Flashcards in Anxiety Disorders, Somatoform Disorders, and Related Conditions Deck (54):
What happens in anxiety?
The individual is frightened but the SOURCE of the danger is NOT KNOWN, not recognized, or inadequate to account for the symptoms.
The physiologic manifestations of anxiety are similar to those of ...?
The physiologic manifestations of anxiety include:
1. Shakiness and sweating.
2. Palpitations (subjective experience of tachycardia).
3. Tingling in the extremities and numbness around the mouth.
4. Dizziness and syncope (fainting).
5. GI and urinary disturbances (eg diarrhea and urinary frequency).
6. Mydriasis (pupil dilation).
Classification and occurrence of the anxiety disorders - DSM-IV-IR includes:
1. Panic disorder (with or without agoraphobia).
2. Phobias (specific and social).
3. Obsessive-compulsive disorder (OCD).
4. Generalized anxiety disorder (GAD).
5. Post-traumatic stress disorder (PTSD).
6. Acute stress disorder (ASD).
Is adjustment disorder an anxiety disorder?
NO - But it is very common and also because it often must be distinguished from PTSD.
What are the MC treated mental health problems?
The ANXIETY DISORDERS.
The organic basis of anxiety - Neurotransmitters involved in the development of anxiety include:
1. NE (incr. activity).
2. Serotonin (decr. activity).
3. GABA (decr. activity).
Site of noradrenergic neurons?
The locus ceruleus.
The site of serotonergic neurons:
Which nucleus plays a role in OCD?
Which cortices are most likely to be involved in anxiety disorders?
TEMPORAL + FRONTAL CORTICES.
10 ORGANIC causes of anxiety:
1. Excessive caffeine intake.
2. Substance abuse.
4. B12 def.
6. Cardiac arrhythmia.
8. Pulmonary disease.
If the etiology is PRIMARILY organic, the diagnoses ...?
1. Substance-induced anxiety disorder.
2. Anxiety disorder caused by a general medical condition may be appropriate.
Management of anxiety disorders - Antianxiety agents:
Because they carry a high risk of dependence and addiction,they are usually used for ...?
ONLY A LIMITED AMOUNT OF TIME to treat acute anxiety symptoms.
Because they work quickly, benzodiazepines, particularly ALPRAZOLAM (Xanax), are used for ...?
Emergency department management of PANIC ATTACKS.
Buspirone (BuSpar) is a ...?
NON-BENZODIAZEPINE antianxiety agent.
Why is buspirone useful as LONG-TERM maintenance therapy for patients with GAD?
Because of its LOW ABUSE POTENTIAL.
How long does buspirone take to act?
It takes up to 2 weeks to work, buspirone has little immediate effect on ANXIETY SYMPTOMS
Why do we use beta blockers in anxiety disorders?
Eg propranolol (Inderal) are used to control AUTONOMIC SYMPTOMS (tachycardia) in anxiety disorders, particularly for anxiety about performing in public or taking an examination.
Management of anxiety disorders - Antidepressants:
3. ESPECIALLY SSRIs.
Efficacy of SSRIs:
1. Paroxetine (Paxil).
2. Fluoxetine (Prozac).
3. Sertraline (Zoloft).
--> The most effective long-term (maintenance) therapy for PANIC DISORDER + OCD and have shown efficacy also in PTSD.
Recently, which drugs were approved to treat GAD?
1. SSRIs (Escitalopram [Lexapro]).
2. SNRIs --> Venlafaxine (effexor), duloxetine (Cymbalta) were approved to treat GAD.
Which drugs indicated in the management of SOCIAL PHOBIA?
Management of anxiety disorders - Psychological management?
Systematic desensitization + cognitive therapy = The MOST EFFECTIVE management for phobias and are useful adjuncts to pharmacotherapy in other anxiety disorders.
Management of the anxiety disorders - Psychological management - Behavioral therapies:
Such as flooding and implosion, also are useful.
Management of the anxiety disorders - Psychological management - Support groups (eg victim survivor groups) are:
Particularly useful for ASD + PTSD.
DSM-IV-TR Classification of the anxiety disorders and adjustment disorder - Panic disorder (with or without agoraphobia):
1. Episodic (about twice weekly) periods of intense anxiety (panic attacks).
2. Cardiac and respiratory symptoms and the conviction that one is about to die or lose one's mind.
3. Sudden onset of symptoms, increasing in intensity over a period of approx. 10min, and lasting about 30min (attacks rarely follow a fixed pattern).
4. Attacks can be included by administration of sodium lactate or CO2.
5. Strong genetic component.
6. More common in young women in their 20s.
7. In panic disorder with agoraphobia, characteristics and symptoms of panic disorder (see above) are associated with fear of open places or situations in which the patient cannot escape or obtain help (agoraphobia).
8. Panic disorder with agoraphobia with separation anxiety disorder in childhood.
DSM-IV-TR Classification of the anxiety disorders and adjustment disorder - Phobias (specific and social):
1. In specific phobia, there is an irrational fear of certain things (eg elevators, snakes, or closed-in areas).
2. In social phobia (aka social anxiety disorder), there is an exaggerated fear of embarassment in social situations (eg public speaking, eating in public, using public restrooms).
3. Because of the fear, the patient avoids the object or situation.
4. Avoidance leads to social and occupational impairment.
DSM-IV-TR Classification of the anxiety disorders and adjustment disorder - OCDs:
1. Recurring, intrusive feelings, thoughts, and images (obsessions) that cause anxiety).
2. Anxiety is relieved in pat by performing repetitive actions (compulsions).
3. A common obsession is avoidance of hand contamination and a compulsive need to wash the hands after touching things.
4. Obsessive doubts lead to compulsive checking (eg of gas jets on the stove) and counting of objects, obsessive need for symmetry leads to compulsive ordering and arranging, and obsessive concern discarding valuables leads to compulsive hoarding.
5. Patients usually have insight (ie they realize that these thoughts and behaviors are irrational and want to eliminate them).
6. Usually starts in adulthood, but may begin in childhood.
7. Genetic factors are involved.
8. Increased in 1st-degree relatives of Tourette disorder patients.
DSM-IV-TR Classification of the anxiety disorders and adjustment disorder - Generalized anxiety disorder:
1. Persistent anxiety symptoms including hyperarousal and worrying lasting 6mos or more.
2. GI symptoms are common.
3. Symptoms are not related to a specific person or situation (ie free-floating anxiety).
4. Commonly starts during the 20s.
DSM-IV-TR Classification of the anxiety disorders and adjustment disorder - PTSD and Acute Stress Disorder (ASD):
1. Symptoms occurring after a catastrophic (life-threatening or potentially fatal event, eg war, house fire, serious accident, rape, robbery) affecting the patient or the patient's close friend or relative.
2. Symptoms can be divided into 4 types (reexperiencing, hyperarousal, emotional numbing, avoidance).
3. In PTSD, symptoms last for more than 1 mo (sometimes a yr) and may have delayed onset.
4. In ASD, symptoms last only between 2 days and 4 weeks.
PTSD and ASD - The 4 types of symptoms:
1. Reexperiencing = intrusive memories of the event [flashbacks] and nightmares.
2. Hyperarousal = Anxiety, increased startle response, impaired sleep, hypervigilance.
3. Emotional numbing (eg difficulty connecting with others).
4. Avoidance (eg survivor's guilt, dissociation, social withdrawal).
DSM-IV-TR Classification of the anxiety disorders and adjustment disorder - Adjustment disorder:
1. Emotional symptoms (eg anxiety, depression, or conduct problems) causing social, school, or work impairment occcurring within 3 mos and lasting less than 6mos after a serious life event (eg divorce, bankruptcy, changing residence) but do not meet full criteria for a mood or anxiety disorder.
2. Symptoms can persist for more than 6 mos in the presence of a chronic stressor.
3. Not diagnosed if the symptoms represent typical bereavement.
Somatoform disorders - Characterized by ...?
Physical symptoms without explainable organic cause.
Somatoform disorders - The patient thinks that the symptoms have an organic cause but ...?
The symptoms are believed to be PSYCHOLOGICAL, and thus are unconscious expressions of unacceptable feelings.
Most somatoform disorders are ...?
More common in women, ALTHOUGH hypochondriasis occurs equally in men and women.
DSM-IV-TR Classification of the somatoform disorders:
1. Somatization disorder.
3. Conversion disorder.
4. Body dysmorphic disorder.
5. Pain disorder.
Somatization disorder - Characteristics:
1. History over years of at least 2 GI symptoms (eg nausea), 4 pain symptoms, 1 sexual symptom (eg menstrual problems), and 1 pseudoneurological symptom (eg paralysis).
Hypochondriasis - Characteristics:
1. Exaggerated concern with health and illness lasting at least 6 mos.
2. Concern persists despite medical evaluation and reassurance.
3. More common in middle + old age.
4. Goes to many different doctors seeking help ("doctor shopping").
Conversion disorder - Characteristics:
1. Sudden, dramatic loss of sensory or motor function (eg blindness, paralysis), often associated with a stressful life event.
2. More common in UNSOPHISTICATED adolescents and young adults.
3. Patients appear relatively unworried ("la belle indifference").
Body dysmorphic disorder - Characteristics:
1. Excessive focus on a minor or imagined physical defect.
2. Symptoms are NOT accounted for by anorexia nervosa.
3. Onset usually in the late teens.
Pain disorder - Characteristics:
1. Intense acute or chronic pain not explained completely by physical disease and closely associated with psychological stress.
2. Onset usually in the 30s and 40s.
Somatoform disorders - DDx:
1. Unidentified organic disease - Most important.
2. Factitious disorder.
3. Malingering (faking or feigning illness).
4. Masked depression.
Management of somatoform disorders - Effective strategies include:
1. Forming a good physician-patient relationship (eg scheduling regular monthly appointments, providing reassurance).
2. Providing a multidisciplinary approach including other medical professionals (eg pain management, mental health services).
3. Identifying and decreasing the social difficulties in the patient's life that may intensify the symptoms.
Management of the somatoform disorders - What may also be useful?
1. Antianxiety and antidepressant agents.
3. Behavioral relaxation therapy.
Factitious disorder (Formerly Munchausen syndrome) - Characteristics:
1. Conscious simulation of physical or psychiatric illness to gain attention from medical personell.
2. Undergoes unnecessary medical and surgical procedures.
3. Has a "grid abdomen" (multiple crossed scars from repeated surgeries).
Factitious disorder by proxy:
1. Conscious simulation of illness in another person, typically a in a child by a parent, to obtain attention by medical personell.
2. Is a form of CHILD ABUSE, because the child undergoes unnecessary medical and surgical procedures.
3. Must be reported to child welfare authorities (state social service agency).
1. Consious stimulation or exaggeration of physical or psychiatric illness for financial (eg insuranc settlement) or other obvious gain (eg avoiding incarceration).
2. Avoids treatment by medical personell.
3. Health complaints cease as soon as the desired gain is obtained.
While individuals with somatoform disorders truly believe that they are ill, patients with factitious disorders and malingering?
FEIGN MENTAL OR PHYSICAL ILLNESS, or actually induce physical illness in themselves or others for psychological gain (factitious disorder) or tangible gain (malingering).
Patients with factitious disorders often have worked in ...?
The medical field (eg nurses, technicians) and know how to persuasively simulate an illness.
Is malingering a psychiatric disorder?
Feigned symptoms most commonly include?
1. Abdominal pain.
2. Fever (by heating the thermometer).
3. Blood in the urine (by adding blood from a needle stick).
4. Induction of tachycardia (by drug administration).
5. Skin lesions (by injuring easily reached areas).