Term
| Definition of anxiety? How do you distinguish between pathologic and non-pathologic anxiety |
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Definition
-the subjective experience of fear and its physical manifestations
-pathologic anxiety is that that is inappropriate with no real source of fear or the source is not sufficient to account for the severity of the symptoms |
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Term
| Neurotransmitter imbalances in anxiety disorders |
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Definition
| inc NE, dec GABA, dec serotonin |
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Term
| Discrete period of heightened anxiety that classically that peak in several minutes, and usually subside in 25 minutes but may continue for over an hour |
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Definition
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Term
| What are the DSM criteria for panic attack? |
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Definition
1) Discrete period of intense fear and discomfort that is accompanied by at least four of the following:
"PANIC"
-palpatations
-abdominal distress
-Numbness
-nausea
-Intense fear (death,depersonalization, fear of losing control, going crazy)
-Choking
-chills
-chest pain
-chizziness (dizziness, light-headedness) |
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Term
| 24 year-old female in ER with pounding heart, SOB, sweating that lasted for 20 minutes. She says she thought she was going to die. She has had six of these episodes in the last month and fears having another. |
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Definition
| Panic Disorder. -characterized by panic attacks and persistent fear of having additional attacks; -DSM IV criteria: spontaneous recurrent panic attacks with no obvious precipitant + at least one of the attcks has been followed by a minimum of 1 month of persistent concern about having another attack, worry anout the implications of the attack ("am I out of control") and a significant change in behavior related to the attacks (avoid situations that may provoke attacks) |
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Term
| What are the 2 types of panic disorder diagnoses? |
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Definition
| Panic disorder with and without agoraphobia |
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Term
| What substances are known to induce panic attacks? |
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Definition
| Carbon dioxide, caffeine, nicotine |
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Term
| Differential diagnosis for panic disorder |
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Definition
| CHF; angina; MI; Thyrotoxicosis; tmeporal lobe epilepsy; MS; pheo; Carcinoid syndrome; COPD (cardiac, pulmonary, endocrine, neuro); also psych (OCD, depression, phobic disorders, PTSD) and substances (amphetamine, caffeine, nicotine, cocaine, hallucinogens) |
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Term
| Treatment of acute panic attacks/anxiety |
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Definition
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Term
| What is the long-term maintenance therapy for panic attacks |
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Definition
SSRIs (especially paroxetine, sertraline)
-need higher doses than for depression drugs take 2-4 weeks to become effective; continue tx for 8-12 months. May also consider clomipramine and imipramine |
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Term
| What can happen if you start SSRIs at too high a dose in patients with panic disorder? |
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Definition
| They are prone to developing "activation side effects" which are sxs that mimic those of panic |
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Term
| Fear of being alone in public places. Often develops secondary to panic attcks due to apprehension about having another panic attack in public places where escape may be difficult |
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Definition
Agoraphobia (diagnosed alone or as a panic disorder with agoraphobia)
-DSM IV criteria (must meet all):
1) anxiety about being in places where escape might be difficult in the event of a panic attack
2) the situations are either avoided or endured with deep distress or endured with the help of a companion
3)These sxs cannot be better explained by another mental dx
-Examples: avoidance of buses, bridges, crowds, outside the home alone |
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Term
| What is the typical clinical progression of panic attacks and agoraphobia? |
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Definition
| A person with panic attack while shopping --> fear of entering supermarket -->add'l attacks-->progressive and more general fear of public places |
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Term
| A 35 year-old woman with pounding heart, SOB, sweating when she takes the train to work. Sxs also occur when she is in crowded waiting areas. She has decided to avoid the train and get a ride from her friend to work. |
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Definition
| Panic disoder with agoraphobia. Tx: SSRIs |
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Term
| An irrational fear that leads to avoidance of the feared object or situation |
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Definition
| Specific phobia. Strong exaggerated fear of a particular object or situation.
-DSM IV criteria: 1) persistent excessive fear due to situation or object; 2) Exposure to the situation brings about an immediate anxiety response; 3)The patient recognizes that the fear is excessive; 4) The situation is avoided when possible or tolerated with intense anxiety; 5) If the person is <18, the duration must be at least 6 months |
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Term
| What is the most common mental disorder in the US? |
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Definition
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Term
| Treatment of specific phobia |
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Definition
| Systemic desensitization with or without hypnosis; may give a short course of benzos or beta-blockers to dec. autonomic sxs. |
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Term
| 20 year-old college student has always been "shy" and avoids answering questions in class. Last Monday, she stayed home although she had to give a speech in class because she did not want to make a fool out of herself in front of her classmates |
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Definition
| Social phobia. DSM IV criteria the same as for specific phobia, except that the feared situation is related to social settings in which the patient might be embarrassed/humiliated in front of other persons; Tx: paroxetine, beta-blockers for performance anxiety |
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Term
| a recurrent or intrusive thought, feeling, or idea |
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Definition
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Term
| a conscious, repetitive behavior linked to an obsession that, when performed, functions to relieve anxiety caused by the obsession |
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Definition
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Term
| 28 y.o. medical student distressed by his reptitive checking of the car door to see if it is locked. This happens several times and has led to his being late for his clerkships and getting yelled at by his chief. |
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Definition
| OCD.
-DSM IV criteria:
1) obsessions (recurrent and persistent intrusive thoughts or impulses that cause marked anxiety and are not just worries about real problems +/- compulsions (repetitive behaviors that the person feels driven to perform in response to an obession with the behaviors reducing the distress by not necessarily related to the distress)
2) the person is aware that obsessions and compulsions are are unreasonable and excessive; 3) The obsession cause distress, are time consuming, or significantly interfere with daily functioning; -sxs are ego-dystonic and patients recognize that they are sick |
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Term
| What are the four main patterns of obsessions and compulsions |
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Definition
| 1. contamination, doubt (door lock), symmetry, intrusive thoughts with no compulsion (thoughts are often sexual or violent) |
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Term
| Person excessively preoccupied with details, lists, and organization. Person is overconscientious and inflexible and perceives no problems |
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Definition
| OCPD (Axis II personality disorder; don't confuse with OCD); Sxs are ego-syntonic and patients lack insight |
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Term
| OCD is associated with which other diseases? |
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Definition
MDD, eating disorders, anxiety disorders, OCPD.
-May also occur in patients with first-degree relative with Tourette's |
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Term
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Definition
*High-dose SSRIs (higher-than-normal doses often needed), TCAs
- Behavioral therapy as effective as drugs (but best outcomes when used together) with the technique being exposure and response prevention (ERP); ECT in refractory or severe cases; cingulotomy (surgery) last resort |
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Term
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Definition
| Only 30% of patients show significant improvement with treatment; 40% remain significantly impaired |
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Term
| 23 y.o. woman raped 5 months ago complains of recurrent thoguhts of that event every time she's touched for the past 2 months. +nightmares that keep her up. Anxious when these thoughts "pop in" and difficulty working at her job. |
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Definition
| PTSD. DSM IV criteria: 1) Having experienced or witnessed a traumatic event with an initial reaction of intense fear or horror; 2) persistent reexperiencing of the event (dreams, flashbacks); 3) Avoidance of stimuli ass'd with the trauma; 4) numbing of responsiveness (limited range of affect, feelings of detachment or estrangement from others); 5) persistent sxs of increased arousal (difficulty sleeping); 6) sxs present for at least 1 month |
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Term
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Definition
| TCAs, SSRIs, MAOIs, AEDs (for flashbacks and nightmares) |
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Term
| 2 weeks after witnessing a car accident in which his friend was killed, a young person has stopped going to classes and has been extremely anxious |
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Definition
| Acute stress disorder; DSM IV criteria: short anxiety in response to to a traumatic event. Sxs within 1 month of traumatic event and last for a maximum of 1 month. Sxs similar to those of PTSD; tx: same as PTSD |
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Term
| Young person office clerk reports that she worries if she is capable of doing her job and feels as though she is not good enough. She worries about mortgage payments, telephone bills, cleaning the house for the past 3 years. |
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Definition
| Generalized Anxiety Disorder -free floating anxiety that causes significant distress and is present most days fo the week for at least 6 months; -DSM criteria: 1) excessive worky about daily events and activities for at least 6 months; 2) Difficult to control the worry; (3) Must be associated with at lest 3 of the following: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance |
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Term
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Definition
| Tx: combination of psychotherapy and pharmacotherapy; buspirone, benzos (clonazepam, diazepam; should be tapered asap due to risk of tolerance and dependence), SSRIs, venlafaxine (extended release) + behavioral therapy, psychotherapy |
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Term
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Definition
Alternative to benzos and venlafaxine for the tx of GAD
- 1-2 weeks for effect
- have anxiolytic action at 5HT-1A receptor
-useful in alcoholics (does not potentiate the CNS depression)
-Low potential for abuse or addiction |
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Term
| Maladaptive behavior or emotional sxs that develops within 3 months of a non-lifethreatening event and end withing 6 months and cause significant impairment in daily functioning or interpersonal relationships |
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Definition
| Adjustment disorder. DSM IV criteria: Development of emotional or behavioral sxs (may be aggression, depressed mood, anxiety) within 3 mons after a stressful life event that produce either severe distress in excess of what would be expected after such an event, or significant impariment in daily functioning; 2) the sxs are not those of bereavement; 3) Sxs resolve within 6 months after the stressor has terminated; -tx: supportive psychotherapy and treatment of insomnia, anxiety or depression |
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