents that the child stayed in his bunk all day complaining of stomach cramps and dizziness. What do you do? What diagnosis?
Rule out medical issues. Ask them to stay a few more days.
Separation Anxiety Disorder
If a child begins attending a new school, her teaching informs her parents that she never raises her hand to answer questions in class and refuses to speak to anyone, even if she is called on. The girl interacts normally with others at home, but she often wakes in the middle of the night crying. What diagnosis?
Selective mutism – fear of speaking
Must be present for 1 month
If a person has a phobia of something very specific (animals, small spaces, blood, water, storms, heights), what diagnosis?
How can you treat specific phobia?
Flooding & systemic desensitization (pair the spider with something relaxing)
If a person has a problem with performing public speaking, eating or writing in public, urinating in public bathrooms, and attending social events – what diagnosis?
Social anxiety disorder
How do you treat social anxiety disorder?
Cognitive behavioral therapy (assertive training) – remember the person might not be able to leave their house due to fear!
Pharm = SSRI, SNRI’s (take several weeks) benzo’s prn (to treat acutely, but weigh addiction possibility)
Propranolol for stage freight
What other condition can manifest into social phobia?
avoidant personality disorder
A 28-yo-woman complains of being lonely. She says that she longs to have a close circle of friends, but is terrified in social situations and avoids all invitations from co-workers to attend social events. She worries that others will notice her social withdrawal and talk about her. What diagnosis?
Social anxiety disorder (because she DOES have insight into herself, and desires friends)
*Remember avoidant personality – they have NO insight into their own actions
If a patient has SOB, tremulous, sweating, palpitations, chest pain, and nausea that came on abruptly (took about a minute to begin) while shopping. EKG, PE, and cardiac enzymes/labs are all normal – what disorder should you consider?
What must you ask about for a panic disorder?
If they have any concern over these episodes & for recurrence → that’s what leads to the diagnosis of a panic disorder
How do you treat panic disorder?
Benzo’s, SSRI, SNRI’s, PAIRED WITH THERAPY (cognitive behavioral)
They will diminish in frequency, they won’t go away right away
If a student presents with excessive worrying about their school performance, stating that he can’t turn his brain off – what diagnosis?
What two things does a person need to be diagnosed with GAD?
Impact daily function for 6 months
How do you treat GAD?
SSRI’s. If extremely acute you can use a benzo (but MUST have a plan to down titrate & get them off them)
Relaxation training/behavioral therapy
What else does a person with GAD have on PE?
Trouble concentrating, muscle tension, and being easily fatigued
How do you diagnose obsessive compulsive disorder?
Recurrent obsessions (recurrent intrusive thought), compulsions (recurrent intrusive action) – that interferes with daily functioning
If a person is older with a sudden onset of OCD – what do you need to do?
Look for acute medical or drug-related infections
How do you treat OCD?
SSRI’s! Cognitive behavioral therapy is hit-or-miss
What is different about treatment for anxiety/OCD when compared to depression?
Anxiety = HIGH DOSE (but titrate to the effective amount)
Depression = low dose
How do we differentiate OCD from OCPD?
OCD has compulsions & obsessions that they cannot control
45-yr-old man refuses to cut his shoulder-length hair for a new job and his employer threatens to dismiss him. The man admits to the employer that he wears his hair so long because he wants to cover his excessively large and pointy ears. Physical examination reveals mildly prominent ears that would not attract attention. The man fears being made fun of if the public was able to see his ears. What diagnosis? How do you treat it?
Body dysmorphic disorder
SSRI’s; CBT (but need to be on meds beforehand)
Body dysmorphic disorder is difficult to treat, why?
Because it is ego-syntonic (they don’t know they have a problem)
If a patient has a hard time of parting with possessions that really have no value. You notice that she has scabies and is not well kept – what diagnosis?
What does ego-syntonic mean?
The person doesn't know they have a problem
How do you treat hoarding disorder?
SSRI’s, CBT*** primarily (often some type of trauma in the person’s history)
If a patient has a problem with pulling one hair, often twirling it until it falls out – what diagnosis?
How do you treat trichotillomanis?
SSRI’s & CBT
If a patient picks at their skin until they bleed, or picks at their calluses and scabs – what diagnosis?
If a child was emotionally withdrawn behavior toward adult caregivers, the child seeks minimal comfort when distressed, and limited positive affect – what diagnosis?
Reactive attachment disorder
What must a child have in order to diagnose reactive attachment disorder?
Insufficient care & disturbance occurs before age 5, and has a developmental age of at least 9 months
What must a patient have in order to diagnose a posttraumatic stress disorder?
1+ intrusion symptoms = recurrent memories, dreams, feeling of recurrence, distress of re-exposure, physiological reactivity
1+ Avoidance symptoms = Memories, thoughts, feelings
2+ negative cognitions = Poor memory, self-concept, cause/consequence, emotional state, interest/participation, detachment, loss of positive thoughts.
2+ arousal symptoms = Irritability, recklessness, hypervigilance, exaggerated startle, poor concentration, sleep disturbance
How do you treat posttraumatic stress disorder?
group therapy; pharmacology (SSRIs); don’t debrief – just begin immediate therapy/counseling
How do you treat the nightmares in PTSD?
Prazosim (alpha blocker)
Which SSRI is best for PTSD?
What is the timeline for PTSD?
greater than 1 month
What is the timeline for acute stress disorder?
It’s just like PTSD but lasts from 3 days to 1 month (with an acute episode)
If a patient presents with a “nervous breakdown” what do you think of?
What are the triggers for an adjustment disorder?
Divorce, job loss, medical issues (cancer), etc → occurs within 3 months of stressor
What are the subtypes of adjustment disorders?
Adjustment disorder WITH… depression, anxiety, disturbance of conduct, mixed disturbances