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PMHNP > Stress, Anxiety, and Somatic Disorders > Flashcards

Stress, Anxiety, and Somatic Disorders Flashcards

1
Q

Theories of Stress

A
  • Diathesis Model: Individual heritable vulnerability that when acted on by a stressor produces disease/dysfunction
  • Hans Selye’s General Adaptation Syndrome (GAS) An emotional or physiological change due to a perceived event or stressor
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2
Q

Flight or Fight

A
  • Hypothalamus stimulates the sympathetic nervous system
  • SNS stimulates the adrenal medulla
  • Adrenal medulla releases epinephrine and norepinephrine
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3
Q

Sustained Stress

A
  • Adrenocorticotropic hormone (ACTH) stimulates the adrenal cortex
  • Release of mineralcorticoids
  • Vasopressin
  • Growth Hormone
  • TSH stimulates the thyroid gland
  • Gonadotropins
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4
Q

Generalized Anxiety Disorder

A
  • At least three symptoms

* Symptoms present more days than not over the course of six months

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5
Q

GAD: Short term pharmacotherapy

A
  • Benzodiazepines
  • Clonazepam for social phobia
  • Alprazolam for phobia
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6
Q

GAD Long Term Pharmacotherapies SSRIs/SNRIs

A
  • Fluoxetine (SSRI) for OCD, 20-80 mg/day
  • Paroxetine (SSRI) for panic, OCD, social anxiety, 40-60 mg/day
  • Sertraline (SSRI) for panic, OCD, PTSD, 50 -200 mg/day
  • Vilazodone (5-HT1A receptor partial agonist)
  • Effexor (SNRI) efficacy comparable to SSRI
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7
Q

GAD Long term Pharmacotherapy

A
  • Oxcarbazepine (Trileptal)
  • Divalproex sodium (Depakote)
  • Buspirone (Buspar)
  • Beta blockers
  • Chlorodiazepoxide (Librium) for substance withdrawal
  • Tricyclic Antidepressants
  • Clomipramine (Anafranil) for OCD
  • Amitriptyline and Tazodone for agoraphobia
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8
Q

Panic Disorder

A
  • At least four symptoms
  • Panic disorder includes recurrent unexpected attacks; Attacks are then followed by at least one month of one of both
      • Persistent concern/worry about future attacks
      • Significant maladaptive change in behavior
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9
Q

Panic Attack treatment

A
  • Anxiolytics
  • Antidepressants
  • CBT
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10
Q

Phobias

A
  • Fear/anxiety/avoidance lasting at least 6 months
  • Out of proportion to actual danger
  • Causes clinically significant stress
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11
Q

Phobias: Etiology

A
  • Specific phobias: increased amygdala activation; conditioning, modeling, traumatic experience
  • Social phobia: increased activity in the limbic and paralimbic regions; traumatic social experience
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12
Q

Phobias Treatment

A
  • Benzos when phobic stimuli is unavoidable
  • SSRIs when repeated exposure is expected
  • Desensitization
  • Flooding (implosive therapy)
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13
Q

Obsessive Compulsive Disorder

A
  • Presence of obsessions, compulsions, or both
  • Obsessions/compulsions are time consuming or cause clinically significant distress
  • DSM 5 Specifiers: with good/fair insight, with poor insight, with absent insight/delusional beliefs
  • tic-related
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14
Q

OCD Assessment

A
  • Yale-Brown obsessive Compulsive Scale
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15
Q

OCD Management

A
  • Allow time for rituals
  • Assist with the development of more adaptive methods of coping
  • Behavior therapy
    Meditation and relaxation techniques
  • SSRIs: Fluoxetine, setraline, paroxetine, citalopram, escitalopram
  • Clomipramine (Anafranil)
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16
Q

Body Dysmorphic Disorder

A
  • Preoccupation with at least one perceived defect/flaw
  • Individual has performed repetitive acts in response
  • Preoccupation causes clinically significant distress
  • Not better explained by an eating disorder
  • DSM 5 specifiers: good/fair insight, poor insight, absent insight/delusional beliefs, muscle dysphoria
17
Q

Body Dysmorphic Disorder Assessment

A
  • Body Dysmorphic Disorder Questionnaire-Dermatology version
  • Dysmorphic Concern Questionnaire
  • Body Dysmorphic Disorder Symptom Scale
  • SSRIs
  • Tricyclic when SSRIs not effective
  • Neuroleptic agents to reduce psychotic symptoms
  • CBT
18
Q

PTSD

A
  • Exposure to a threat
  • Intrusive symptoms; one or more symptoms
  • Persistent avoidance of stimuli
  • Negative alterations in cognition/mood: at least two symptoms
  • Marked alterations in arousal.reactivity: at least two symptoms
  • Disturbances longer than a month
  • Disturbances cause clinically significant distress
  • Disturbance longer than a month differentiates from Acute Stress Disorder
19
Q

PTSD: Etiology

A
  • Exposure to traumatic events activates the amygdala

* The orbitoprefrontal cortex is less capable of inhibiting activation

20
Q

PTSD: Screening Tools

A
  • PTSD checklist

* Clinician Administered PTSD scale

21
Q

PTSD: Pharmacologic Interventions

A
  • SSRIs: Sertraline
  • SNRIs: Venlafaxine
  • Alph adrenergic receptor blocker: Prazosin
  • Benzodiazepines
22
Q

PTSD: Non-Pharmacologic Interventions

A
  • Individual therapy
  • Cognitive therapy
  • Behavior therapy
  • Group/family therapy
23
Q

Adjustment Disorder

A
  • Emotional or Behavioral symptoms in response to an identifiable stressor within 3 months of stressor
  • Symptoms do not persist more than six months post stressor
  • Categorized with Trauma/Stressor related disorders: Adjustment disorder, Acute Stress Disorder, PTSD
24
Q

Adjustment Disorder: Management

A
  • Crisis Intervention
  • Brief therapy
  • Supportive techniques
  • Pharmacotherapy for target symptoms
25
Q

Somatic Symptom Disorder

A
  • One or more somatic symptoms that are distressing
  • Excessive thoughts, feelings or behaviors related to the somatic symptoms
  • State of being somatic lasts more than 6 months
  • Medically unexplained symptoms
  • Chronic use of health resources
26
Q

Somatic Symtom Disorder: Management

A
  • Tricyclic antidepressants: first line
  • SSRI for treating anxiety
  • CBT
  • Relaxation therapy
  • Family Therapy
  • Psychoeducation
27
Q

Conversion Disorder

A
  • Loss/change in physiologic function without medical cause
  • Symptoms of altered voluntary motor or sensory function
  • Neurologic symptoms inconsistent with neurological disease
28
Q

Conversion Disorder: Etiology

A
  • Hypofunction of the dominant hemisphere and over activity of the non-dominant side
  • Decreased rCBF in the left temporal region
  • Activation of the orbitofrontal cortex and the anterior cingulate gyrus
  • Repression of unconscious intrapsychic conflicts and conversion of anxiety into physical symptoms
  • Classical conditioning
29
Q

Conversion disorder: Management

A
  • Education
  • CBT
  • Physical therapy
  • Antidepressants, hypnosis, psychodynamic psychotherapy for refractory cases
30
Q

Dissociative Amnesia

A
  • Sudden inability to recall important personal information: simple or fugue (new identity)
  • Localized: No memory of details associated with traumatic event
  • Selective: Remembers selective details
  • Generalized: Recall of past life and identity lost
  • Continuous: Unable to recall events after a specific time
  • Use Dissociative Experiences Scale Revised
31
Q

Management

A
  • Most resolve spontaneously
  • Supportive psychotherapy
  • Hypnosis
  • Assist patient in learning adaptive coping skills
  • Amobarbital for guided interview
32
Q

Dissociative Identity Disorder

A
  • Formerly known as Multiple Personality Disorder
  • Disruption of identity characterized by two or more distinct personalities
  • Related alterations in affect, behavior, perceptions, memory, cognition
  • Gaps in personal information recall
  • Usually precipitated by stress
33
Q

Dissociative Disorder: Etiology

A
  • Hx of early, on-going abuse
  • Inborn tendency to dissociate
  • Poor mother-infant attachment
34
Q

Dissociative Disorder: Management

A
  • Psychotherapy
  • Hypnosis
  • Impress the importance of merging personalities
  • Safety
  • Antidepressants, anti-anxiety meds, antipsychotics for target symptoms.
35
Q

Depersonalization/Derealization Disorder

A
  • Depersonalization: Experiences of unreality, detachment, or being an outside observer to one’s thoughts, feelings, sensations
  • Derealization: Experiences of unreality or detachment with respect to surroundings
  • During the episode, reality testing remains intact
  • Transient symptoms are common, approximately 50% adult population
36
Q

Depersonalization/Derealization Treatment

A
  • Promote accurate perception of self and environment
  • Assist patient with responding to stress
  • No particularly theory more helpful
  • Hypnosis
  • Benzos for anxiety
  • SSRIs, SNRIs for anxiety and depressive symptoms

PMHNP (19 decks)

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