What are the levels of anxiety. Explain each
- Mild: can be productive; more observant, learning is possible
- Moderate: attention = more selective; perceptual field narrows; might see peripheral but if someone points it out first
- Severe: tunnel vision; perceptual field = greatly reduced
- Panic: perceptual field is reduced to a detail which is elaborated by distortion or the focus is scattered
Explain panic attack and the symptoms that appear
Discrete period of intense fear or discomfort, symptoms develop abruptly and peak within 10 mins of onset
Four or more of these sx must be present:
- palpitations
- sweating
- trembling or shaking
- SOB and or sensation of smothering
- feelings of choking
- chest pain
- nausea or abdominal distress
**need to rule out MI with ECG, labs (troponin, BNP, CBC) and vitals
Explain panic disorder
Recurrent, unexpected panic attacks
at least one of the attacks have been followed by one month or more of one the following:
- persistent concern about having a panic attack
- worry about implications of the attack and its consequences
- significant change in behavior related to the attacks (they avoid things that they think will cause a panic attack)
What is agoraphobia
anxiety about being in places or situations from which escape might be difficult or embarrassing or fear of having an unexpected panic attack without help being available
Explain generalized anxiety disorder
Excessive anxiety and worry occurring more days than not for at LEAST 6 months
Explain selective mutism
consistent failure to speak in social situations when there is an expectation to speak
What are the meds or substances that can cause anxiety
Meds:
- bronchodilators, amphetamines, steroids
Substances:
- caffeine, cocaine, and stimulants
What are the treatment options for anxiety
Therapy:
- CBT = primary treatment therapy
- behavioral
- exposure (prolonged exposure and cognitive processing used for specific phobias)
Psychopharmacology;
- in addition to other therapies
- ameliorate symptom distress
- safety net or rescue meds (SSRI, Benzos)
What would benzodiazepines be used for?
used for acute episodes; never for long term use because they can become addicted and experience withdraw symptoms
What are the types of OCD
- OCD
- body dysmorphic disorder
- hoarding
- trichotillomania
- excoriation
- substance/med induced
- OCD due to general medical condition
- OCD other specified or unspecified
explain OCD
recurrent obsessions (thoughts) or compulsions (behaviors) or a combo of the two
- persistent thoughts, impulses, or images that cause anxiety or distress
- not always worries about real life problems
- person tries to ignore by thinking of other thoughts and actions
- they have insight, meaning they understand their illness and the compulsions but its just who they are
What is trichotillomania
recurrent pulling out of one’s hair resulting in hair loss
What is excoriation disorder
recurrent skin picking resulting in lesions
What are the specifiers for body dysmorphic disorder
- with muscle dysmorphia
- with level of insight (absent, poor, good or fair)
What are the interventions for OCD
Therapy:
- exposure and response prevention
- thought stopping (replacing thoughts with other thoughts to reduce anxiety)
- relaxation techniques
- cognitive restructuring
Psychopharmacology:
- antidepressants (SSRIs to include fluoxetine, fluvoxamine, paroxetine and sertraline) or tricyclics (clomipramine)
What are the risk factors for PTSD
What is the onset to remission for males and females
Risk factors;
- prior dx of ASD (acute stress disorder)
- extent, duration and intensity of the traumatic event
- environmental factors
- onset to remission for women is 4 years compared to 1 year for men
Explain acute stress disorder
- sx must be at least 3 days and up to 1 month after the even exposure
- experienced directly or indirectly, witnessed or confronted with an event involving actual or threatened death or serious injury, or threat to the physical integrity of self or others
- doesn’t include e-media, tv, movie or picture exposure unless its work related
What are the moods associated with acute stress disorder
- intrusion, negative mood, dissociative, avoidance, arousal
Explain intrusion and negative mood
Intrusion:
- distressing memories, dreams, dissociative reactions, marked psychological and or physiological distress in response to internal or external cues
Negative mood:
- persistent inability to experience positive emotions
explain Dissociative and avoidance behaviors
Dissociative:
- depersonalization or derealization, event amnesia not related to organic causes
Avoidance:
- efforts made to distressing memories, thoughts or feeling or external reminders that are associated with the event
explain arousal
sleep disturbance, irritability or anger outbursts, hypervigilance, difficulty concentrating or exaggerated startle response
Explain PTSD
- must have sx for at least 1 month
- experienced, directly or indirectly, witnessed or confronted with an event involving actual or threatened death or serious injury, or threat to the physical integrity of self or others
What are the re-experiencing that PTSD patients experience
- recurrent and intrusive recollections (repetitive play in children with themes of the trauma)
- recurrent dreams (frightening dreams without recognizable content in children)
- dissociation: acting or feeling the event were recurring (re-enactment in young children)
- intense psychological distress at exposure to internal and external cues that resemble the event
- marked physiological reactions to internal or external cues that symbolize the event
What falls under reactivity for PTSD patients
- difficulty falling or staying asleep
- irritability or anger outbursts
- difficulty concentrating
- hypervigilance
- exaggerated startle response
- reckless or self destructive behavior
What are the interventions for PTSD patients
Therapy:
- individual and group therapy
- community support groups
Psychopharmacology:
- SSRIs to include sertraline (zoloft) and paroxetine (paxil)