Anxiety Disorders-Heh

Question 1

What are clinical features of Panic Disorder?

Answer 1

• recurrent, unexpected anxiety/panic attacks
• 1 month concern about having another attack, worry about implications of another attack or significant change in behavior related to the attack (avoidance)
• symptoms: palpitations, sweating, trembling, sensations of SOB, choking sensation, CP, nausea, feel dizzy/faint, derealization, fear of losing control and dying, paresthesias, chills or hot flashes
• sudden attacks, 5-30 minutes long with residual symptoms
• bad prognosis: vivid memory of 1st attack, occurs at night, severe symptoms

Question 2

What are some features of agoraphobia?

Answer 2

• Unfamiliar setting/crowds/wide open spaces
• Inability to escape a place or situation
• Unable to get help in event of panic attack
• Feel trapped
• Need to be accompanied in crowded places
• Social embarrassment

Question 3

How can Panic Disorder course clinically (changes that take place with each additional panic attack)?

Answer 3

higher baseline develops –> more likely to develop panic attacks more frequently with residual anxiety and longer recovery

self-medication with alcohol or medication often leads to depression

Question 4

What is the DSM IV criteria for Generalized Anxiety Disorder?

Answer 4

-excessive worry/anxiety about life and things that they should not be worrying about for at least 6 months (affecting different activities)

• 3 or more: WATCHERS
• Worry
• Anxiety
• Tension in mm.
• Concentration difficulties
• Hyperarousal (irritability)
• Energy loss
• Restlessness
• Sleep disturbance

Question 5

What is a phobia? What are the 3 DSM categories of phobia?

Answer 5

-Irrational fear (and disproportionate to any danger) of specific objects, places, situations or activities

• agoraphobia
• social phobia
• specific phobia

Question 6

What is Social Phobia/Social Anxiety Disorder?

How do children and adults with this diagnosis differ?

Answer 6

• Fear of humiliation or embarrassment in public places
• Fear of being observed by other people
• Fear public speaking, eating in restaurants, writing in public, using public bathroom, using the telephone
• Children: crying, tantrum, freezing, shrinking away from social situations
• adults: situationally predisposed panic attacks

-children do not realize that their fear is disproportionate to the situations and adults do

Question 7

What is the difference between obsessions and compulsions?

Answer 7

• Obsessions: Persistent and recurrent thoughts/ideas/impulses or images that experienced as intrusive /inappropriate and cause anxiety/distress. (common are contamination and pathological doubt)
• Compulsions: Repetitive and intentional behaviors(mental acts) or rituals are performed in response to the obsession.
• ->Complusions meant to neutralize or reduce the anxiety/distress. (washing and checking)

Question 8

What are the criteria for a PTSD diagnosis (DSM IV)?

Answer 8

TRAUMA

• Traumatic event (proximal to pt and with intense fear, helplessness or horror)
• Re-experience
• Avoidance
• Unable to function
• Month or more of symptoms
• Arousal increased (irritable, anger outbursts, difficulty sleeping, exaggerated startle response, difficulty concentrating)

Question 9

What is the difference between acute, chronic and delayed PTSD?

Answer 9

• acute: 1 month-3 month duration
• chronic: > 3months
• delayed: symptoms began after > 6 months

Question 10

What is the diagnosis for a pt with PTSD symptoms but less than 1 month?

Answer 10

Acute Stress Disorder:

• Maximum of 1 month duration
• greater # dissociative symptoms
• likely to develop PTSD

Question 11

What neuropathological changes are seen in PTSD?

Answer 11

• smaller hippocampal area (antidepressants will make this bigger)
• fewer serotonin 1B receptors in their brain stress circuits