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30 Cards in this Set
- Front
- Back
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Etiology
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Cause
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Epidemiology
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Distributions of disorders and diseases among population
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Acute Stress Disorder
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o Should be diagnosed before PTSD
o Wait 48 hours o Caused by a trauma o Unsure of the genetic component |
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Types of Anxiety Disorder
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-Panic disorder (w/wo agoraphobia)
-Agoraphobia w/o panic -Specific Phobia -Social Phobia -Obsessive Compulsive Disorder (ODD) -Acute Stress Disorder (ASD) -Posttraumatic Stress Disorder (PTSD) -Generalized Anxiety Disorder -Anxiety d/t General Medical Condition -Substance Induced Anxiety Disorder -Anxiety Disorder NOS |
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Panic Attack
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o Characterized by:
-Intense fear of doom that comes out of the blue -Discrete period of intense apprehension -People think they are having a heart attack -SEEK MEDICAL ATTENTION ASAP!! |
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Panic Attack Types
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- Unexpected, situationally bound (if they are exposed to something they are extremely afraid of), situationally predisposed (someone who thinks about their fear and has a panic attack)
- 1 in 4 people will have a diagnosis of anxiety in their life - 30% of women 19% of men |
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Panic Attack Symptoms
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o Symptoms:
-Fearfulness -Feelings of impending doom accompanied by at least 4 of 13 somatic/cognitive symptoms o Subjective Sense: ? To ask -Have you ever had a panic attack? A Time when you suddenly overwhelmingly frightened or anxious o Follow Up: Have you experiences ___ with it? How intense was it? -Panic Attack Symptoms (13) |
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Panic Disorder
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-Patten of constant and intermittent feelings of anxiety
-Not focused on specific fear -Begin to associate with anticipated catastrophes, health outcomes, travel activities -Need to worry about the consequences of having a heart attack -A couple of minutes long -Start to associate panic with certain areas • Example: Elevators • Only a phobia IF they were afraid of elevators BEFORE having the panic attack |
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Panic Disorder
o Etiology o Epidemiology o Triggers: |
o Etiology
-Between ages of 5-11 o Epidemiology -Not sure if it is instilled in kids or a family history -If the age of onset is before age 20, first degree relatives are up to 20 times more likely to have panic disorder -All rates we have are if people are seeking treatment o Diagnostic Criteria o Triggers: -They will eventually learn their triggers -Can desensitize and lessen symptoms |
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Panic Disorder
o Comorbities o Course: |
o Comorbities are common
-Depression -Depression occurs 1st followed by panic • Obsessive worry can lead to panid -Comorbid PTSD, OCD, and phobic are common • Panic attacks are not a criteria of PTSD. Someone can have both. • 1 month- quialifies -Course: • Age of onset o Bimodal onset -In adolescence and in later life around age 45 in women. |
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Panic Disorder Differential Diagnosing
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-R/O general medical condition
• Hypertension, asthma, heart attack, stroke can mimic panic -R/O substance induced panic -R/O Generalized Anxiety Disorder -R/R PTSD -R/O Specific phobia |
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Panic Disorder with Agoraphobia Diagnostic Characteristics
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-Recurrent panic attacks, required
-Agoraphobia with panic: Attacks cause • Fear of additional attacks • Fear of implications of attacks • Significant changes in ADL’s • Presence of agoraphobia • Fear of leaving home • Fear of crowds • Fear of having episode without escape • Fear of being trapped • Fear of being crazy • Fear of dying |
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Agoraphobia
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o Agoraphobia most often occurs in the context of panic disorder
- Debate if can occur without panic attack o Agoraphobia is: extreme anxiety about being in a situation from which escape would be difficult or embarrassing - Never agoraphobia by itself. Need history of panic disorder - People will develop this is they are scared of becoming sick or of germs. o Agoraphobia is: anxiety about help not being available if “something happens to cause a panic attack” o Often associated with where panic attack occurred- places to avoid |
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Panic Disorder Coding
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o Panic Disorder with Agoraphobia: 300.21
o Panic Disorder without Agoraphobia: 300.01 o Agoraphobia by itself: 300.22 |
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Specific Phobia
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- Specific Phobia: radically alters life
o Types of Phobia - Animals - Natural Environment • Storms, hurricanes, tornadoes, heights - Blood-injection-injury • Needles, giving blood, passing out from blood - Situationally • Tunnels, bridges, • Peak in childhood and in mid 20s - Others • Choking, contracting an illness, falling down, being away from walls, costumed characters - Diagnostic Features - Prevalence • 4-8.8% of the population • GIVE KIDS AT LEAST 6 MONTHS - Familial Patterns: • Learned behaviors! - Differential Diagnosing • Page 449 • Exposure to the stimulus provokes and immediate phobic response • Kids might become clingy or freeze • Person recognizes the fear is excessive - Coding: 300.29- specify subtype • Animal, natural environment, blood injection, situational, other |
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- Social Phobia
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o Used to be social anxiety disorder
o Marked fear of social or performance situations - Elective mutism in kids, temper tantrums - Speaking in a social situation o Specified for Generalized o Course o Familial Patterns - More common in first degree relatives |
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- Social Phobia Diagnostic Criteria
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- Possible scrutiny, individual fear that they will act in a way that will be humiliating or embarrassing
- Recognizes the situation is excessive or unreasonable - Must be more than 6 months if under age 18 - Not the result of a substance!!! • Example: marijuana (panarnoia) |
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- Social Phobia Diagnostic Features
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- Children under 18 must have 6 months duration
- Generalized social phobia if occurs in most situations - Look for avoidant or dependent personality disorder to co occur - Code: 300.23 - Subtype: Generalized - Avoidant personality disorder and dependent personality disorder are long-term disorders. • They are often engrained |
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- OCD
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o Essential Features
- Recurrent obsessions and compulsions • Time consuming (more than one hour a day) • Causes distress (know it is a problem and cannot stop) • If try to stop it causes more anxiety • 20-29 for females • Worse under times of stress • Very difficult to treat • Periods of normalcy by extremely difficult to treat. • All about minimizing the compulsions • Higher for identical than fraternal twins (stronger genetic component) • Learned • Highly comorbid with tourettes |
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o Obsession
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• Contamination GERMS
o Washing hands, cleaning for HOURS, cleaning things that are already clean, not letting others clean because they cannot do it as well • Doubt • Order o Have to be lined up • Injury o Start often as superstitions o Step on a crack break your mothers back o Doing something prevents and injury • Sexual Imagery o Sexual images of children |
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o Compulsion
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o Specifier- with poor insight
- Thought it was okay o R/O body dysmorphic disorder (preoccuptation with an imagined flaw), anorexia (obsession being skinny, compulsions= cutting food super tiny, chewing everything 200 times) hypochondria, guilt, paraphilias, trichotillomania (pulling out your own hair) o Diagnostic Criteria - Page 462 - Not simply worried about real life problems - Person attempts to ignore this or NEUTRALIZE with other thoughts or actions - Person recognizes that obsessions are a thought from their own mind and not from thought insertion - Compulsions are felt driven to perform and rules must apply rigidly - All 4 compulsions and both Obsession o Code: 300.3 o Specifier: With poor insight |
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- Acute Stress Disorder
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o Develops Dissociative Symptoms (3 or more)
- Diagnosed RIGHT after trauma occurs so it is more common in acute stress disorder - Subjective sense of numbing, detachment, absence of emotional responsiveness - Reduction of awareness of surroundings in a daze - Derealization - Depersonalization - Dissociative Amnesia • Will remember things from before and after the trauma. • Events during the trauma are gone o Event is re-experienced - Recurrent images - Nightmares - Illusions - Flashbacks - Déjà vu o Marked anxiety or hyper vigilance, arousal o Exposed to Traumatic Event o Lasts at least 2 days maximum of 4 weeks o Needs 6 criteria. o *DURATION* o Code: 308.3 |
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- Post traumatic Stress Disorder (PTSD)
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o Course of Disorder
- Trauma must be presented • Trauma type 1: a single breach of boundary (intruder in your home, single rape, tsunami, witness someone blowing up by IED • Traumas type 2: insidious pervasive trauma (kidnapping, military, - Can occur at any age depending on age the trauma occured - Symptoms start within 3 months of trauma • Specifier for delayed onset o 6 months to a year after stressor - Initially acute stress disorder • Persists for more than 4 weeks |
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Post traumatic Stress Disorder (PTSD)
Persistent Symptoms |
Persistent Symptoms of increases arousal with 2 or more
• Sleep difficulties • Irritability • Concentration problems • Hypervigilance • Startle response • Must be CAUSED by the trauma - Not a lot of medications work for PTSD - A lot of people tend to self medicate - Benzo’s, SSRI’s may take the edge off - E. Duration of more than one month • Acute: Less than three months • Chronic: 3 or more months • Delayed Onset: occurs 6 months after stressor - F. Causes clinically significant impairment |
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Post traumatic Stress Disorder (PTSD)
o Differential Diagnosing |
o Differential Diagnosing
• Longer than 4 weeks • Rule out adjustment disorder o Lesser level of stress • Numbing, hyperarousal avoidance that preexists. • Suicidal is NOT criteria of PTSD • Major depressive disorder often comorbid • Phobic disorders coexist • Panic disorder is very common - CODE: 309.81 |
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Post traumatic Stress Disorder (PTSD)
o Criteria |
- A. Traumatic event experienced (both present)
• Experienced/witnessed traumatic event • Response involved intense fear/horror helplessness o In children, this will be shown through agitation or disorganized behavior - Experience is extreme and would effect anybody - B. Traumatic event is re-experiences (need at least 1) • Intrusive depressing memories o Kids act it out with dolls o Distressing dreams o Feels as though still occurring - Delusions, hallucinations, flashbacks o Distress at exposure o Hyperalert - C. Persistent avoidance of stumuli (need 3) • Feelings of detachment from others o Not relating to others • Restricted range of affect o Feel flat like they cannot love • Sense of foreshortened future o No necessarily suicidal, but feel they will die young, not get married, not have a career. • Diminished interest in pleasurable activities - D. Persistent Symptoms of increases arousal with 2 or more • Sleep difficulties • Irritability • Concentration problems • Hypervigilance • Startle response • Must be CAUSED by the trauma - Not a lot of medications work for PTSD - A lot of people tend to self medicate - Benzo’s, SSRI’s may take the edge off - E. Duration of more than one month • Acute: Less than three months • Chronic: 3 or more months • Delayed Onset: occurs 6 months after stressor - F. Causes clinically significant impairment |
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- Generalized Anxiety Disorder (GAD)
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most debilitating of anxiety disorders
o Includes over anxious disorder of childhood o Usually diagnosed before age 20. Rare afterwards o Has familial association but unsure of how strong it is. o 55-60% of people who present with the disorder are female. o GAD - Has highest rate of comorbidities • Depression, substance abuse, and depression - Highest rate of SSDI in anxiety cluster - Has highest rate of somatic complaints • IBS is caused by stress - Lead the most restrictive lives - Most social and occupational problems of anxiety disorders o VERY difficult to treat |
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Generalized Anxiety Disorder (GAD)
o Characteristics |
- Excessive worry
- Occurs most days most of the time - Persists over a long period of time - Opportunistic- not related to specific stimuli • Causes preoccupation with worries that interfere with ADL’s • Often not focused on a particular concern • Co-occurs with mood disorders - Diagnostic Criteria • 6 months before diagnosed • RULE OUT: Multiple physical complaints and meet a somatic disorder, serious illness (hypochondria), • CAN get diability • WORRY is the focus - Differential Diagnosis - Opportunistic - Culture, Age, Gender - Code: 300.02 |
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Other Anxiety Disorders
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o Anxiety disorder d/t general medical condition (293.84) Specify with GAD, w/ panic attacks, or w/ OC symptoms
o Substance induced anxiety D/O. Specify with GAD, with panic attacks, with obsessive symptoms, or with phobic symptoms. Specify with onset during intoxication or with onset during withdrawal |
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o Anxiety NOS 300.00
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- Mixed anxiety depressive disorder
- Social phobic symptoms related to a GMC - Do not meet full criteria - Unable to determine |
