anxiety disorders

Question 1

anxiety: general concept

Answer 1

universal, basic emotion
apprehension, uneasy, tension, uncertain, dread from real or perceived threat (unknown, vague, conflictual)
reponse to internal or external stimuli
phys, emotoinal, cog, bheavioral s/s
evolutionary response to impending doom -> f/f (autonomic response)
conscious, subconscious, unconscious

Question 2

pathological anx

Answer 2

no real threat, passed long ago, sub adaptive coping with maladaptive
greater anx than expected of situation -> flashback, obsessions, compulsions; side tracks daily activities
lasts longer than expected

Question 3

anx v fear

Answer 3

anx = stress response from thoughts
fear = rxn to specific danger
normal anx = necessary for survival

Question 4

theories of anx d/o

Answer 4

bio (genetic - fam; neurobio - amygdala)
psych: shy, timid, low self esteem
cultural: parents
env: abuse, tobacco, caffeine
learned behavior
early unmet needs

Question 5

cultural considerations

Answer 5

some express via somatic, others cog

Question 6

mild anx

Answer 6

normal, every day, adaptive, motivate to survive

Question 7

mild anx: perceptual field

Answer 7

heightened -> see, hear, grasp more info; sharper obs, focus is flexible and aware of anx

Question 8

mild anx: ability to problem solve

Answer 8

work effectively toward goal, examine alternatives

Question 9

mild anx: phys s/s

Answer 9

slight discomfort, attention seeking, restless, easily startled, irritable/impatient
mild tension relieving behavior -> foot or finger tapping, lip chew, fidget

Question 10

moderate anx: perceptual field

Answer 10

narrowed: some details excluded, grasp less of what is going on
focus on source (selective attention), less able to pay attention

Question 11

moderate anx: ability to problem solve

Answer 11

not optimal, can follow directions

Question 12

moderate anx: phys s/s

Answer 12

sympathetic NS
tension, pounding heart, tachy, tachypnic, perspiration
mild somatic: HA, urinary freq, backache, insomnia
voice tremor, poor [], shake

Question 13

mild and mod

Answer 13

can alert that something is wrong, can take action to correct

Question 14

severe anx: perceptual field

Answer 14

greatly decreased and distorted, focus on details or 1 specific, scattered attention

Question 15

severe anx: ability to problem solve

Answer 15

feels impossible, cant see connections btw events/details, dazed and confused

Question 16

severe anx: phys s/s

Answer 16

behavior automatic and aimed at decreasing or relieving anx, dread, confusion, purposeless activity, impending doom, diaphoretic, withdrawal, loud and rapid speech, threats and demand
more intense somatic complaints: chest discomfort, dizzy, n, insomnia

Question 17

panic: perceptual field

Answer 17

most extreme
cant process env, focus lost -> depersonalization (feel unreal) and derealization (world unreal)

Question 18

panic: problem state

Answer 18

cant process, disorganized or irrational reasoning

Question 19

panic: phys s/s

Answer 19

terror, immobile, hyperactive, flight
unintelligible com or inability to speak, amplified or muffled sounds
somatic = paresthesia, SOB, dizzy, chest pain, n, tremble, chills, overheat, palp
severe withdrawal
hallucinations and/or delusions
out of touch with reality

Question 20

severe and panic

Answer 20

no problem solving

Question 21

defense against anx

Answer 21

automatic coping, protect from anx
enable individual to maintain self image by blocking: feelings, conflicts, mem
unhealthy/healthy
not always apparent to individual using them

Question 22

defense mechanism: altruism

Answer 22

unconscious, caring and concern about well being of others

Question 23

defense mechanism: compsensation

Answer 23

counterbalance perceived deficiencies by emphasizing strengths

Question 24

defense mechanism: conversion

Answer 24

anx into phys s/s w/o cause

Question 25

defense mechanism: denial

Answer 25

ignore thoughts to escape

Question 26

defense mechanism: displacement

Answer 26

transfer emotions associated with something else to something non threatening

Question 27

defense mechanism: dissociation

Answer 27

disrupt consciousness, mem, identity, perception -. result in compartmentalization of uncomfortable aspects of oneself

Question 28

defense mechanism: identification

Answer 28

attributing characteristics of person or group to self

Question 29

defense mechanism: intellectualization

Answer 29

events analyzed based on remote cold facts w/o passion

Question 30

defense mechanism: projection

Answer 30

reject emotionally unacceptable features in attributing them to others

Question 31

defense mechanism: rationalization

Answer 31

justify illogical/unreasonable ideas, develop acceptable explanations that satisfy teller and listener

Question 32

defense mechanism: rxn formation

Answer 32

acceptable feelings controlled, kept out of awareness, dev opposite emotion or behavior

Question 33

defense mechanism: regression

Answer 33

revert to earlier primitive behavior

Question 34

defense mechanism: spliting

Answer 34

cant integrate good and bad

Question 35

defense mechanism: sublimation

Answer 35

transform negative into less damaging and even productive

Question 36

defense mechanism: suppression

Answer 36

consciously exclude unacceptable thoughts and feelings

Question 37

defense mechanism: undoing

Answer 37

make up for regrettable act

Question 38

use of defense mech

Answer 38

often use variety to different degrees freq, intensity, duration varies effective mediation decreases anx ineffective = increased anx and other issues

Question 39

adaptive defense mech

Answer 39

problem solve, talk, cry, sleep, exercise, deep breathe, imagery, relax

Question 40

maladaptive defense mech

Answer 40

blame, negative self talk, obsessive compulsive behaviors, aggressive acting out behaviors, withdrawal, excessive eating, drinking, spend, gambling, drug use, sex

Question 41

take action: mild - mod anx

Answer 41

identify, anticipate anx provoking nonverbal comm, feelings/concerns, clarify, thoughts and feelings prior to onset, problem solv,e alternative solutions, outlets for excess energy decrease anx: calm, recognize, listen, explore behaviors that helped in past, provide alternative coping

Question 42

take action: severe to panic

Answer 42

safety in all areas, always remain with clear and simply, repeat if needed, low pitch, speak slow quiet env with minimal stim, reinforce reality, need for meds?, r/o suicide

Question 43

anx d/o overview

Answer 43

most common, all ages and gender (F 2:1), v treatable, chronic and persistent ineffective coping all d/o have excessive irrational fear and dread basic principles: strong genetic, s/s begin child/early adult, recognize thoughts/behaviors to decrease anx, allow continuation of behavior until other strategies are in place

Question 44

separation anx d/o

Answer 44

normal infant dev (8 mo, peak at 18 mo, then decrease) dev appropriate levels of concern about being away from s/o, scared something will happen to cause perm separation intense anx -> interfere with normal F adults: harm avoidance, worry, shy, uncertain, lack of self direction, impaired social and occupational F

Question 45

generalized anx

Answer 45

anx >6 mo, excessive and persistent, F > M accompanied by muscle tension, autonomic hyperactive, startle, difficult [] comorbid: MDD and other anx, OH abuse, most have other d/o

Question 46

generalized anx: dsm5

Answer 46

excessive worry and anx occuring more days than not for at least 6 mo, about several events or activities difficult to control worry anx and worry accompanied by at least 3 for at least 6 mo (only 1 for kids): restlessness/on edge, easily fatigued, difficult [] or blank mind, irritable, muscle tense, sleep disturbance anx, worry, or phys s/s cause sig distress or impair F not caused by something else

Question 47

generalized anx: rf

Answer 47

unresolved conflicts, cog misinterpretations, life stressor, genetic predis behavioral inhibition: shy, fear, withdrawal in familiar situations

Question 48

generalized anx: children and adolescents

Answer 48

excessive worry and fear without cause future and past, school acceptance, fam, finance, personal abilities, school perfectionist, overzealous, reassurance

Question 49

generalized anx: children and adolescents - tm

Answer 49

CBT, antidep, antianx

Question 50

generalized anx: clinical course

Answer 50

chronic, fluctuate severity, all ages may have mild dep often present in primary care with somatic - muscle ache, sore, GI poor sleep, irritable, tremble, twitch, poor [], exaggerated startle, sense of ill being, uneasy, fear of imminent disaster

Question 51

generalized anx: tm

Answer 51

pharm and psych SSRI, SNRI, TCA, BB, antiH (hydroxyzine), antianx, anticonvulsants, antipsych behavioral (thought stopping), CBT -> change faulty thinking thats leads to d/o med considerations: SSRI, SNRI are first line, assess suicide, 4-8 wk for efficacy (dose, change class, 2nd)

Question 52

generalized anx: tm - antianx

Answer 52

somatic and psych

Question 53

generalized anx: tm - BB

Answer 53

controversial, interact with SSRI and TCA CV s/s dont d/c abruptly bc hypoT, nightmare, brady, dep short term phys s by bringing down HR or BP

Question 54

generalized anx: tm - benzos

Answer 54

quick onset, no long term benefit, dependency issue, wd, rebound anx with abrupt stop use lowest dose, sedative so fall risk and machinery avoid OH/sedatives and caffeine take with food caution in those with hx substance abuse enhance gaba for calming effect promote sleep muscle relaxant properties promote amnesion: flunitrazepam - date rape tertatogenic - no preg antidote: flumazenil

Question 55

generalized anx: tm - MAOI

Answer 55

used less often refractory dep and atypical dep htn crisis when taken with tyramine SE: CNS stim, ortho hypoT, can lead to rapid increase in BP, stroke, coma significant drug to drug interactions: antihtn, SSRI, indirect acting sympathomimetics (ephedrine), TCA, merperidine

Question 56

generalized anx: tm - buprorpion

Answer 56

atypical antidep stim affect, decrease appetite 1-3 wks for effect doesnt tend to affect libido and sexual F, combo therapy to counter SE of other meds SE: seizure, agitation, HA, dry mouth, c, weight loss, GI upset, dizzy, tremor

Question 57

generalized anx: tm - anti anx meds teaching

Answer 57

interact with antacids, decrease abs dont change dose or freq without hcp may be unsafe to handle mech equip OH and other antianx meds can potentiate effects caffeine and nicotine decrease desired effects can be excreted in breast milk benzos and SSRIs may cause w/d take meds after meal for GI s/s drug interaction can occur

Question 58

generalized anx: tm - therapy

Answer 58

systemic desensitization: gradually introduced to feared object and taught to relax flooding: exposed to large amount of undesirable stim to extinguish anx response, prolonged exposure to survival possible, anx decrease self care, deep breathing, exercise, progressive muscle relax, mental imagery, meditate, biofeedback

Question 59

generalized anx: tm - busprione

Answer 59

anti anx med when pt sensitive to SSRI + results after several weeks relieve anx with less drowsy and abuse potential low tox and non habit forming

Question 60

generalized anx: tm - hydroxyzine

Answer 60

antiH but has different moa that makes it effective for reducing anx s/s

Question 61

specific phobias

Answer 61

persistent irrational fear, desire to aovid almost always provokes immediate fear or anx -> overwhelm, crippling, decrease F never unexpected meds not successful -> psychotherapy, desensitize, flood

Question 62

specific phobias: agroaphobia

Answer 62

most persistent and severe escape may be difficult or embarrassing, help may not be avail common situations: alone outside, alone at home, traveling, bridge, elevator, crowd associated with ACe, stress, overprotective/emotional cool fam, genes tm: SSRI, antidep, benzo, desensitize, flooding, CBT

Question 63

social anx d/o

Answer 63

social or performance (public speaking) situation that could be "-" eval public speaking self conscious ex: criticize, humiliate, negative eval/embarrassment, w/d or intense discomfort can worry for days or weeks before, uncomfortable throughout encounter interfere with F

Question 64

social anx d/o: s/s

Answer 64

blush, diaphoretic, tremble, n, difficulty talking, all eyes on them

Question 65

social anx d/o: rf

Answer 65

mistreatment, SCE, shy, parents shy (genetics and modeling) increased risk of MDD, SUD

Question 66

social anx d/o: tm

Answer 66

SSRI and benzo

Question 67

panic d/o

Answer 67

attacks sudden extreme apprehension/fear, impending doom, mins then subside suspend normal F, decrease perceptual field, misinterpret reality OH or SUD common -> self medicate etiology: fam hx, genetics, early childhood stress epidemiology: associated with dep, med conditions (htn, smoke, marijuana), F with agoraphobia more likely to experience s/s after remisison

Question 68

panic d/o: s/s

Answer 68

chest pain, palp, pounding heart, tachy, diaphoretic, tremble/shake, SOB/smother, choke, n or abd distress, sizzy, unsteady, lightheaded, faint chills/heat, paresthesia, derealization, depersonalization, fear of losing control or going crazy, fear of dying

Question 69

panic d/o: 2 important psych s/s

Answer 69

anticipatory anx: fearful expect of panic anx onset avoidance anx: strategies in crease feelings of control, decrease risk of panic anx

Question 70

panic d/o: tm

Answer 70

CBT, distraction, + self talk, flooding, relax antidep: SSRI, SNRI, TCA, MAOI, benzo = 2nd line

Question 71

panic d/o: emergency care

Answer 71

rule out life threatening -> esp cardiac, stay with, reassure, clear directions, decrease stim, walk with, prn anti anx

Question 72

obsessions

Answer 72

unwanted, intrusive, persistent impulses or images, recur so they cant be dismissed even when attempt to do so seem senseless - may not see it as out of ordinary, not consistent with self perception or usual thought pattern ex: contamination, symmetry, hurting someone

Question 73

compulsions

Answer 73

behaviors performed repeatedly (bc short term relief), ritualistic, goal of prevent/relieve anx and distress caused by obsessions ex: hand washing, touch in sequence, counting, lock and unlock

Question 74

OCD

Answer 74

cycle time consuming, distressing to self and others repetitive unwanted thoughts/obsessions repeated activities/rituals/compulsions usually center around theme gradual onset, impair F, humiliation/shame, cog impair maybe, stress can increase s/s, abuse can increase R, genes, usually occur with anx d/o continuum, F>M, 20s-30s onset, M affected more often younger and mostly obsessions, F = more cleaning and checking rituals with onset early 20s, most only seek tm when d/o sig affect life

Question 75

OCD: tm

Answer 75

v difficult can help control s/s SSRI: clomipramine, fluoxetine, fluvoxamine, paroxetine, sertraline CBT: exposure and response exposure DBS: 18+, last resort TMS: 22-68, last resort

Question 76

OCD: children and adolescents

Answer 76

1/3 onset here and/or, take 1+hr/day, think behavior will prevent bad thing from happening

Question 77

OCD: children and adolescents - tm

Answer 77

meds: clomipramine, fluvoxamine, fluoxetine, sertraline therapy: behavior (exposure and response prevention) and CBT for adolescents only

Question 78

body dysmorphic d/o

Answer 78

preoccupation with 1+ perceived defect of flaws that aren't visible to appear slight to others obsessive thinking and compulsive behaviors or mental acts (compare to others) compulsive behaviors: check mirror and camouflaging, excess groom, skin pick, seek reassurance cosmetic sx provide temp relief intrusive, unwanted, time consuming, difficult to control, embarrassed, shame, anx, disgust, dep 12-13 onset, most before 18, increased r/o suicide

Question 79

body dysmorphic d/o: tm

Answer 79

chronic tm response limited CBT, SSRI alternative therapies like biofeedback, meditation, relaxation

Question 80

hoarding

Answer 80

difficulty discarding or parting with possessions regardless of value cause sig distress and impair F M > F s/s begin in adolescence, interfere with F in 20s, sig impair in 30s, worsen MDD or anx, OCD safety w/n home may or may not be aware of problem

Question 81

trichotillomania

Answer 81

hair pulling any body region: scalp, brows, lashes pain decreases anx, like NSSI, most unaware until notice clump wks - decades, F > M tm: behavior, SSRI

Question 82

excoriation d/o

Answer 82

skin picking result in lesions - swollen or broken skin also rub, squeeze, lance, bite deal with stress, relieve anx or without realizing F > M, w/ OCD, trichotillomania tm: SSRI and CBT usually chronic -> fluctuate wks - yrs if untreated several hrs/day