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Psych Anxiety Disorders
KYCOM Block 12
62
Psychology
Graduate
12/04/2013

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Cards

Term
define anxiety due to general medical condition
Definition
symptoms of anxiety, fear, avoidance, or increased arousal due to direct effect of general medical condition
Term
define substance induced anxiety disorder
Definition
symptoms of anxiety, fear, avoidance, or increased arousal due to direct effect of medication, drug abuse, or toxin
Term
define psychotic or mood disorder
Definition
not an anxiety disorder

symptoms of anxiety, fear, avoidance, or increased arousal with 6mo+ of excessive worry and associated symptoms occuring exclusivley during a mood or psychotic episode
Term
define seperation anxiety disorder
Definition
symptoms of anxiety, fear, avoidance, or increased arousal due to concern with seperation from figures
onset in childhood
Term
define panic disorder
Definition
symptoms of anxiety, fear, avoidance, or increased arousal with unexplained panic attacks and worry about attacks or change in behavior
Term
who gets panic disorder
Definition
more common in females
Term
define agoraphobia
Definition
anxiety about being in places from which escape might be difficult or embarassing in the event of a panic attack
Term
define PTSD
Definition
symptoms of anxiety, fear, avoidance, or increased arousal due to severe traumatic event with re-experiencing of event, arousal, and avoidance of associated stimuli for 1 mo+
Term
what if someone shows PTSD signs for less than a month
Definition
its called acute stress disorder
Term
who gets PTSD
Definition
more common in females
Term
define OCD
Definition
symptoms of anxiety, fear, avoidance, or increased arousal with complusions or obsessions
Term
who gets OCD
Definition
equal in male and females
Term
define GAD
Definition
symptoms of anxiety, fear, avoidance, or increased arousal with 6mo+ of excessivel worry plus associated symptoms
Term
who gets GAD
Definition
more common in females
Term
define social phobia
Definition
symptoms of anxiety, fear, avoidance, or increased arousal due to specific object or situation (if social consider avoidant personality disorder)
Term
who gets social phobia
Definition
equal in males and females
Term
who gets phobias
Definition
more common in females
Term
define adjustment disorder with anxiety
Definition
symptoms of anxiety, fear, avoidance, or increased arousal that does not meet criteria for other anxiety disorders and developed from response to stressor
Term
define anxiety disorder not otherwise specified
Definition
symptoms of anxiety, fear, avoidance, or increased arousal that do not meet criteria for specific anxiety disorder
Term
signs of panic disorder
Definition
intense fear and discomfort with 4+ of these...
palpitations, increased HR
sweating
trembling or shaking
SOB/smothering
feeling of choking
nausea or abdominal distress
dizzy, unsteady, lt headed, faintness
de-realization, depersonalization
fear of loosing control or going crazy
fear of dying
paresthesias
chills or hot flashes
reoccuring unexpected attacks
w/ or w/o agorophobia
Term
define depersonalization
Definition
being detached from self
Term
define paresthesias
Definition
numbness or tingling
Term
to diagnose panic disorder the attack must be followed by 1mo+ of one of these
Definition
persistent concern of additional attacks
worry about implications of attack or consequences
change in bahavior related to attacks
Term
panic disorder cannot have association with
Definition
substance abuse, medication, hyperthyroidism, other medical condition, mental disorder, social phbia, phobia, OCD, PTSD, seperation enxiety
Term
what are the comorbidities with panic disorder
Definition
depression
other enxiety disorders
Term
signs of agoraphobia
Definition
avoidance of situation where escape is difficult
safety or stress reducing behaviors in crowded situations like finding escape, going with friends

periods of exacerbation and remission
Term
tx acute agoraphobia
Definition
BDZ
Term
tx first steps agoraphobia
Definition
CBT
Term
tx second steps in agoraphobia
Definition
SNRI/SSRI (+BDZ if needed) > BDZ > TCA
Term
how do you tx someone with agoraphibia and comorbid depression
Definition
use antidepression with different mechanism (SSRI + buproprion)
Term
what are the goals of CBT for agoraphobia
Definition
focus on negative/irrational thoughts
give homework or joirnaling and imagry and talk about event, thoughts, emotions, and behaviors

situational or graded exposure to feared stimuli

incorporate: exercise, relaxation, techniques (breathing), spirituality

psychodynamic therpay: talks about defense mechanisms
Term
what is the prognosis of agoraphobia
Definition
33% recover
50% have limited impairment
20% have major impairment
Term
what are predictors of poor prognosis for agorphobia
Definition
more severe, initial panic attacks or agoraphobia
longer duration of illness
comorbid depression
hx seperation from parent (death, divorce)
high interpersonal sensitivity
single marital status
Term
what signs are requided for all PTSD diagnosis
Definition
symptoms for 1mo+, acute <3mo, chronic >3mo
may be delayed onset >6mo

social occupational other impairment due to experiencing, witnessing, confronting event with threatened death or injury to self or others with response of intense fear, helplessness, horror
(agitation and disorganized behavior in kids)
Term
for PTSD the pt must have at least 1 rexperiencing sign, what are they
Definition
recurrent distressiing recollections(images, thoughts, perceptions) (kids may occur with theses from trauma)

recurrent dreams of event in kids they may not have no recollection and will dream and wake up scared

feeling as if the event were reoccuring(reliving, hallucinations, illusions, flash backs) awake or intoxicated

psychological distress on exposure to event cues

psysiological reactivity to event cues
Term
to diagnose PTSD they need to have 3+ avoidance or numbing symptoms, what are they
Definition
avoiding thoughts, feelings, or conversation associated with event

avoiding activities, places, or people associated with event

cannot recall important aspects of event

diminished interest in significant activities

feeling detached from others

restricted range of affect (unable to love)

sense of fore shorted future (no expectation of career, marriage, children)
Term
to diagnose PTSD they need to have 2+ increased arousal symptoms, what are they
Definition
difficulty falling or staying asleep
iritability or ourbursts of anger
difficulty concentrating
hypervifilence
exaggerated starte response
Term
what are the risk factors for PTSD
Definition
post trauma prior to initiating trauma
hx PTSD, depression, anxiety disorder
family hx of anxiety or parental PTSD
cormorbid axis II disorder
disrupted parental attachments
high premorbid intelligence may be protective
Term
comotbidities with PTSD
Definition
depression, OCD, panic, phobia
Term
first step in PTSD tx
Definition
education and CBT focusing on negatice/catastrophic thoughts, exposure to behavorial tx, anxiety/anger, group therapy
Term
medicals for PTSD
Definition
SSRI > SNRI > TCA
Term
prognosis PTSD
Definition
often symptomatic for decades
Term
perdictors for bad prognosis PTSD
Definition
greater number of symptoms
psychiatric hx of ther anxety/mood disorder

higher numbing or hyperarousal to stress

cormobid medical illness

female, childhood teauma, alcohol abuse
Term
what are the required obsessive symptoms of OCD
Definition
reicrrent rhoughts, impulses, or images that are intrusive and inappropirate causing anxiety or distress

thoughts, impulses, images not just excessive worry about real life problems

attmpt to neutralize thoughs, imulses, images with actions or thoughts

recognizes impulses, thoughts, or images are a product of their own mind
Term
what are the required compulsion symptoms of OCD
Definition
repetitive behaviors or mental acts in response to obsession or according to rules

acts are to reduce distress or prevent some event but are not connected in realisit way and are more to neutralize thoughts
Term
define OCD with poor insight
Definition
some point in time the person does not realize obsessions and compulsions are excessive or unreasonable
Term
first step in OCD tx
Definition
CBT, education, graded exposure
Term
OCD meds
Definition
SSRI high doses, clomipramine, both
add anti-psychotic if severe
Term
what percautions need to be taken with clomipramine
Definition
requies EKG, BP, HR, blood level monitoring esp in combo with other meds
Term
prognosis of OCD
Definition
50% progressive disease
80% improve in 40 yrs
25% fluctuating course
15% phasic course with periods of complete remoission
Term
what are signs of worse OCD prognosis
Definition
ealy age of onset, longer duration
obsessions and compulsions
poor baswline social function
magical thinking
Term
GAD must have 3+ of these symptoms for _____
Definition
6 mo+

rstlessness or on edge
easily fatigued
difficulty concentrating or mind blands
irritability
muscle tension
sleep disturbance

no other axis 1 disorder, general medical condition, mood disorder, psychotic disorder, developmental disorder

impairment in social, occupational, or other areas of functioning
Term
tx GAD
Definition
CBT, relaxation therapy, psychodynamic therapy, breathing therapy

SNRI/SSRI (venlafaxine XR DOC)

may adjust for individual symptoms or metabolic profile
Term
comorbidities GAD
Definition
major depression
other anxiety disorders
Term
symptoms of social phobia
Definition
anxiety of unfamillar people, possible scrutiny, showing anxiety, doing something embarassing (kids unable to have relationships with famillar people, peers, adults)

exposure to situation causes anxiety (in kids causes crying, tantrum, freezing, shrinking)

recognizes fear is excessive (except in kids)

social situations or performance avoided interfering with normal routine, occupation, or relationships

>6mo if under 10yo

not due to substances, general medical condition, other mental disorder or is unrelated to it
Term
comorbidities with social phobia
Definition
2x risk of alcohol dependence
6x risk of mood disorders
Term
tx social phobia
Definition
CBT > SNRI/SSRI > BDZ > TCA
B blockers for acute/performance

social skills training (role play, rehersal, imagry, visualization)
Term
prognosis of social phobia
Definition
if onset is early it is chronic course
50% recovery by 25 yo
Term
signs of poor prognosis in social phobia
Definition
onset before 8-11 yo
psychiatic or medical comorbidity
more symptoms oat baseline
low education status
Term
what are signs of a phobia
Definition
cured by object or situational removel
exposure inavairably provokes immediate anxiety

children: crying, tantrums, freezing, clinging

recognition that fear is excessive

avoiding phobia, interferes with reoutine, occupation, relationship

if <18 yo lasts more than 6mo

not explained by OCD, PTSD, seperation anxiety, social phobia, panic disorder, agoraphobia
Term
what are the types of phobia
Definition
animal
natural: heights, storms
blood injection
situational: airplane, elevator
choking
vomiting
illness
loud sounds
costumed characters
Term
comorbidities with phobia
Definition
depression
somatoform disorders
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