Behavioral Science: Anxiety 1 & 2 Flashcards Preview

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Flashcards in Behavioral Science: Anxiety 1 & 2 Deck (26):
1

Symptoms for a dx of anxiety

1. persistent (>6 months)
2. interfere with normal functioning
3. cause significant distress

2

Neurobiological factors a/w anxiety

Low serotonin, GABA
High Norepi, glutamate

3

GAD

A. Excessive anxiety/worry most days for at least 6 months, about more than one event/activity
B. Difficult to control worry
C. A/w at least 3 of the following: restlessness, fatigue, difficulty concentrting, irritability, muscle tension, sleep disturbance
D. causes significant impairment
E. no other explanation for symptoms

4

Features of GAD

Women > Men
May have had anxious parents
Self medicate
Without tx tends to get worse

5

Treatment of GAD

Therapy, meds, Beta blockers for performance anxiety

6

Therapy for GAD

CBT, psychodynamic

7

Meds for GAD

Antidepressants: escitalopram/paroxetine, venlafaxine, duloxetine
Buspirone (5HT1a receptor agonist)
Benzos

8

Panic disorder

A. Recurrent unexpected panic attacks
B. At least 1 attack followed by at least 1 month of one or both of the following:
- concern about additional panic attacks or consequences
- significant maladaptive change in behavior related to attacks
C. No other explanation for symptoms

9

Panic attack

An abrupt surge of intense fear or discomfort, peaks within minutes, that is unexpected. Includes at least 4 of the following:
- palpitations, pounding heart, accelerated heart rate
- sweating
- shaking/trembling
- sensation of shortness of breath or smothering
- choking sensation
- chest pain/discomfort
- nausea
- dizziness, lightheadedness or fainting
- chills or heat
- paresthesias
- derealization
- fear of losing control
- fear of dying

10

Agoraphobia

A. Fear/anxiety of at least 2 of the following:
- using public transport
- being in open spaces
- being in enclosed spaces
- standing in line or in a crowd
- being outside the home alone
B. Fear of not being able to escape situation
C. Situation almost always produces fear/anxiety
D. Avoids situations
E. Fear/anxiety out of proportion to actual danger
F. At least 6 months duration
G. Causes significant impairment
H. No other explanation for symptoms

11

Tx for agoraphobia

Therapy: CBT (systematic desensitization or flooding), psychodynamic

Meds: emergency--> quick acting benzos, long term: SSRI/SNRI. Can also use intermediate acting benzos long term but it's not first line tx due to addictive potential

Or a combo

12

Specific phobia

A. At least 6 months
B. Causes significant impairment
C. Marked fear/anxiety of specific object/situation
D. Object/situation almost always causes fear/anxiety
E. Actively avoids object/situation
F. Fear/anxiety out of proportion to actual danger
G. No other explanation for sx

13

Social Anxiety Disorder

A. At least 6 months
B. Causes significant impairment
C. Marked/fear anxiety when exposed to social situation with possible scrutiny by others
D. Fear of acting in ways that will be negatively scrutinized
E. Social situations provoke fear
F. Avoids social situations
G. Fear/anxiety out of proportion to actual threat
H. No other explanation for symptoms

14

Performance anxiety

For of social anxiety where the fear is restricted to public speaking or performing and does not generalize to other aspects of life

15

Tx for specific phobia

Therapy (1st line): Flooding, systemic desensitization, psychodynamic
Medication: sedatives?

16

Tx for social anxiety disorder

Therapy: CBT, assertiveness training, group therapy
Meds: SSRI/SNRI (1st line), paroxetine/venlafaxine ER
MAOI: Phenelzine, tranylcypromine
Beta Blockers: propanalol, 1st line for performance anxiety online

17

OCD

A. Presence of obsessions and compulsions
B. Must be either:
1. Time consuming (>1h/day), or
2. Cause clinically significant distress
{must have 1 or 2}
3. not substance induced
4. not better explained as the sx of another mental or medical disorder

18

Obsession

Recurrent/persistent thoughts, urges, or images
- intrusive and unwanted
- cause anxiety and distress
- patient tries to ignore/suppress the thoughts OR try and neutralize them with a thought or action

19

Compulsion

Repetitive behavior or activity that the patient performs in response to an obsession or as a set of rules that must be strictly adhered to
- typically undoes or reduces anxiety
- stopping the compulsion often dramatically increases the anxiety

20

OCD demographics and prognosis

- Equal in men and women
- often onset is after a stressful event
- onset is earlier in men (19) than women (22)
- long but variable outcome, generally the hardest anxiety to treat
- up to 2/3 of Tourette's pts have OCD

21

Tx for OCD

Psychotherapy: CBT is as effective as drugs, with longer lasting effect (exposure and response prevention), ACT: Acceptance and commitment therapy, Supportive psychotherapy/dynamic psychotherapy

Drugs: 1st: SSRIs, higher dose than MDD
2nd: Clomipramine
3rd: Antipsychotics or other antidepressants
- benzos don't work

22

Differential dx for OCD

1. Tourette's
2. Temporal lobe epilepsy
3. Obsessive Compulsive Personality Disorder
- OCD pts typically have insight into their behavior
- OCPD pts do not...rigid, moralistic, list and pattern oriented.

23

PTSD

A. Exposure to actual or threatened traumatic event.
- Sx must be present at least 1 month
- must cause significant stress/impairment
- not the result of drugs/medical condition

B. Intrusion symptom a/w event

C. Avoidance of stimuli a/w traumatic event

D. Negative changes in cognition and mood a/w event, at least 2 of the following:
- dissociative amnesia or repression
- persistent, exaggerated beliefs of oneself, others, or the world
- distortion of thoughts of the event causing them to blame themselves
- persistently negative emotional state
- decreased interest in activity
- detachment from others
- inability to experience positive emotions

E. Alterations in arousal/reactivity, at least 2 of the following:
- irritable/angry outbursts, verbal/physical aggression
- reckless/self destructive behavior
- hypervigilance
- exaggerated startle response
- problems with concentration
- sleep disturbance

24

Modes of Exposure in PTSD

- directly witnessing event
- witnessing event happen to others
- learning that family/friend experienced event
- directly experiencing repeated/extreme exposure to horrific details of event

25

Acute Stress Disorder

Same criteria A-D as PTSD, but must persist for 3 days-1 month post exposure (versus >1 month for PTSD)
- a precursor to PTSD
- best time to treat! can prevent PTSD

26

Tx of PTSD, ASD

Psychotherapy: Cognitive therapy, behavioral therapy, eye-movement desensitization and reprocessing, psychodynamic therapy, support groups and family therapy

Drugs:
1st: SSRI
2nd: TCAs (amitryptyline and imipramine), atypical antipsychotics
3rd: MAOIs, trazodone, anticonvulsants, clonidine, propanalol

Prazosin (a1 inhibitor) for nightmares