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117 Cards in this Set

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  • Back
What is the first thing to do when a patient presents with anxiety?
determine the LEVEL of anxiety
What is the most common psychiatric illness?
anxiety disorders
What is anxiety?
a universal, uncomfortable feeling of apprehension or dread
Describe the stimulus to anxiety
can be either internal or external
List the 4 types of symptoms that anxiety can produce.
1. physical
2. emotional (affective)
3. cognitive
4. behavioral
What 3 features must you look at to determine if the anxiety is normal or abnormal?
1. intensity
2. cause
3. degree
What is normal anxiety?
anxiety that is appropriate to a situation and dissipates when the situation resolves (people do activities to reduce anxiety)
What is abnormal anxiety determined by?
1. intensity of anxiety relative to the situation
2. trigger for anxiety
3. symptoms
When is anxiety a disorder?
when it inhibits the person's ability to function in work and relationships
What are the symptom classes of anxiety? know examples
1. physical
2. affective
3. cognitive
4. behavioral
What are 3 sub-categories of cognitive anxiety symptoms?
1. sensory-perceptual
2. thinking difficulties
3. conceptual
What does Peplau's model determine?
the degrees of anxiety
What are Peplau's degrees of anxiety?
1. mild
2. moderate
3. severe
4. panic
Describe mild anxiety
Occurs when you sense that something is different due to your INCREASED SENSORY STIMULATION

(ex: more alert than before, during a test, for example)
Describe moderate anxiety
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)
Describe severe anxiety.
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)
What physiological changes occur during severe anxiety?
muscles tighten, vital signs increase
Describe panic.
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
What physiological symptoms occur during panic?
1. vital signs much increased
2. pupils enlarged
What percentage of the population will experience an anxiety disorder (AD) at least once in their lifetime?
14%
Which gender do ADs effect more?
women
What factors increase the risk of developing an AD (4)?
1. smokers
2. below age 45
3. separated/divorced
4. survivors of abuse

5. low SES (book)
What are ADs commonly associated with?
1. other psychiatric illnesses
(mood disorders)

2. physiologic disorders
(heart, respiratory dx)
Which psychiatric disorder is most commonly treated in children?
anxiety
What is a panic attack?
sudden, discrete periods of intense fear or discomfort that are accompanies by significant physical and cognitive symptoms

an extreme, overwhelming form of anxiety
When does a panic attack usually peak?
after 10 minutes
How long can a panic attack last?
up to 30 minutes, followed by a gradual return to normal functioning
What is the primary concern during a panic attack?
safety
What are common fears that evoke a panic attack?
1. feelings of impending doom/death
2. fear of going crazy or losing control
3. desperation
During a panic attack, what is one strongly urged to do?
flee or escape
Why might a person suffering a panic attack go to the ER or urgent care?
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
Are the frequency and severity of panic attacks predictable?
no, they vary in frequency and severity
What does one with panic disorder worry about?
Since they experience recurrent, unexpected panic attacks, it leaves them with a worry about when the next attack will occur
How many characteristic symptoms must be present in order for the patient to meet the DSM-IV criteria for a panic attack?
4

(see notes for list)
What are 2 ways that panic attacks are driven?
1. internally (results from an uncomfortable, internal feeling)
2. externally (from actually seeing a feared object)
What is a phobia?
persistent, unrealistic fears of situations, objects or activities

can be developed after suffering from panic attacks
What is acrophobia?
fear of heights
What is agoraphobia?
fear of open places
What is ailurophobia?
fear of cats
What is algophobia?
fear of pain
What is arachnophobia?
fear of spiders
What is brontophobia?
fear of thunder
What is claustrophobia?
fear of closed spaces
What is cynophobia?
fear of dogs
What is entomophobia?
fear of insects
What is hematophobia?
fear of blood
What is microphobia?
fear of germs
What is nyctophobia?
fear of night or dark places
What is ophidiophobia?
fear of snakes
What is phonophobia?
fear of loud noises
What is photophobia?
fear of light
What is pyrophobia?
fear of fire
What is tobophobia?
stage fright
What is xenophobia?
fear of strangers
What is zoophobia?
fear of animal or animals
If a patient has a panic attack, which emergency interventions should you carry out?
1. stay with patient
2. remain calm
3. give clear, simple instructions
4. provide reassurance and non-stimulating environment
5. administer PRN anxiolytic meds
What is panic disorder?
a chronic condition that has several exacerbations and remissions during the course of the disease
What is panic disorder characterized by?
the appearance of disabling attacks of panic that often lead to phobias
Generally describe the 2 criteria for panic disorder.
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
Can panic disorder be diagnosed with or without agoraphobia.
both
What are 2 types of cognitive therapy that are intended to treat panic disorder?
1. cognitive restructuring
2. interoceptive exposure technique
What is cognitive restructuring?
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
What is interoceptive exposure technique?
exposure to sensations experienced during the panic attack

(ie running up the stairs to evoke the feared sensations, such as tachycardia)
What does interoceptor exposure technique teach the patient?
that the sensations don't have to progress to panic attacks
Which behavioral theory is meant to treat panic disorder?
desensitization
What does desensitization do?
it helps to break down a fearful situation into small, manageable steps
What does desensitization particularly help?
it helps reduce situational avoidance
What are relaxation techniques supposed to do?
ease physical symptoms and refocus attention
List 4 relaxation techniques.
1. deep breathing exercises
2. progressive relaxation
3. positive visualization or guided imagery
4. listening to music
What are 4 types of pharmacologic treatments for anxiety disorder?
1. SSRIs
2. SNRIs
3. TCAs
4. MAOIs
Why should you slowly give drugs like Zoloft and Prozac?
to prevent overstimulation
Which drugs are first line treatment for anxiety disorders?
SSRIs
Why are patients who take SSRIs often lost to follow up?
SSRIs take a long time to kick in
What is OCD?
When severe obsessions/compulsions take up more than 1 hour per day and interfere with functioning
What are obsessions
unwanted, recurrent, intrusive thoughts
What is the most common obsession?
fear of contamination
What are compulsions?
ritualistic, repetitive behaviors that relieve anxiety

may endanger health and safety
Give examples of compulsions
1. hand washing
2. checking
3. praying
4. counting
What is trichotillomania?
hair pulling, a way of distracting self from compulsions
How do we know when a behavior reaches to a compulsive level?
when the ritual behavior exceeds cultural norms
What type of behavioral therapy is used to treat OCD?
exposure and response prevention
What is exposure and response prevention?
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
In addition to behavioral therapy, what are 3 other treatments for OCD?
1. partial hospitalization
2. day treatment
3. medication
Which types of meds are used for OCD?
1. SSRIs
2. SNRIs
3. TCAs
4. MAOIs
Name 5 potential treatments for OCD
1. relaxation techniques
2. support groups
3. ECT
4. deep brain stimulation
5. psychosurgery
What is generalized anxiety disorder (GAD) characterized by?
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
When does GAD onset occur usually?
early 20s, can be either gradual (typical) or acute
Which gender experiences GAD more often?
women
What does chronic GAD potentially lead to?
immunosuppression
Which comorbities typically occur with GAD?
1. panic disorder
2. substance abuse (anxiolytics, alcohol)
3. MDD, phobias, and dysthymia
What are 3 categories of signs and symptoms of GAD?
1. excessive physiologic arousal (ie shortness of breath, tachy)
2. distorted cognitive processes
(ie poor concentration)
3. poor coping
(ie self medicating)
What are for classes of treatment for GAD?
1. relaxation techniques
2. psychotherapy
3. cognitive therapy
4. biofeedback therapy
How is psychotherapy useful in treating GAD?
helps the patient:

1. identify and deal with the cause
2. anticipate reaction
3. deal with anxiety
How does cognitive therapy help patients with GAD?
helps the patient change their negative thoughts
Describe the purpose of biofeedback treatment for GAD.
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?)
What do relaxation techniques do?
decrease arousal
What are the 4 pharmacologic treatments for GAD?
1. BuSpar (buspirone)
2. benzodiazepines
3. SSRIs
4. TCAs
What is the onset of benzos?
immediate
Describe the effects of benzos.
1. decrease vigilance
2. ease muscle tension
3. increase GABA
Describe the timing of benzos
increase the dose slowly

limit it's use to 6 weeks
What is BuSpar?
non-benzo anxiolytic
What does BuSpar do?
it decreases postsynaptic serotonin with chronic anxiety
What is the downside of BuSpar?
it takes a long time to work
When does PTSD occur?
after experiencing or witnessing a serious traumatic event
What is PTSD?
1. persistent and recurrent flashbacks
2. reliving event
3. reminders
4. avoidance of reminders
Which gender is affected more from PTSD?
women
Which disorders are PTSD patients at risk for developing?
1. anxiety disorders
2. mood disorders
3. substance abuse
What is a flashback?
waking recollections of an event
Describe the degrees of PTSD
mild to severe

acute to chronic
Differentiate between acute and chronic PTSD
acute: duration of symptoms is less than 3 months

chronic: duration of symptoms is more than 3 months
List the PTSD signs and symptoms
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
Name 6 types of tx for PTSD
1. psychotherapy
2. exposure therapy
3. stress management
4. relaxation technique
5. group therapy
6. pharmacologic tx
List the 5 types of drugs for PTSD
1. benzos
2. SSRIs
3. MAOIs
4. TCAs
5. Beta Blockers
What can immediate administration of the beta blocker propanolol do?
it can inhibit bad memories when given within 6 hours of the trauma
In children and adolescents with PTSD, what do the symptoms depend on?
1. developmental age at trauma exposure
2. trauma type
3. time until treatment initiated
What effect can trauma during pre/peri-verbal development have?
serious, lifelong manifestations
What type of response might children/adolescents with PTSD have to meds?
idiosyncratic response to medications