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117 Cards in this Set
- Front
- Back
What is the first thing to do when a patient presents with anxiety?
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determine the LEVEL of anxiety
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What is the most common psychiatric illness?
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anxiety disorders
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What is anxiety?
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a universal, uncomfortable feeling of apprehension or dread
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Describe the stimulus to anxiety
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can be either internal or external
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List the 4 types of symptoms that anxiety can produce.
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1. physical
2. emotional (affective) 3. cognitive 4. behavioral |
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What 3 features must you look at to determine if the anxiety is normal or abnormal?
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1. intensity
2. cause 3. degree |
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What is normal anxiety?
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anxiety that is appropriate to a situation and dissipates when the situation resolves (people do activities to reduce anxiety)
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What is abnormal anxiety determined by?
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1. intensity of anxiety relative to the situation
2. trigger for anxiety 3. symptoms |
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When is anxiety a disorder?
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when it inhibits the person's ability to function in work and relationships
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What are the symptom classes of anxiety? know examples
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1. physical
2. affective 3. cognitive 4. behavioral |
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What are 3 sub-categories of cognitive anxiety symptoms?
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1. sensory-perceptual
2. thinking difficulties 3. conceptual |
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What does Peplau's model determine?
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the degrees of anxiety
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What are Peplau's degrees of anxiety?
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1. mild
2. moderate 3. severe 4. panic |
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Describe mild anxiety
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Occurs when you sense that something is different due to your INCREASED SENSORY STIMULATION
(ex: more alert than before, during a test, for example) |
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Describe moderate anxiety
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the disturbed feeling that something is wrong, resulting in nervousness and agitation
(ex: able to sustain attention to a particular focus, selectively inattentive to contents outside the focal area) |
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Describe severe anxiety.
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At this level, primitive survival skills take over. Physiologic changes and difficulty in thinking/reasoning occurs.
(tendency to not notice what's going on outside of the focus of attention) |
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What physiological changes occur during severe anxiety?
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muscles tighten, vital signs increase
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Describe panic.
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An adrenalin surge in which the emotional-psychomotor realm predominates
felt to be an enormous threat to survival, so cognitive function is focused on defense |
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What physiological symptoms occur during panic?
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1. vital signs much increased
2. pupils enlarged |
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What percentage of the population will experience an anxiety disorder (AD) at least once in their lifetime?
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14%
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Which gender do ADs effect more?
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women
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What factors increase the risk of developing an AD (4)?
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1. smokers
2. below age 45 3. separated/divorced 4. survivors of abuse 5. low SES (book) |
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What are ADs commonly associated with?
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1. other psychiatric illnesses
(mood disorders) 2. physiologic disorders (heart, respiratory dx) |
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Which psychiatric disorder is most commonly treated in children?
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anxiety
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What is a panic attack?
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sudden, discrete periods of intense fear or discomfort that are accompanies by significant physical and cognitive symptoms
an extreme, overwhelming form of anxiety |
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When does a panic attack usually peak?
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after 10 minutes
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How long can a panic attack last?
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up to 30 minutes, followed by a gradual return to normal functioning
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What is the primary concern during a panic attack?
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safety
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What are common fears that evoke a panic attack?
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1. feelings of impending doom/death
2. fear of going crazy or losing control 3. desperation |
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During a panic attack, what is one strongly urged to do?
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flee or escape
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Why might a person suffering a panic attack go to the ER or urgent care?
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Panic attacks cause fear of death because they mimic symptoms of a heart attack. Patients often feel:
-like they are dying -palpitations -chest discomfort -rapid pulse -nausea, dizziness -sweating -paresthesias -trembling -shortness of breath |
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Are the frequency and severity of panic attacks predictable?
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no, they vary in frequency and severity
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What does one with panic disorder worry about?
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Since they experience recurrent, unexpected panic attacks, it leaves them with a worry about when the next attack will occur
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How many characteristic symptoms must be present in order for the patient to meet the DSM-IV criteria for a panic attack?
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4
(see notes for list) |
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What are 2 ways that panic attacks are driven?
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1. internally (results from an uncomfortable, internal feeling)
2. externally (from actually seeing a feared object) |
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What is a phobia?
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persistent, unrealistic fears of situations, objects or activities
can be developed after suffering from panic attacks |
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What is acrophobia?
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fear of heights
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What is agoraphobia?
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fear of open places
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What is ailurophobia?
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fear of cats
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What is algophobia?
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fear of pain
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What is arachnophobia?
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fear of spiders
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What is brontophobia?
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fear of thunder
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What is claustrophobia?
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fear of closed spaces
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What is cynophobia?
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fear of dogs
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What is entomophobia?
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fear of insects
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What is hematophobia?
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fear of blood
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What is microphobia?
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fear of germs
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What is nyctophobia?
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fear of night or dark places
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What is ophidiophobia?
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fear of snakes
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What is phonophobia?
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fear of loud noises
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What is photophobia?
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fear of light
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What is pyrophobia?
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fear of fire
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What is tobophobia?
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stage fright
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What is xenophobia?
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fear of strangers
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What is zoophobia?
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fear of animal or animals
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If a patient has a panic attack, which emergency interventions should you carry out?
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1. stay with patient
2. remain calm 3. give clear, simple instructions 4. provide reassurance and non-stimulating environment 5. administer PRN anxiolytic meds |
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What is panic disorder?
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a chronic condition that has several exacerbations and remissions during the course of the disease
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What is panic disorder characterized by?
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the appearance of disabling attacks of panic that often lead to phobias
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Generally describe the 2 criteria for panic disorder.
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1. recurrent, unexpected panic attacks
2. at least 1 of the attacks has been followed by 1+ month of 1 or more of the following: -persistent concern about having more attacks -worry about the implications of the attack -change in behavior related to the attack |
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Can panic disorder be diagnosed with or without agoraphobia.
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both
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What are 2 types of cognitive therapy that are intended to treat panic disorder?
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1. cognitive restructuring
2. interoceptive exposure technique |
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What is cognitive restructuring?
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when the patient identifies, evaluates and restructures thoughts
enables the patient to replace negative thoughts enables the patient to realize that the panic attack is separate and independent of the trigger |
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What is interoceptive exposure technique?
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exposure to sensations experienced during the panic attack
(ie running up the stairs to evoke the feared sensations, such as tachycardia) |
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What does interoceptor exposure technique teach the patient?
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that the sensations don't have to progress to panic attacks
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Which behavioral theory is meant to treat panic disorder?
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desensitization
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What does desensitization do?
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it helps to break down a fearful situation into small, manageable steps
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What does desensitization particularly help?
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it helps reduce situational avoidance
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What are relaxation techniques supposed to do?
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ease physical symptoms and refocus attention
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List 4 relaxation techniques.
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1. deep breathing exercises
2. progressive relaxation 3. positive visualization or guided imagery 4. listening to music |
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What are 4 types of pharmacologic treatments for anxiety disorder?
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1. SSRIs
2. SNRIs 3. TCAs 4. MAOIs |
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Why should you slowly give drugs like Zoloft and Prozac?
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to prevent overstimulation
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Which drugs are first line treatment for anxiety disorders?
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SSRIs
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Why are patients who take SSRIs often lost to follow up?
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SSRIs take a long time to kick in
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What is OCD?
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When severe obsessions/compulsions take up more than 1 hour per day and interfere with functioning
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What are obsessions
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unwanted, recurrent, intrusive thoughts
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What is the most common obsession?
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fear of contamination
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What are compulsions?
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ritualistic, repetitive behaviors that relieve anxiety
may endanger health and safety |
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Give examples of compulsions
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1. hand washing
2. checking 3. praying 4. counting |
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What is trichotillomania?
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hair pulling, a way of distracting self from compulsions
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How do we know when a behavior reaches to a compulsive level?
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when the ritual behavior exceeds cultural norms
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What type of behavioral therapy is used to treat OCD?
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exposure and response prevention
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What is exposure and response prevention?
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1. exposure to object/situation that triggers obsessions
2. refrain from engaging in compulsive response 3. write down what happens as a result of the restraint 4. patient learns to manage intense anxiety |
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In addition to behavioral therapy, what are 3 other treatments for OCD?
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1. partial hospitalization
2. day treatment 3. medication |
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Which types of meds are used for OCD?
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1. SSRIs
2. SNRIs 3. TCAs 4. MAOIs |
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Name 5 potential treatments for OCD
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1. relaxation techniques
2. support groups 3. ECT 4. deep brain stimulation 5. psychosurgery |
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What is generalized anxiety disorder (GAD) characterized by?
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excessive worry and anxiety almost daily for at least months
usually the anxiety does not pertain to a specific situation; rather, it concerns a number of real-live activities or events |
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When does GAD onset occur usually?
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early 20s, can be either gradual (typical) or acute
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Which gender experiences GAD more often?
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women
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What does chronic GAD potentially lead to?
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immunosuppression
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Which comorbities typically occur with GAD?
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1. panic disorder
2. substance abuse (anxiolytics, alcohol) 3. MDD, phobias, and dysthymia |
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What are 3 categories of signs and symptoms of GAD?
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1. excessive physiologic arousal (ie shortness of breath, tachy)
2. distorted cognitive processes (ie poor concentration) 3. poor coping (ie self medicating) |
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What are for classes of treatment for GAD?
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1. relaxation techniques
2. psychotherapy 3. cognitive therapy 4. biofeedback therapy |
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How is psychotherapy useful in treating GAD?
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helps the patient:
1. identify and deal with the cause 2. anticipate reaction 3. deal with anxiety |
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How does cognitive therapy help patients with GAD?
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helps the patient change their negative thoughts
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Describe the purpose of biofeedback treatment for GAD.
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ease the physical signs of GAD by helping the patient recognize and change their response
(ie, induces BP, HR, RR, T perspiration changes to mimic anxiety, showing the patient that he doesn't have to always get an attack?) |
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What do relaxation techniques do?
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decrease arousal
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What are the 4 pharmacologic treatments for GAD?
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1. BuSpar (buspirone)
2. benzodiazepines 3. SSRIs 4. TCAs |
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What is the onset of benzos?
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immediate
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Describe the effects of benzos.
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1. decrease vigilance
2. ease muscle tension 3. increase GABA |
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Describe the timing of benzos
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increase the dose slowly
limit it's use to 6 weeks |
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What is BuSpar?
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non-benzo anxiolytic
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What does BuSpar do?
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it decreases postsynaptic serotonin with chronic anxiety
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What is the downside of BuSpar?
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it takes a long time to work
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When does PTSD occur?
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after experiencing or witnessing a serious traumatic event
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What is PTSD?
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1. persistent and recurrent flashbacks
2. reliving event 3. reminders 4. avoidance of reminders |
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Which gender is affected more from PTSD?
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women
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Which disorders are PTSD patients at risk for developing?
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1. anxiety disorders
2. mood disorders 3. substance abuse |
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What is a flashback?
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waking recollections of an event
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Describe the degrees of PTSD
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mild to severe
acute to chronic |
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Differentiate between acute and chronic PTSD
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acute: duration of symptoms is less than 3 months
chronic: duration of symptoms is more than 3 months |
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List the PTSD signs and symptoms
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1. anger
2. poor impulse control 3. chronic anxiety and tension 4. avoidance (ppl, place, things associated with traumatic experience) 5. emo detachment or numbness 6. depersonalization 7. difficulty concentrating 8. insomnia 9. inability to recall details of event 10. labile affect 11. hypervigilance 12. social withdrawal 13. decreased self esteem 14. hopelessness 15. sense of being permanently damaged 16. relationship problems 17. survivor guilt |
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Name 6 types of tx for PTSD
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1. psychotherapy
2. exposure therapy 3. stress management 4. relaxation technique 5. group therapy 6. pharmacologic tx |
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List the 5 types of drugs for PTSD
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1. benzos
2. SSRIs 3. MAOIs 4. TCAs 5. Beta Blockers |
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What can immediate administration of the beta blocker propanolol do?
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it can inhibit bad memories when given within 6 hours of the trauma
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In children and adolescents with PTSD, what do the symptoms depend on?
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1. developmental age at trauma exposure
2. trauma type 3. time until treatment initiated |
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What effect can trauma during pre/peri-verbal development have?
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serious, lifelong manifestations
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What type of response might children/adolescents with PTSD have to meds?
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idiosyncratic response to medications
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