Anxiety and Stress-related Disorders Flashcards
(129 cards)
1
Q
What is the most common mental disorder in the US?
A
Anxiety and stress disorders
2
Q
What often is most common comorbid with?
A
depression - underlying
eating disorders
bipolar disorder
substance abuse
3
Q
What gender is anxiety more prevalent in a lifetime?
A
women 30% to men 19%
- cultural underreported
4
Q
What percentage of people with anxiety receive tx?
A
36.9%
5
Q
What is the recovery rate of anxiety?
A
low
6
Q
What is the recurrence rates of anxiety?
A
high
7
Q
Anxiety interferes with
A
personal
academic
occupational
social functioning
8
Q
Stress can go both ways, what are the ways?
A
High eustress
Low distress
9
Q
Eustress
A
good stress
- motivation
- exciting anticipation
10
Q
Stress distress
A
negative
- cause emotional, physical, or psychological problems
11
Q
What are the different types of stress?
A
psychosocial
psychological
physical
spiritual
12
Q
Psychosocial stress
A
in their appearance or lost opportubity
- break up no acceptance
- low self-esteem
13
Q
Psychological stress
A
- new baby
- intense emotion
- can be positive intense
14
Q
Spiritual stress
A
crisis of faith
- difficulty connecting with faith
- what is my purpose and why am i here
15
Q
Stress can contribute to
A
worsening s/s of a mental health condition
16
Q
If a patient has schizophrenia and anxiety, then
A
hallucinations and delusions will excel
17
Q
If a patient has bipolar disorder and anxiety, then
A
triggers both mania and depression
- paranoia and anger with self-harm
18
Q
Healthy coping defense mechanisms for anxiety
A
Altruism
Sublimation
Humor
Suppression (short term)
19
Q
Intermediate defense mechanisms for anxiety
A
Repression
Displacement
Reaction formation,
Somatization
Undoing
Rationalization
20
Q
primitive(immature) defense mechanisms of anxiety
A
Passive aggression
Acting out behaviors
Dissociation
Devaluation
Idealization
Splitting
Projection
21
Q
Altruism
A
stress goes to motivation of other welfare
- do nice things for others
22
Q
Sublimation
A
takes stress and puts it into something socially acceptable
- working out
- long-term permanent conversion
23
Q
Managing Stress: relaxation/calm techniques
A
reframing/de-catastrophizing = realistic
- “You will look forward to the end of it”
sleep
physical exercise
reduce caffeine
24
Q
Physiology of Anxiety and Stress
A
Originates in amygdala
- alerts hypothalamus
- engages SNS
- physiological s/s
25
Physiology of thoughts about anxiety
the limbic system sends neural messages to **cerebral cortex**
26
What neurotransmitters affect anxiety disorders?
Serotonin
Norepinephrine
GABA
27
With anxiety, serotonin is
decreased
28
What is the reason for giving SSRIs to anxiety patients?
decreased serotonin levels
29
With anxiety, norepinephrine is
increased
30
What is the reason for giving noradrenergic drugs to anxiety patients?
norepinephrine is increased
31
Norepinephrine medications for anxiety
propanolol
clonidine
32
What is the reason for giving Benzodiazepines to anxiety patients?
GABA altered
- benzo receptors sensitivity diminished
33
What is given for acute anxiety?
Benzodiazepines
34
Short-term effects of Epinephrine and Norepinephrine
Elevated heart & resp rate
Elevated FFAs, glucose, & triglycerides
Increased platelet aggregation
Increased kidney clearance
Increased blood to skeletal muscles
Increased muscular tension
**primitive help to run away from the bear**
35
Long-term effects of Epinephrine and Norepinephrine
High resting heart rate
Heart disease
Platelet aggregation
Reactive high BP
Hypercholesteremia & hyperlipidemia
Renal/hepatic problems
Glucose intolerance
Chronic muscle tension
Hyperventilation
Digestive problems
Chronic anxiety/anger
36
Short-term effects of Cortisol
Decreased fluid loss
Increase glucose/gluconeogenesis
Less inflammation
Less brain norepinephrine
37
Long-term effects of Cortisol
Immune system compromise
Atherosclerosis
**Depression**
Insulin insensitivity
Obesity
Hyperlipidemia
Protein breakdown in blood, bones (osteoporosis), muscle (heart) immunoglobulins
38
Chronic Stress results in
HTN
Heart disease/stokes
Diabetes
CA
Ulcers/Chronic GI problems
Atherosclerosis
Arthritis
Autoimmune diseases/allergies/eczema
Kidney and liver diseases
Chronic GI problems
HA
39
PTSD dx criteria
Exposure to actual or threatened death, injury, or sexual violence
Presence of intrusion symptoms
Avoidance of associated stimuli (external reminders)
Negative alt in cognitions/mood
Altered arousal & reactivity
Symptoms lasting **longer than one month**
Often presents with **suicidal ideation & depression
NOT attributed to the physiological effects of a substance**
40
What type of exposure can cause PTSD?
- direct experience
- witnessing in person
- occurs to close family members or friends and actual or threatened death violent or accidental
- experience repeat or extreme exposure to aversive details of the events (first responders, police)
**does not apply to media, TV, movies, or pictures unless work-related**
41
Presence of 1+ intrusion s/s with traumatic events
-recurrent and involuntary memories
-dissociative reactions (**flashbacks**)
-intense or prolonged distress with exposure to internal or external cues
- physiological reactions that symbolize or resemble trauma
42
What are negative alterations in cognition and mood with PTSD?
dissociative amnesia (not head injury, alcohol, or drugs)
negative beliefs (I am bad, no one can be trusted, completely dangerous, permanently ruined)
constant negative emotional state
diminished interest in interest or activities
detachment or estrangement
unable to experience positive emotions
43
PTSD alteration arousal and reactivity
irritable and angry outbursts (no provocation)
- verbal/physical with people or objects
reckless or self-destructive behaviors
hypervigilance
exaggerated startle response
concentration problems
difficulty sleeping, staying asleep, or restless sleeping
44
PTSD with dissociative s/s
PTSD s/s and depersonalization and derealization
- NOT attributed to substance (blackouts, intoxication, complex partial seizures)
45
Depersonalization
persistent experience of detachment (like outside observer)
- dream, sense of unreality of self/body/time moving slowly
46
Derealization
persistent unreality of surroundings
- feels dreamlike, distant, distorted
47
S/S of PTSD (mnemonic)
Traumatic event
Re-experience the trauma
Avoiding things associated with trauma
Unable to focus
Month (1)
Arousal increase (hypervigilance, startle response)
48
PTSD Tx
Cognitive behavioral therapy
**Prolonged exposure therapy**
EMDR: Eye movement & reprocessing
Adaptive disclosure
**Meds: SSRIs
Meds: Others to treat target symptoms (such as psychosis) - Antipsychotic, low dose olanzapine
prazosin for nightmares**
49
Acute Stress Disorder Dx criteria
Exposure to actual or threatened death, injury, or sexual violence - medical emergency, car wreck
Negative mood
Dissociative & avoidance behaviors
Arousal Symptoms
Intrusion Symptoms
Hypervigilance
**Longer than 3 days but Resolution of symptoms within 1 month**
50
Tx of acute stress disorder
May resolve without treatment
- support and coping
Meds: Benzos prn for severe symptoms
51
Dissociative Identity Disorder formerly known as
multiple personality disorder
52
Dissociative amnesia
unable to recall info about self
53
Dissociative amnesia with fugue
amnesia for identity involve travel or wandering
54
Depersonalization
experience unreality or detachment from mind/self/body
55
Derealization
experience unreality or detachment from surroundings
56
Trauma-informed care high ACE scores
increased risk for physical and psychiatric disorders and adverse childhood experiences
57
for dissociative disorders = TIC recognizes the impact of trauma on
health
how trauma impacts behavior seeking treatment
awareness that service systems have potential to retraumatize victims
58
Anxiety order
Normal (good)
Acute (with loss/change of someone)
Pathological (absent of a threat and cause loss of functioning)
59
Different Anxiety Disorders
Generalized Anxiety Disorder (GAD)
OCD
Phobic Disorders (Agoraphobia, Social Anxiety, specific phobics)
Panic Disorders (w/ or w/o agoraphobia)
60
Neurobiological theory for anxiety disorders
Lower levels of serotonin-serotonin dysfunction
Increased levels of norepinephrine-alterations in the noradrenergic system
Altered GABA-Alterations in the benzodiazepine receptors
61
genetics theory for anxiety disorders
40% hereditary
62
behavioral theory for anxiety disorders
learned response
63
cognitive theory for anxiety disorders
cognitive distortion in thinking
64
cultural considerations for anxiety disorders
Sociocultural variations (transition mental to physical)
- tinnitus, neck soreness, HA, uncontrollable screaming or crying (not counted)
Somatic symptoms and cognitive symptoms vary between cultures
65
Mild anxiety s/s (green)
Heightened awareness
**Still able to work, learn, & solve problems**
slight psychomotor agitation - slight restless, pacing, tapping foot
66
Mild anxiety interventions
Reframing that this is a positive thing
Allow ventilation
Activity to release energy
Identify triggers
**Focus on communication
Monitor level of anxiety**
NO MEDS
67
Moderate anxiety s/s (yellow)
**Narrowed perceptual field**
Selective inattention
Less able to problem-solve
**HR & RR up
Somatic complaints - tinnitus, HA**
68
What level of anxiety will cause VS changes?
moderate
- start anxiolytics PRN
69
Moderate anxiety interventions
Reframing
Allow ventilation
Activity to release energy
Identify triggers
**Focus on communication
Monitor level of anxiety
PRN anxiolytic**
70
Severe anxiety s/s (orange)
Perceptual **field very limited**
**Scattered** attention,
Distorted perceptions
Diminished problem-solving ability
**Tunnel vision
Sense of impending doom
Somatic symptoms - Intense difficulty breathing, freeze, GI upset, Nausea **
**Pt can still be redirectable and in control of their behavior**
71
Severe anxiety interventions
Remain calm
**Stay with patient and be calm and low pitched with simple sentences**
**PRN anxiolytics**
**Pt can still be redirectable and in control of their behavior - main difference**
72
Panic level anxiety s/s (red)
**Unable to focus on environment**
Feeling of doom
Disorganized thinking
No problem solving
**Emotional paralysis**
Increased HR, Respirations
**Irrational
Agitation = self harm and violence**
73
Panic-level anxiety interventions
**Stay with patient - guide them**
Remain **calm**
Simple direct statements
**Assure safety**
- if violent last option is sedatives
PRN anxiolytic
**Minimize environmental stimulation**
- no groups
74
Panic Disorder Dx criteria
**recurrent unexpected panic attacks w/o clear triggers**
***rapid onset*** from calm to anxious (peak at 10 minutes) **0 to 100 real quick**
**4+** s/s
followed by 1 month of **fear of reoccurrence and maladaptive** change in behavior
75
Panic Disorder s/s
Palpitations, pounding heart, or accelerated heart rate.
Sweating.
Trembling or shaking.
Sensations of shortness of breath or smothering.
Feelings of choking.
Chest pain or discomfort.
Nausea or abdominal distress.
Feeling dizzy, unsteady, light-headed, or faint.
Chills or heat sensations.
Paresthesias (numbness or tingling sensations).
Derealization (feelings of unreality) or depersonalization (being detached from oneself).
Fear of losing control or “going crazy.”
Fear of dying.
76
Panic Disorder is comorbid with
agoraphobia and depression
77
Panic Disorders are usually followed for a month of
**persistent concern about additional panic attacks or consequences** (losing control, heart attack, "going crazy"
behaviors to avoid exercise of unfamiliar situations
not explained by a cardiac or hyperthyroidism problem
78
Panic Disorder Tx
CBT (reframing)
1 - antidepressants (longer term)
2 - Benzo (short term)
79
Phobic Disorders Dx
fear or anxiety about an object or situation
- provokes immediate fear or anxiety
- actively avoids/endures with intense fear or anxiety
**OUT OF PROPORTION to actual danger and sociocultural context**
significant distress o impairment in social, work, or functioning
**6+ months**
not explained by another mental disorder
80
Agoraphobia
Fear of leaving the house
Using public transportation
Being in open spaces (eg, parking lot, marketplace)
Being in an enclosed place (eg, shop, theater)
Standing in line or being in a crowd
Being alone outside the home
81
Agoraphobia Dx consists of s/s for
Marked fear with 2+ s/s in 5 situations
6+ months
disproportionate to the risk of danger
distress or impairment
82
Social Anxiety Dx
6+ months of fear and anxiety of social situations where they will be scrutinized by others
83
The Social Anxiety must involve
A negative evaluation by others (eg, that patients will be humiliated, embarrassed, or rejected or will offend others).
84
What must be present for SAD?
The **same social situations** nearly always trigger fear or anxiety.
Patients **actively avoid** the situation.
Fear/anxiety/avoidance
Is out of proportion to the actual threat (taking into account sociocultural norms).
Causes **significant distress or significantly impair social or occupational functioning**
85
Specific Phobias Dx is the
fear of 1+ specific objects or situations
86
Acrophobia
fear of heights
87
Claustrophobia
fear of closed spaces
88
Arachnophobia
fear os spiders
89
Pteromechanophobia
fear of flying
90
Tx for Phobias
CBT
Assertiveness Training (agoraphobia)
systematic **desentization**
social skills training (Social Anxiety Disorder)
Meds: **SSRIs, beta blockers, benzo
Benzo will help in the moment but not the overall disorder**
91
GAD Dx
excessive worries/anxiety < 6 months
- **Ask if they can't control the worrying**
- 3+ s/s
- R/o SUBSTANCE ABUSE OR OTHER DISORDERS
92
S/S of GAD
Restlessness or a keyed-up or on-edge feeling
Easily fatigability
Difficulty concentrating
Irritability
Muscle tension
Disturbed sleep
93
GAD Tx
CBT
Stress Mgmt
psychical activity
meds: **SSRI, SNRI, buspirone
- teach that effectiveness will take a while**
Benzo - acute
94
Anxiety r/t other medical conditions
COPD
Parkinson’s
Metabolic disorders
Hyperthyroidism
95
OCD S/S
Presence of obsessions, compulsions, or both
**Unable to ignore or suppress thoughts or actions**
Obsessions & compulsions are time consuming; **> 1 hour a day**
1st degree relative has it as a childhood
96
Questions to ask OCD patients
do you do certain thinks repetitively
do you have intrusive thoughts you cant shut out
do you have to do things in a specific certain way
97
Obsessions in OCD
Recurrent & persistent thoughts, urges or images which are unwanted and intrusive causing distress to the individual
98
Compulsions of OCD
Repetitive behaviors that the individual is compelled to perform in response to related obsession
99
What is aimed to alleviate anxiety in OCD
compulsions
100
Obsession of contamination = compulsion of
washing and cleaning
101
Obsession of loss, fear of loss = compulsion of
acquiring, collect, save
102
Obsession of symmetry = compulsion of
order, arranging, and repeating (counting)
103
Obsession of causing harm = compulsion of
avoid contact
104
Tx of OCD
Exposure / Response Prevention - force delay between thoughts and compulsions
Medication: SSRIs
105
OCD-related disorders
Body dysmorphia
hoarding
trichotillomania
skin picking disorder
106
Trichotillomania
hair pulling out and bald spots
107
Assessment for Anxiety Disorder
Level of anxiety
Suicide risk
Use of coping/defense mechanisms
108
Standardized Scale Ratings for Anxiety
The Clinically Useful Anxiety Outcome Scale
Generalized Anxiety Disorder Screener
Hamilton Rating Scale for Anxiety
109
Priority for Anxiety pts
safety and therapeutic communication
110
Medications for Anxiety
Antidepressants - **SSRI**, SNRI
Anxiolytics - Benzo, buspirone, hydroxyzine, beat blockers
111
Interventions for Anxiety
communication
expression of feelings and thoughts
decrease environmental stimuli
limit stimulants
diversional activities and stress reduction techniques
milieu therapy
112
What are the first line antianxiety drugs?
SNRI SSRI
113
SSRI works
blocks reuptake of serotonin
114
SSRI example
Paroxetine = GAD
115
SNRI works with
blocks reuptake of serotonin and norepinephrine
116
SNRI example
Venlafaxine = mixed anxiety and depression, anxiety, and nerve pain
117
Noradrenergic drugs
Propanolol
Clonidine
118
Propanolol MOA
blocks adrenergic receptor activity
119
Clonidine MOA
stimulates adrenergic receptors
120
Propanolol use
short-term relief of social anxiety and performance anxiety
121
Clonidine used
anxiety disorders, panic attacks
122
Benzodiazepines MOA
Binds to benzodiazapine receptors, facilitates GABA, slows neural transmission
123
benzo example
Alprazolam – may be used short term to treat panic disorder and agoraphobia
124
Buspirone MOA
serotonin receptor partial agonist
125
Buspirone tx
worry associated with GAD
126
What drug is only FDA-approved for GAD?
Buspirone (Buspar)
127
Benzodiazepines
- onset
- sedating?
- dependence and withdrawal?
- change with age
- PRN
Rapid onset
Sedating
Dependence & withdrawal
Tolerance varies with increased age
May be used PRN
128
Buspirone (Buspar)
- onset
- sedating?
- dependence and withdrawal?
- change with age
- PRN
Delayed onset
Non-sedating
No dependence or withdrawal
No pharmacokinetic change with age
Not suitable for PRN use
129
Hydroxyzine pamoate (Vistaril)
- onset
- sedating?
- dependence and withdrawal?
- PRN
Rapid onset
Sedating
No dependence or withdrawal
May be used PRN
