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Clin Med- P > Anxiety, OCD, Trauma > Flashcards

Anxiety, OCD, Trauma Flashcards

1
Q

what are the three D’s of psych disorders?

A

deviance, discomfort, dysfunction

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2
Q

anxiety disorders must significantly impact at least _____ area of functioning to be considered a disorder

A

one

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3
Q

what % of Americans 18 yrs and older have anxiety annually

A

18%

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4
Q

anxiety is a response to what two things

A

danger or threat

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5
Q

what body response is activated for anxiety?

A

fight/flight (sympathetic)

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6
Q

most anxiety disorders will present with what symptoms?

A

physical

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7
Q

what three things can be a comorbid condition with anxiety?

A

depression, substance abuse, another anxiety disorder

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8
Q

differential diagnoses for anxiety? (4)

A

1) . substance intoxication (stimulants) /withdrawal (CNS depressants)
2) . Caffeine
3) . Medical conditions (endocrine disorders, cardiovascular problems, arrhythmias)
4) . Psych disorders (depression, mania, obsessive disorders)

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9
Q

psychotherapy options for anxiety? (3)

A

Cognitive-behavioral
Supportive with problem-solving
Structured relaxation and stress management

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10
Q

psychopharmacology options for anxiety? when is this used?

A

When symptoms significantly interfere with functioning
1). Antidepressant and antianxiety medications
(SSRIs or Buspirone)
2). Benzodiazepines (limited basis only- addictive and pt develops tolerance)
3). Herbal remedies (passiflora, valerian) – mixed results

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11
Q

five types of anxiety disorders

A

1) . panic disorder
2) . panic attack
3) . generalized anxiety disorder
4) . phobia (specific phobia)
5) . social anxiety disorder

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12
Q

panic disorders are more common in what sex?

A

female (2-3x)

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13
Q

what % of primary care patients have a panic disorder?

A

7%

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14
Q

to be diagnosed with a panic disorder, you need to have what 4 things?

A

1) . recurrent unexpected panic attacks
2) . at least 1 attack has been followed by 1 month or more of persistent worry about having another attack or significant change in behavior related to attack (avoidance)
3) . not direct effects of substance or medical condition
4) . not better accounted for by another mental disorder

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15
Q

panic attack: abrupt surge of ______ _______, symptoms develop ______ and reach peak within a few ______

A

intense fear; abruptly; minutes

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16
Q

panic attack: must have at least 4 of what symptoms to develop abruptly

A

SYMPATHETIC OVERDRIVE:
Palpitations, pounding heart, accelerated heart rate
Sweating
Trembling or shaking
Sensations of shortness of breath or smothering
Feeling of choking
Chest pain or discomfort
Nausea or abdominal distress
Feeling dizzy, unsteady, lightheaded, or faint
Derealization (feelings of unreality) or depersonalization (being detached from oneself)
Fear of losing control or going crazy
Fear of dying
Parasthesias (numbness or tingling sensations)
Chills or hot flushes

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17
Q

what is agoraphobia?

A 
marked fear or anxiety about situation/place where escape might be difficult:
Using public transportation
Being in open spaces
Being in enclosed spaces
Standing in line or being in a crowd
Being outside of the home alone
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18
Q

7 criteria for agoraphobia

A

1) . fear or anxiety about a specific situation
2) . individual fears or avoids these situations bc escape might be difficult
3) . situations provoke FEAR or ANXIETY
4) . situations are ACTIVELY avoided
5) . fear or anxiety is OUT OF PROPORTION to actual danger
6) . persistent fear/anxiety, lasts 6 months or more
7) . causes significant distress or impairment in functioning

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19
Q

how can panic attacks be debilitating?

A

the person usually stops going to the place where attacks occur or avoid anything associated with the attack

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20
Q

prevalence and more frequent gender for generalized anxiety disorder (GAD)

A

3 percent and 2/3 female

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21
Q

generalized anxiety disorder: ______ comorbidity with other psychiatric disorders

A

high

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22
Q

GAD age of onset

A

about 20

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23
Q

GAD: patient worries about what two things?

A

rational AND irrational things

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24
Q

GAD criteria (6)

A

1) excessive anxiety and worry occurring more days than not for at least SIX months, VARYING ASPECTS of life
2) . out of proportion to event
3) . anxiety and worry associated with three or more of the following
- restlessness
- being easily fatigued
- difficulty concentrating
- irritability
- muscle tension
- sleep disturbance
4) . NOT episodic NOR situational
5) . cause significant impairment in functioning
6) . disturbance not due to direct effects of a substance or general medical condition

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25
Q

treatment of GAD (therapy and meds)

A

1) . psychotherapy- supportive, cognitive behavioral, biofeedback and relaxation
2) . SSRIs- FIRST LINE (paroxetine, venlafaxine, escitalopram); can add buspirone

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26
Q

what is the hallmark symptom of GAD?

A

excessive anxiety about many events including those that are unrealistic

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27
Q

phobias: most _________ but ________ disabling psychological disorder

A

common; least

28
Q

specific phobia: gender prevalence and tends to run in __________

A

females are twice as likely to have it; runs in families

29
Q

social phobia: gender prevalence and some evidence of ________ factors

A

more common among women; genetic

30
Q

specific phobia is the only psych disorder that can be _______

A

cured

31
Q

specific phobia criteria (6)

A

1) . persistent fear or anxiety about a specific object or situation FOR AT LEAST 6 MONTHS
2) . exposure to the phobic situation provokes immediate fear/anxiety
3) . phobic situation is avoided or endured with intense anxiety
4) . fear or anxiety is out of proportion to the actual danger
5) . causes impairment in functioning
6) . not due to substance use or other medical condition

32
Q

social phobia criteria (6)

A

1) . persistent fear or anxiety about one or more social situations in which person is exposed to possible scrutiny by others FOR AT LEAST 6 MONTHS
2) . fear of showing anxiety symptoms that will be negatively evaluated
3) . social situations are avoided or endured with intense anxiety
4) . fear or anxiety is out of proportion to actual threat
5) . causes impairment in functioning
6) . not due to another substance

33
Q

treatment for specific phobias (therapy and meds)

A

therapy- exposure and desensitization therapy tx of choice for specific phobias
meds- short term benzos or BBs for some pts
a). paroxetine for social phobia
b). BB’s for performance situations
c). benzos for infrequent events

34
Q

are phobias are always caused by a negative prior experience with the feared object?

A

no

35
Q

what are the five obsessive-compulsive related disorders?

A

1) . obsessive compulsive disorder
2) . body dysmorphic disorder
3) . Hoarding disorder
4) . trichotillomania
5) . Excoriation

36
Q

Obsessive-Compulsive and Related Disorders: common pattern of ___________ or driven ________ behaviors

A

compulsive; repetitive

37
Q

obsessive-compulsive DO: average age of onset and 3 comorbid conditions

A

20 yo, early adulthood

-eating DOs, anxiety DOs, depression

38
Q

what is a rumination? it occurs frequently in what psych condition?

A

persistent thought in a patient’s mind that they can’t get rid of; depression

39
Q

obsessions are defined by what three things?

A

1) . Recurrent and persistent thoughts, urges, or images that are intrusive/unwanted **cause marked anxiety or distress
2) . The person attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e. by performing a compulsion)
3) . usually EGO-DYSTONIC: inconsistent with one’s own personal beliefs

40
Q

compulsions are defined by what three things?

A

1) . repetitive behaviors that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly
2) . the behaviors or mental acts are aimed at preventing or reducing distress or anxiety, or preventing some dreaded event or situation (but not connected in a realistic way)
3) . Cause distress, impairment in functioning or time consuming

41
Q

three criteria of OC disorder

A

1) . presence of either obsessions or compulsions or both
2) . impairment in functioning
3) . not due to effects of a substance or other medical condition

42
Q

management of OCD (therapy and meds)

A

1) . FIRST LINE = Cognitive behavioral psychotherapy (exposure with response prevention)
2) . meds- SSRIs (sertraline) and clomipramine (TCA)

43
Q

OC disorder: rates of full remission after therapy & meds ___-____%

A

6-43%

44
Q

what is body dysmorphic disorder?

A

preoccupied with imagined or exaggerated physical defect in appearance AND becomes obsessed with perceived defect

45
Q

body dysmorphic disorder criteria (4)

A

1) . Preoccupation with AT LEAST ONE or more perceived defects or flaws in physical appearance that are not observable
2) . causes person to be ashamed or feel self-conscious = leading to functional impairment
3) . the individual has performed repetitive behaviors or mental acts in response to the appearance concerns (i.e. mirror checking, excessive grooming, skin picking)
4) . Not better explained by concerns with body fat or weight in an individual whose symptoms meet dx criteria for an eating disorder

46
Q

treatment of BDD

A

SSRIs and/or CBT

1) . CBT: exposure with response prevention and cognitive restructuring
2) . SSRIs and clomipramine

47
Q

what treatment should be discouraged in BDD?

A

surgical and cosmetic tx bc patient is rarely satisfied with the results and keeps undergoing surgery

48
Q

hoarding disorder criteria (4)

A

1) . persistent difficulty discarding or parting with possessions (regardless of value)
2) . difficulty is due to a perceived need to save the items
3) . results in accumulation of possessions that clutter living areas
4) . causes impairment in functioning

49
Q

treatment of hoarding disorder

A

CBT: helping change the maladaptive beliefs about the need to retain possessions
HARD TO TX
little data on med use

50
Q

what is trichotillomania? what is it used as a coping response for?

A

Recurrent pulling out of one’s hair, resulting in hair loss, with repeated attempts to stop; coping response to deal with stress or anxiety

51
Q

what is the first line tx of trichotillomania?

A

habit reversal therapy: self-monitoring, awareness training, stimulus control, counter-conditioning

52
Q

what is excoriation? treatment?

A

compulsive or repetitive picking of the skin, resulting in skin lesions or sores that don’t heal; repeated attempts to stop; tx is behavioral therapy

53
Q

what are the five trauma and stressor related disorders? (2 peds)

A

pediatrics:

1) . reactive attachment disorder
2) . disinhibited social engagement disorder
3) . PTSD
4) . acute stress disorder
5) . adjustment disorder

54
Q

what is important about the onset of trauma and stressor related disorders?

A

the patient must have an event to cause/trigger these disorders

55
Q

PTSD has high comorbidity with what three disorders?

A

depression, substance abuse, panic disorder

56
Q

PTSD: has to inflict feeling of ___________ in a person

A

helplessness

57
Q

PTSD criteria (8)

A

1) . traumatic event: exposure to actual threat or threatened death, sexual violence
- experienced it
- witnessed it in person on others
- learned that it occurred to close family member or friend
- experienced repeated exposure to aversive details of the event
2) . presence of 1 or more intrusion symptom
- distressing memories
- distressing dreams
- dissociative reactions (if the event were recurring)
- intense psychological distress
- physiological reactivity on exposure to something that resembles an aspect of the event
3) . persistent avoidance of stimuli by 1 or both
- avoidance of distressing memories, thoughts, or feelings about the event
- avoidance of external reminders (people, places, activities)
4) . negative alterations in cognition and mood (2 or more)
- psychogenic amnesia
- persistent negative beliefs about oneself, others, world
- distorted cognitions that blame oneself or others
- persistent negative emotional state
- diminished interest
- feelings of detachment or estrangement from others
- persistent inability to experience positive emotions
5) . alterations in arousal and reactivity (hyperarousal), 2 or more
- irritable behavior and angry
- reckless or self destructive behavior
- hypervigilance
- startle response
- problems with concentration
- sleep disturbance
6) . duration is MORE THAN ONE MONTH
7) . significant impairment in functioning
8) . not attributable to effects of a substance or other medical condition

58
Q

what is a flashback?

A

similar to a hallucination but specific ONLY to PTSD

59
Q

what is psychogenic amnesia?

A

inability to remember an important aspect of the trauma

60
Q

Management of PTSD (therapy, meds)

A

1) . multidisciplinary team- psychotherapist, psychiatrist, substance abuse counselor, peer groups, family therapy
2) . Meds- SSRIs first line, trazodone maybe for insomnia, prazosin for nightmares
3) . Cognitive behavioral treatment- prolonged exposure therapy, coping strategies

61
Q

what is acute stress disorder?

A

same symptoms as PTSD (need 9 of them) but traumatic event occurred LESS THAN ONE MONTH AGO and symptoms resolve within THOSE 4 WEEKS, lasting AT LEAST THREE DAYS (if symptoms last longer than one month, then PTSD diagnosis is given)

62
Q

how to treat acute stress DO

A

counseling and psychotherapy first line

63
Q

tx for agoraphobia?

A

CBT and SSRIs

64
Q

tx for panic disorder

A

SSRIs- first line
**may start with benzos too and taper benzos once SSRIs effective
CBT + Meds = IDEAL

65
Q

how to treat acute panic attacks

A

BENZOs (Xanax or klonopin)

*watch for dependence

66
Q

treatment for social anxiety disorder

A

psychotherapy FIRST LINE (CBT- desensitization)
SSRIs- fluoxetine, sertraline
**meds and psychotherapy

67
Q

4 major patterns of OCD

A

1) . contamination: compulsion may include hand washing or cleaning
2) . pathologic doubt: forgetting to unplug iron to avoid potential danger
3) . symmetry/precision: ordering or counting
4) . intrusive obsessive thoughts without compulsions

Clin Med- P (124 decks)

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