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2 components of anxiety

1. Awareness of the psychological sensations (Palpations and sweating)

2. Awareness of being nervous or frightened


Psychoanalytic anxiety

Things that happen during childhood may contribute to how you function as an adult


Behavioral anxiety

A conditioned response to a specific environmental stimulus.


Existential anxiety

No specifically identifiable stimulus exists, chronically feeling anxious.


Panic Disorder definition

Acute, intense attack of anxiety associated with personality disorganization; overwhelming and accompanied by feelings of impending doom.


Panic Disorder clinical presentation

- Attack often begins within a 10 minute period of rapidly increasing symptoms.

- Signs Include tachycardia, palpitations, dyspnea, sweating, dizziness, trembling, chest pain/discomfort, nausea and depersonalization.


Panic Disorder ddx

MI, anemia, angina, hyperventilation, tumor, hyperthyroidism, cocaine, alcohol/drug withdrawal, systemic infection


Panic Disorder DSM 5 criteria

1. Recurrent unexpected panic attacks with >4 symptoms

2. At least 1 of the attacks has been followed by 1 month of one of the following:

3. Persistent concern or worry about additional panic attacks

4. Significant maladapted change in behavior related to the attacks.


Social anxiety disorder definition

Intense of persistent fear of social situations, including situations that involve scrutiny or contact with strangers.


Social anxiety disorder clinical presentation

- Anxiety is preventing an individual from participating in desired activities of causes marked distress during such activities.

- Social settings causes intense fear, will avoid completely.

- Feels their fear is excessive or unreasonable.


Social anxiety disorder ddx

- Appropriate fear or shyness

- Agoraphobia, panic disorder, avoidant personality, MDD, schizoid personality.


Social anxiety disorder DSM-5 criteria

- Mark fear/anxiety about social situations where possible scrutiny by others as an option

- Fear he/she act in a way/show anxiety symptoms and will be negatively evaluated

- Social situations always provoke fear/anxiety

- Social situations avoided/endured with intense fear/anxiety

- Fear of anxiety out of proportion to actual threat of social situations

- Fear/anxiety/avoidance is persistent for > 6 months

- Significant distress/ impairment and social/occupation/other areas of functioning


GAD definition

Excessive anxiety/ worrying about several events/activities for most days of at least a 6 mo period.


GAD ddx

- Neurological, endocrinological, metabolic, and medication related

- Other anxiety disorders such as panic disorder, phobias, OCD, and PTSD.


GAD DSM-5 Criteria

- Anxiety and worrying associated with 3 or more of the following 6 symptoms

- Restlessness or feeling keyed up or on edge

- Being easily fatigued

- Difficulty concentrating or mind going blank

- Irritability

- Muscle tension

- Sleep disturbances (falling or staying asleep)

- Anxiety/worrying/physical symptoms cause significant distress/impairment in social, occupational, or other areas of functioning.


Sexual assault: historical elements.

- Age and identifying information for both victim and assailant.

- Date, time, location of alleged assault = emergency contraception (most effective w/in 72 hr).

- Circumstances of assault

- Obtain details of the assault itself.

- Actual or attempted–vaginal/anal/oral and w/ assailants penis/ finger/tongue/object.

- Condom or lubricant use?

- Ejaculation? If so where? Inside or outside of body?

- Did they urinate?

- Injuries on victim or on assailant that resulted in bleeding? Was the assailant scratched?

- Were physical restraints used? Weapons? Drugs? EtOH?

- Allergies or medications.

- Activities after victim was assaulted = change clothing?, bathing? Douching? Dental hygiene?, urination/defecation?

- Gynecological history


- Contraception use

- Pregnancy hx

- Last voluntary sexual encounter.

- Recent episode of gynecological infection

- Previous pelvic surgeries


Sexual assault: forensic evidence

- Clothing–each article separately packaged in paper bag

- Known blood sample of patient

- Toxicology testing of blood and urine

- Oral swabs/smear–up to 24 hours post assault.

- Head hair combings

- Fingernail scrapings (DNA)

- Foreign material collection

- Swabs of bite marks or areas where assailant’s mouth touched the patient

- Pubic hair combings–15 to 20 hairs

- External genital swabs

- Vaginal swabs/smears–Cx sampling (96 to 120 hrs post assault)

- pap smear

- woods lamp (used to detect semen)

- use only saline w/speculum

- Perianal swabs

- Anorectal swabs/smears–up to 24 hours post assault

- Forensic photography–3 views per injury–one w/ruler for scale


Sexual assault: what do you prescribe to prevent pregnancy?

- levonorgestrel 1.5 g po x 1 (plan B)


Sexual assault: what do you prescribe to prevent gonorrhea?

- ceftriaxone 250 mg IM or cefixime 400 mg po x 1


Sexual assault: what do you prescribe to prevent chlamydia?

- azithromycin 1 g po x 1 or doxycycline 100 mg po bid x 7 days(may cause nausea)


Sexual assault: what do you prescribe to prevent trichomonas and BV?

- Flagyl 2 g po x 1 (may cause nausea)


Sexual assault: what do you prescribe to prevent Hep B?

- Vaccine x 1 w/ 2nd and 3rd vaccines (4 w and 6 mo) or hepatitis B immune globulin


Sexual assault: what do you prescribe to prevent tetanus?

- Td toxoid 0.5 mL IM x 1


Sexual assault: what do you prescribe to prevent HIV?

- Zidovudine 200 mg po TID x 4 w
- lamivudine 150 mg po BID x 4 w
and consult w/ infectious dz specialist


Define Psychological

- Craving and the behavior involved in procurement of a drug


Define Physiologic

- Withdrawal symptoms on discontinuance of the drug


Define abuse

- Use of any drug, usually by self administration, in a manner that deviates from approved social or medical patterns


Define Misuse

Similar to abuse, but usually applies to drugs prescribed by physicians that are not properly used.


define addiction

- The repeated and increased use of substance that deprivation of which gives rise to symptoms of distress and an irresistible urge to use the agent again which leads to physical and mental deterioration.


define intoxication

- A reversible syndrome caused by a specific substance that affects one of more of the following mental functions: memory, orientation, mood, judgement, and behavioral, social or occupational functioning