Flashcards in CM: Anxiety and OCDs Deck (26):
When does normal anxiety become pathological?
when it exceeds certain intensity, duration, or is inappropriate for the situation
What is the psychoanalytic theory of anxiety?
conflicts between Id and the Superego - anxiety signals Ego to keep Id repressed
What are the behavioral theories of anxiety?
cognitive distortion (overestimates threat or underestimates ability to deal with it)
What major medical conditions can cause anxiety disorders?
hyperthyroidism, hypothyroidism, hypoparathyroidism, b12 def, pheo, MS, postencephalitic complications, epilepsy, cardiomyopathy, hypoglycemia, anemia
What are substances/meds that can cause anxiety disorders?
amphetamines, cocaine, LSD, amyl nitrate, alcohol withdrawal
initiation of asthma meds, steroids, antidepressants, withdrawal of barbiturates or benzos
caffeine, decongestants, ephedra
What is panic disorder?
recurrent and UNEXPECTED panic attacks: episodes of intense fear or discomfort that start abruptly, accelerate rapidly, and usually last 10-20 min
attacks lead to concern/worry about implications or complications and change in behavior to avoid attacks
anticipatory anxiety about next attacks --> avoidance
usual rule-outs apply
What are symptoms of panic attacks?
cardio-pulm: palpitations, chest pain, SOB
GI: choking, nausea, ab discomfort
autonomic: sweating, shaking, chills, dizziness
psychological: fear of losing control, going crazy, dying
depersonalization and derealization
What is important to remember about panic attacks?
they can occur in a variety of anxiety disorders, presence of panic attacks alone not sufficient to diagnose panic disorder
What are phobias?
irrational fear of object or situation that leads to its avoidance, anticipation, and endurance with high degree of distress
pts recognize fear is excessive but feels out of their control
What is agoraphobia?
fear of places and situations in which escape might be difficult or embarrassing (crossing bridge, public transport, enclosed spaces, standing in line, leaving house alone), fear help won't be there if panic symptoms
often comorbid w panic disorder
leads to avoidance or endurance w distress
What is the general treatment of panic disorder?
most antidepressants, potent benzos
CBT - misinterpretation of bodily sensations, education about panic attacks
behavioral therapy - relaxation training, deep breathing
What is social anxiety disorder?
fear of one or more social situations in which person might feel scrutinized, humiliated, or embarrassed
leads to avoidance, anticipation or endurance w distress
pts recognize fear is excessive
What is a specifier used in social anxiety disorder?
w performance only - fear is restricted to speaking or performing in public
What is the general treatment of social anxiety disorder?
most antidepressants and benzos
CBT - identify negative autonomic thoughts, challenging the thinking errors, formation of rational alternatives
for performance only - pre-performance meds (beta-blockers - one of few times used in psychiatric disorders)
What is the general treatment for specific phobias?
exposure therapy/systematic desensitization: create hierarchy of fear inducing situations and start with least feared - use relaxation techniques to tolerate w/o anxiety, move to next situation, etc
What is generalized anxiety disorder (GAD)?
chronic, excessive anxiety and worry that causes impairment or distress, present at least 6 mos
includes physical symptoms (insomnia, fatigue, restless sleep, irritability, muscle tension, reduced concentration)
What is the general treatment of GAD?
anxiolytic antidepressants, benzos, buspirone (only here, not panic attacks)
cognitive, behavioral, and supportive therapies
What is OCD?
obsessions and/or compulsions
recognized as excessive or unreasonable
causes impairment (time-consuming) and distress
preventing can cause panic attack
What is the general treatment of OCD?
SSRIs or clopmipramine (seretonergic TCA) - may take months for beneficial effect
psychosurgery in life-threatening cases
CBT - exposure and response prevention: flooding (exposure in vivo) or implosion (exposure via mental imagery) - prevents ability to carry out compulsions
What is body dysmorphic disorder?
preoccupations w having profound bodily deformity - obsessions or delusions
reality: no deformity or minor feature
causes distress or impairment
insidious onset w gradual worsening, interventions to correct defect almost always unsuccessful and can make worse - some antidepressants may help
What is an exception to BDD?
should not be diagnosed if also has anorexia nervosa - preoccupation w being overweight while actually being underweight is part of eating disorder
What is hoarding disorder?
difficulty discarding or parting w possessions regardless of actual value
thoughts of discarding can cause distress
What is trichotillomania?
hair pulling disorder - usually repeated unsuccessful attempts to stop
What is excoriation disorder?
skin picking - usually repeated unsuccessful attempts to stop
What substances or medications can cause OCDs?
amphetamines or cocaine