Anxiety Disorders Flashcards
(47 cards)
1
Q
Define “normal” reaction to stress vs. Anxiety rxn
A
- Normal” Reaction
A. Emotional reactions to real, external threats
B. Appropriate emotional response to actual danger - Anxiety Reactions
A. Reaction without obvious external threat
B. Response is excessive
2
Q
What are the 4 etilogical theories for anxiety disorders?
A
- Psychodynamic Theory
- Learning Theory
- Cognitive Theory
- Biological Theory
3
Q
What is the psychodynamic theory for anxiety disorders?
A
Rooted in the unconscious conflict
A natural biologically driven response mechanism to survive
4
Q
What is the Learning theory for anxiety disorders?
A
Anxiety disorder develops when environmental cues become associated with anxiety producing events
Example: Fear of air travel would be enhanced by reading about air disasters
5
Q
What is the cognitive theory for anxiety disorders?
A
Emotional states (i.e.: anxiety and depression)
Result of distorted beliefs about self, world, future
Result in autonomic through responses to external or internal cues that trigger anxiety
6
Q
What is the biological theory for anxiety disorders?
A
- Acute fear state = “fight or flight” activation
- Brain regions (amygdala) activated
- Amygdala encodes fearful memory
- Fear and negative anticipatory expectation (anxiety)
- Awareness of fear in the frontal cortex
- Acute fear activates sympathetic nervous system
7
Q
Define GAD
A
At least six (6) months of excessive worry about everyday issues that is disproportionate to any inherent risk, causing distress or impairment.
8
Q
Define mild distress
A
subjective distress that DOES NOT significantly impair daily functioning or relationships
9
Q
define Moderate distress
A
Significant worry that impairs functioning, adversely affects relationships, or causes considerable subjective distress.
10
Q
What are the characteristics of GAD?
A
- Most common anxiety disorder
- Affects about 5% of Americans during lifetime
- Women more common than men
- Begins in early adulthood
- Usually chronic
- Comorbid major depressive disorder
- Mild to moderate familial heredity
- May be associated with bullying or peer victimization
11
Q
What may GAD “look like”?
A
- Emotionally reactive temperament
- May be referred to as “neurotic”
- On edge or restless
- Feeling tired
- Difficulty with concentration
- Irritable
- Muscle tension
- Sleep disturbance
- Constant state of worry and anxiety
- Out of proportion to the level of actual stress or threat
- Physical symptoms may be present
- Present as lack of confidence, perfectionist, conformist
12
Q
What are the GAD DSM V criteria?
A
- Excessive anxiety and worry occurring for more days than not for at least six months
- Individual finds it difficult to control worry
- Anxiety and worry are associated with three or more symptoms present more days than not for the past six months
A. Restlessness and feeling keyed up or on edge
B. Being easily fatigued
C. Difficulty concentrating and mind going blank
D. Irritability
E. Muscle tension
F. Sleep disturbance (difficulty falling, staying asleep, restlessness, unsatisfying sleep) - Anxiety, worry or physical symptoms cause clinically significant distress or impairment in social occupational, or other important areas of functioning
- Disturbance is not attributable to the physiological effects of a substance (drug or prescribed medication) or medical condition (hypothyroidism)
- Disturbance is not better explained by another mental disorder
13
Q
What questions might you ask to evaluate the presence of GAD?
A
- Are you a worrier?
- What do you worry about?
- Over the past few months have you been feeling jittery?
- Irritable?
- Do you feel any muscle tension? Where?
- Do you tire easily?
- Do you have insomnia?
- Do you have trouble concentrating?
14
Q
define panic disorder
A
- Characterized by recurring panic attacks over a one month period and associated with worry about their implications.
- May or may not be associated with specific cues or may occur unexpectedly.
15
Q
What are the characteristics of panic disorder?
A
- Panic attacks can occur in nearly every anxiety disorder
- Panic attacks may or may not be attributed to specific triggers
- Attacks usually last 15 - 30 minutes; residual effects may persist
- Panic disorder is prevalent in 1-3% of the population
16
Q
How is GAD diagnosed?
A
- Excessive worry and anxiety
- Difficult to control
- Occurring more days than not
- At least six months
- Associated with at least three symptoms
- Not better explained by a substance abuse or medical issue
17
Q
When does panic disorder usually develop?
A
- Twice as common in women as men
- May develop any time in the lifespan but most common onset is mid-20s
- Panic disorders may occur in childhood but may become dormant until adulthood
18
Q
What does panic disorder “look like”?
A
- Severe anxiety symptoms
- Rapid onset
- Symptoms escalate within 10 seconds
- Symptoms resolve within 60 minutes (15-30 common)
- Patient feels as if they are having medical emergency
- Myocardial Infarction
- Stroke
- Other serious physical illness
- Shortness of breath
- Dizziness
- Tachycardia
- Tremor
- Hot or cold sensation
- Chest discomfort
19
Q
How is panic disorder diagnosed?
A
Have you ever had a panic attack?
What happens to you physically?
How often do you have a panic attack?
How long do they last?
When was the last one?
When you have a panic attack what goes through your mind?
Can you feel it coming on or does it come out of the blue?
Have you ever passed out during an attack?
Has an attack ever woken you up at night?
Do you recall when you had your first attack?
What makes it better or worse?
20
Q
What are the DSM V criteria for a panic disorder?
A
- Four (or more) of the following symptoms occur
A. Sweating
B. Trembling or shaking
C. Sensation of shortness of breath or smothering
D. Feelings of choking
E. Chest pain or discomfort
F. Nausea or abdominal distress
G. Feeling dizzy, unsteady, light-headed, or faint
H. Chills or heat sensations
I. Paresthesias (numbness or tingling)
J. Derealization or depersonalization
K. Fear of going crazy
L. A fear of dying - At least one attack has been followed by one month or more of one or both of the following
A. Persistent concern or worry about additional panic attacks or their consequences (i.e.: losing control, having a heart attack, “going crazy”)
B. Significant maladaptive change in behavior related to the attacks (i.e.: behaviors designed to avoid having a panic attacks)
C. Disturbance not attributable to another mental health issue
D. Exception: May be diagnosed with Agoraphobia
21
Q
What needs to be excluded to call something a panic attack?
A
- Evaluation Exclusion of Medical Issues
A. Evaluate symptoms
B. Labs
C. Cardiac work up
D. Rule out (this is not all inclusive): tachycardia, pulmonary embolism, transient ischemic attack, hypoglycemia, etc.
22
Q
How is panic disorder treated?
A
- Psychopharmacology
2. Psychotherapy
23
Q
Define Phobia
A
Excessive or unreasonable fears of specific objects or situations that are triggered by actual or anticipated exposure to phobic stimuli.
24
Q
What are the characteristics of phobias?
A
- Most common of all psychiatric disorders
- Onset is usually in childhood or early adult life
- Onset may be marked by having a panic-like reaction in the presence of phobic object
- Social phobias are often the most disabling
- Phobias may be generalized or specific
- People often live “around” specific phobias
25
How do phobias develop?
1. May develop through combination of anxiety disorder and environmental events or experiences
2. Etiology may be unknown
26
What are the sxs of a phobia?
1. Symptoms are phobia-dependent
2. Emotional reaction to an object, place, or situation
3. May be panic attack-like symptoms, hyperventilation, etc. (i.e.: agoraphobia)
4. May be vasodilation, bradycardia, orthostatic hypotension, or fainting on exposure (i.e.: blood draw)
27
What are examples of specific phobias?
Intense, irrational fears or aversion to a specific object, situation other than social situation
```
Typical specific phobias
Animals
Natural Environment
Blood Injections, Injury
Situations
```
28
Define agoraphobia
Anxiety of being in places or situations from which escape may be difficult or embarrassing
Situations are avoided or endured with marked distress
Usually develop as a complication of a panic disorder
Avoidance of situations to which there is no quick escape develops into never leaving home
29
What are the DSM V criteria for agorophobia?
1. Marked fear or anxiety in a least two of the following situations:
A. Using public transportation
B. Being in open spaces
C. Being enclosed in places
D. Standing in line or being in a crowd
E. Being outside of the home alone
2. Individual fears or avoids those situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic type symptoms or other embarrassing or incapacitating symptoms
A. Fear of falling
B. Fear of incontinence
3. Situations almost always provoke fear or anxiety
4. Agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety
5.
Agoraphobia may be diagnosed with Panic Disorder
30
Define social phobia
1. Characterized by extreme anxiety response in situations where they may be observed by others
2. Fear they will embarrass or humiliate themselves
```
3. Typical social phobias
Public speaking
Eating in public
Using public restrooms
Write while others are watching
Perform publically
```
31
What are the DSM V criteria for social phobia?
1. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others (i.e.: having a conversation with, meeting with unfamiliar people), being observed (i.e.: eating or drinking) and performing in front of others (i.e.: public speaking)
2. Fear he/she will act in a way or show anxiety symptoms that will be negatively be evaluated (i.e.: will be humiliating or embarrassing, will lead to rejection or offend others)
3. The social situations almost always provoke fear or anxiety
4. Social situations are avoided or endured with intense fear or anxiety
5. Fear or anxiety is out of proportion to the actual threat posed by the social situation and the sociocultural context
6. The fear, anxiety or avoidance is persistent, typically lasting for 6 months or more
7. Fear, anxiety or avoidance causes clinically significant distress or impairment in social, occupational or other important areas of functioning
8. Fear, anxiety or avoidance is not attributable to the physiological effects of drug abuse or medications or another medical condition
9. Fear, anxiety or avoidance is not otherwise attributed to another mental health issues such as body dysmorphic disorder, autism spectrum, etc.
32
What is the definition of OCD?
1. Obsessions and/or compulsions cause marked distress
A. Take more than one (1) hour per day
```
B. Interfere substantially with
Normal routine
Occupational
Academic
Social activities
Relationships
```
33
What are the characteristics of OCD?
1. Fourth most common mental illness
2. Equal prevalence among males and females
3. Median age of onset is 22-36 years old
4. Obsessions can be culturally specific
5. World Health Organization estimates that OCD is among the top 20 reasons for disability
6. First degree relatives have a higher risk
34
What are the sxs of OCD?
```
1. Behaviors
A. Washing
2. Straightening
A. Ordering rituals
3. Mental Rituals
A. Magical words, number, etc.
4. Checking
5. Hoarding
```
35
What are the DSM V criteria for OCD?
1. DSM V Criteria (of note, is currently classified as its own disorder, no longer classified within Anxiety Disorders in DSM V)
A. Presence of obsession, compulsion or both
B. Obsession (both must be present)
-Recurrent and persistent thoughts and urges that are experienced; these are intrusive, unwanted and cause marked anxiety and distress
-Individual attempts to ignore or suppress thoughts, urges, or images or attempts to neutralize them through compulsion
C. Compulsion (both must be present)
-Repetitive behaviors or mental acts that the individual feels driven to perform in response to the obsession or occurring to rules that much be applied rigidly
-Behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation
- These behaviors or mental acts are not accepted in a realistic way with the what they are designed to neutralize or prevent
3. OCD symptoms not attributable to a substance, prescription medication or any other medical condition
A. Ritualized eating behavior seen in anorexia
B. Skin picking as in excoriation disorder
C. Hair pulling as in trichotillomania
D. Skin picking/cutting as in BPD
E. Repetitive behavior seen in psychosis
36
What is the overview of PTSD?
Lifetime prevalence varies between countries and certain cultural groups
Higher rate in inner cities
Higher rate cities where natural disasters occur
37
When does susceptibility to PTSD increase?
1. Psychiatric history
2. Lower intelligence
3. Female gender
4. Prior exposure to trauma
38
What is the emotional processing theory for PTSD?
1. Complex fear structures which exist in the memory produce cognitive, behavioral, and physiological reactions when activated
2. Alterations in beliefs about the world and the self, brought about by difficulties in processing information about the traumatic event
3. Misinterpretation of benign stimuli as dangerous and of self being in competent
39
What is the cognitive model for PTSD?
1. Negative appraisals of the traumatic event
2. Development of views of the world as a dangerous place and of self as incompetent
3. Leads to sense of current threat in which situations are misinterpreted as threatening
40
What are the sxs of PTSD?
```
Depression
Anxiety
Substance abuse
Irritability
Angry outbursts
Avoidant behaviors
Isolation
Poor coping mechanisms
```
41
What are the DSM V criteria for PTSD?
1. Exposure to an actual or threatened death, serious injury or sexual violence in one or more of the following ways:
2. Directly experiencing the traumatic event
3. Witnessing in person the event(s) as it occurred to others
4. Learning that the traumatic event occurred to a close family member or close friend
5. In the case of the death of a family member or fiend, the events must have been violent or accidental
6. Experiencing repeated or extreme exposure to aversive details of the traumatic event
7. First responders collecting remains
8. Police officers exposed to child abuse repeatedly
9. DOES NOT apply to exposure through media devices
10. Presence of one or more of the following intrusion symptoms associated with the traumatic events beginning after the traumatic event occurred
A. Recurrent, involuntary and intrusive distressing memories of the traumatic events
B. Recurrent, distressing dreams in which the content and/or affect of the dream are related to the traumatic events
C. Dissociative reactions (i.e.: flashbacks) in which the individual feels or acts as if the traumatic events are recurring
D. Intense or prolonged psychological distress of exposure to internal or external cues that symbolize or resemble an aspect of the trauma
E. Marked physiological reactions to infernal or external cues that symbolize or resemble an aspect of the trauma
42
What needs to be considered for a treatment plan?
1. Underlying cause
2. Symptoms
3. Longstanding nature of problem
4. Degree of disability
5. Medical and other mental health issues
43
What are the treatments for GAD?
```
1. SSRI
A. Paroxetine, Escitalopram, Luvox (common for OCD)
2. SNRI
A. Duloxetine, Venlafaxine
3. Tricyclic
A. Imipramine
4. Second Generation Antipsychotic
A. Quentiapine
```
44
What are the benzodiazepines that can be used for GAD?
1. Short Acting: Alprazolam (Xanax)
2. Mid-Acting: Lorazepam (Ativan)
3. Long Acting: Clonazepam (Klonopin)
45
What are the anxiolytics/non benzodiazepines used for GAD?
Buspirone (Buspar)
| Hydroxyzine
46
What are the Psychotherapeutic Interventions
| for GAD?
```
Relaxation
Progressive Muscle Relaxation
Yoga
Guided Imagery
Alpha stimulation
Reiki
Massage
```
47
What are the psychotherapeutic interventions for panic disorder?
1. Exposure Therapy
A. Simulates anxiety situation
B. Client is encouraged to correctly interpret physical cues that predispose anxiety
2. Cognitive Behavioral Therapy
A. Recognizes relationship between cognitions and anxiety
B. Identifies misinterpretations of thoughts
