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89 Cards in this Set
- Front
- Back
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What is acute stress disorder?
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-occurs after a traumatic event. Duration: 2-28 days. Resolution of traumatic event should happen in this time frame
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What is Agoraphobia?
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-fear of being alone in a public place from which escape would be difficult or help would be unavailable in the event of being disabled
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What is anxiety?
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-largely rooted in fear. Best described as a sense of psychological distress.
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What is anxiety disorder?
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-group of conditions in which affected clients experience persistent anxiety that they cannot dismiss. Coping mechanisms are ineffective & anxiety interferes with ADLs. They feel that the core of their personalities is being threatened, even when no actual danger exists.
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What are compulsions?
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-Ritualistic behaviors that people feel compelled to perform either in accord with a specific set of rules or in a routine manner.
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What is generalized anxiety disorder (GAD)?
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-Chronic and excessive worry for at least 6mo, encompassing many aspects of the person’s life.
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What are obessions?
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-Recurrent, intrusive, and persistent ideas, thoughts, images or impulses.
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What is the difference between a panic attack & panic disorder?
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-Panic attack: characterized by discrete period of intense apprehension or terrors without any real accompanying danger, accompanied by at least 4 of 13 somatic or cognitive symptoms.
-Panic disorder: recurrent, unexpected panic attacks that causes clients to worry persistently about recurrences or complications or to undergo behavioral changes in response to the attacks for at least 1 month. |
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What is a phobia?
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-persistent, irrational fear attached to an object of situation that objectively does not pose a significant danger.
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What is PTSD?
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-When symptoms of acute stress disorder continue for more than 1 month and are accompanied by functional impairment or stress.
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What is social phobia?
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-persistent, irrational fear of and compelling desire to avoid situations in which people may be exposed to strangers or to scrutiny from others.
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T/F: stressors frequently are cites as causes of anxiety, & when the mind interprets events as threatening, it responds accordingly c ssx of anxiety & fight/flight response.
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-True
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What are some ssx of anxiety? (hint: same as fight/flight response)
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-HR & BP increase
-blood flow to muscles increase -RR increase -perspiration increase -digestion decrease -blood clotting ability increase -saliva production decrease -immune response decrease -energy-producing stored glycogen released |
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Anxious ppl have feelings of...
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-nervousness,
-vague discomfort, -uncertainty, -self-doubt, -apprehension, -dread, -restlessness |
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Mild anxiety results in...
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-improved functioning
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What is mild anxiety's effects on sensation?
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-Mild anxiety heightens sensory awareness (sight, hearing, taste, small, & touch)
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How does moderate anxiety affect sensation?
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-dulls perception
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How does severe anxiety effect sensation?
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-distorts perception, sensory input diminishes & processing of sensory stimuli becomes scattered & disorganized
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How does Panic effect sensation?
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-great cognitive impairment than severe anxiety; concentration, learning, & problem solving are impossible
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How does anxiety effect congition?
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-Anxiety greatly influences cognitions, the ability to concentrate, learn & solve probs
-Severe anxiety hinder cog function (those with anxiety disorders) -Panic have even great cog impair; concentration, learning, & problem solving are impossible |
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How does mild anxiety effect on verbal ability?
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-speech content & form reflect heightened awareness & cog function
-Alert, confident and relatively secure |
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How does moderate anxiety effect verbal ability?
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-frequent changes of topic, repetitive questioning, joking, wordiness
-Blocking (loss of train of thought), speech rate & volume inc -Change body position frequently, hand gestures, aggressive body postures toward others -Hesitate & procrastinate in meeting social and vocational expectations -Overall picture of restlessness and discontent, provoke feelings of irritation in others |
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How does severe anxiety effect verbal ability?
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-verbalize emotional pain through “I can’t stand this” or “I can’t think”
-Fine & gross motor tremors, grimaces, pacing, hand-wringing & other purposeless activity -Overall extreme emotional discomfort and behavioral disorganization |
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How does panic affect verbal ability?
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-greater emotional pain & behavioral disorganization
-Verbal/nonverb behav suggests psychotic-like state -People are virtually helpless & unable to negotiate simple demands -May scream, run wildly or cling tenaciously for security -Others must initiate protective & calming measures bc prolonged panic can result in death |
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What type of behaviors that are considered normal but become a psychiatric disorder when...
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-Anxiety is greater-than-expected intensity based on the context
-Anxiety prevents fulfillment of professional, personal, or social roles -Anxiety is accompanied by flashbacks, obsessions, or compulsions -Anxiety curtails daily or social activities -Anxiety lasts longer than expected given the precipitating stress |
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What are 2 barriers to tx for anxiety disorders?
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1.lack of gen knowledge of nature & prevalence and positive response to tx
-social stigma around pscyh illness that prevents people from obtaining prompt tx before complications |
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What are the 3 neurobiologic theories for anxiety?
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1. Hereditary predisposition
2. Brian chemistry & developmental factors 3. Brain structures -->physical illness, cocaine, amphetamines, cannabis & caffeine, danger, trauma contribute |
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What is the hereditary predisposition for anixety?
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-Biologic vuln makes them have a lower threshold for stress
--> 50% have affected relatives |
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How does the brain chemistry & developmental factors attribute to anxiety?
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-ANS & noradrenergic system may cause anxiety bc lack of ability to regulate serotonin & GABA (decreased GABA)
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what does the amydala do?
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-can ID incoming sensory info as threatening & instigate anxiety or fear
-Emotional memories in certain part of amygdala play role in phobic disorders -Coordinates fear, memory & emotion with HR, BP & other responses -Anxiety study showed hyperactivity of this brain structure |
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What does the hippocampus do in regards to its role in anxiety?
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-processes threatening stimuli & encodes info into memories
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What does the locus Ceruleus do in regards to anxiety?
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-initiates response to danger, overactive in people like PTSD
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What does the striatum do?
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-motor control, involved with OCD
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What are some psychological theories r/t anxiety?
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-Low self-esteem, shy timid nature in childhood, angry or critical parents, discomfort with aggression
-Long-term exposure to abuse, violence or poverty -Can co-occur with depressive disorders -Learning Theory: anxiety results from conditioning, linking dangerous fear-inducting event (house fire) with a natural event (lighting a match) -Cognitive theory: anxiety a manifestation of distorted thinking: -->People with anx have exaggerated need for approval & view minor mistakes as catastrophes |
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What is generalized anxiety disorder (GAD)?
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-chronic and excessive worry and anxiety more days than not for at least 6mo, encompassing many aspects of the person’s life
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What are some ssx & dx criteria of generalized anixety disorder?
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-Interfere with daily life and relationships
-Persistent & chronic signs of severe: motor tension, autonomic hyperactivity, apprehension -Chronic hypervigilance for potential threats, feeling “on edge” -Hyperarousal causing: inability to concentrate, sleep pattern disturbances, chronic fatigue -Tense & distracted in social situations -Linked to 50% outpatients with depression |
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What is a phobia?
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-is persistent, irrational fear attached to an object or situation that objectively doesn’t pose a significant danger.
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What are some behaviors that ppl c phobia's demonstrate?
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-Anticipatory anxiety & desire to avoid dreaded object/sit
-Usually recognize their excessive and unreasonable fear -Not like panic attacks because fear is always anticipated and never unexpected |
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What is the most persistent & severe phobic disorder?
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-Agroraphobia
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What are some behaviors that ppl c agoraphobia demonstrate?
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•Some have to rearrange their lives (restrict travel, stop leaving house)
•Usually loses enjoyment of life and leads to depression |
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What is social phobia?
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-Fear behaving in a way that may prove humiliating or embarrassing
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What are panic attacks?
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Physiologic and psychological over-response to stressors.
Incorrectly perceive circumstances to be life-threatening |
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What are some ssx of panic attacks?
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-Chest pain, choking, smothering sensations, dizziness, dyspnea, fainting, sweating, hot & cold flashes, palpitations, paresthesias, vertigo.
Feelings of depersonalization or derealizations, fears of dying or going crazy, uncontrollable behaviors Last 5-20minutes to 1 hour Extreme efforts to esacpe |
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What is a panic disorder?
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-may or may not be with agoraphobia, persistent panic attacks for 1 month
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What is OCD?
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People don’t voluntarily produce obsessions but feel cognitively invaded by them despite efforts to ignore them and end up remaining preoccupied with them
Clients engage in compulsions to prevent or reduce anxiety, not to increase pleasure or satisfaction If delay in compulsions, tremendous, anxious tension can only be relieved by doing them OCD can be mild to severe & when symptoms interfere with life then they get tx If they don’t get tx, it can lead to suicide or depression |
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What is a stress disorder?
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-result from exposure to a sever or extraordinary stressor
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What is acute stress disorder (ASD)?
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-•Occurs within 1st month of exposure to extreme trauma
•Symptoms begin during or right after event •Dissociation: state of detachment, world is dreamlike and unreal (primary feature) •Dissociative amnesia: poor memory of specific events surrounding the trauma •Can resolve in 2 to 28 days of the exposure |
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What is PTSD?
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-•ASD lasting longer than 1 month
-->•Symptoms: generalized anxiety, intrusive thoughts or images of trauma, flashbacks, nightmares, sleep disturbances. Need to avoid situations that elicit those memories •Chronic PTSD: lasts longer than 3 months •Delayed PTSD: develop symptoms after 6months •PTSD pts often have low self-esteem, loss of positive and trusting attitudes toward people and society, sense of being damaged, difficulty establishing relationships •Increased risk for substance abuse or dependence, alcohol, weed, sedative-hypnotics |
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What are some co-morbidities & dual dx that occur allong c anxiety?
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-depression,
-substance abuse, -eating disorders, -personality disorders -schizophrenia |
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What are some clues when looking for co-morbidies & anxiety?
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-High alcohol and drug intake
-Hx of barbiturate or benzo dependence -Chronic difficulties in interpersonal relationships or occupation -Hx of frequent use of healthcare services for somatic complaints -negative outlook on self, others and society -Distorted thinking, obsessive or compulsive behavior, hx of an eating disorder |
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What is the st step in ID tx stratigies for an anxiety disorder?
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•First step in identifying treatment strategies for an anxiety disorder is to ascertain whether any physical condition could be precipitating anxiety
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How can CBT help ppl c anxiety?
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-People can recognize thoughts that produce and maintain anxiety and use various techniques to alter those thoughts
-Cog- interventions include: prob-solving strategies, education, help in IDing irrational thinking -Behav- interventions include: reinforcement and exposure to change aberrant behaviors and abnormal response to anxiety-provoking situations. |
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What is the goal of basic cognitive therapy for anxiety?
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-Goal: gain insight into situations that provoke anxiety and then learn new responses to them
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What does basic cognitive therapy for anxiety include?
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-Includes: education & prob-solving, but primarily focuses on learning to ID & change faulty thinking
-Keep a diary of anxious feelings to increase awareness of anxious thoughts -Homework: concrete plan for developing new behaviors |
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What do the clts go through when using basic cognitive therapy for anxiety?
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-Clients will begin to, through self-obs and coaching, gain insight into faulty assumptions that trigger anxiety and begin substituting new ways of managing stressful situations. Some strategies are:
Covert Rehearsal: imagine successfully confronting anxiety-provoking situation Positive coping statements: to prevent anxiety fr escalating, “I can do this, I’ve done it before” Cognitive reframing: change interpretation of anxiety-provoking situations from catastrophic to realistic. “I will not lose everything if I do not do well on my test” |
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What is systematic desensitization in regards to phobia tx?
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-Conditioning technique by which clients learn to replace gradually a panic response with relaxation response
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Systematic desensitization is used for what type of disorders?
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-Behavioral therapy for:
--specific phobias --social phobias --agoraphobia --PTSD |
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How does systematic desensitization work?
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-Confront object of fear in small controlled steps
OR -scale fear 0-10 and begin confronting the 1 or 2 fears while practicing relaxation, then 3 or 4s |
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What is exposure tx in regards to phobia disorders?
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-involves exposure to feared object, but does not involve relaxation or gradual approach
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How does exposure tx work in regards to phobia disorders?
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Clients control how long they’re exposed to fear object (flooding {exposed 1-2hrs} or graduated exposure {up to client})
Eventually, stimulating event loses its effect |
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T/F: practicing controlled breathing before a panic attack can help minimize the attack.
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-True
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What is the relaxation response?
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-physical state of deep rest that counters the fight-or-flight response
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What are the steps to use when performing the relaxation response technique?
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•Sit comfy in quiet, non-distracting place
•Clear mind, focus on breathing, watch chest rise and way air moves out nose •Respond to thoughts by watching them float away, picture calm, peaceful place •Tense each area 8-10 seconds, then relax, then focus on breathing again •sit quietly for 1-2minutes before opening eyes |
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What are some CBT stratigies to use to prevent reccurrent panic attacks?
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-Use cog restructuring to reframe catastrophic thinking
-->Desensitize client to feared situations, educate about disorder, teach breathing techniques |
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What are some CBT stratigies for GAD?
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-teach relaxation tech, stress management, biofeedback
-->Use cog interventions to reframe catas thinking, assist client with prob-solving |
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What are some CBT strategies to use for a clt c OCD?
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-Desensitize to feared situations, educate about the disorder, teach relaxation techniques
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What are some CBT strategies to use for a clt c ASD?
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find support group, engage in therapeutic dialogues with client, teach prob-solving, relaxation techniques
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What are some CBT strategies to use for a clt c specific phobias?
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-Desens client to feared situations
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What are some CBT strategies to use for a clt c social phobia?
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-Challenge negative beliefs
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What are some CBT strategies to use for a clt c PTSD?
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-Encourage client to attend group therapy
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T/F: SSRIs are 1st line alternatives for anxiety disorders?
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-True
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What are some examples of SSRIs?
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-Fluoxetine(Prozac),
-sertraline(Zoloft), -paroxetine(Paxil), -escitalopram(Lexapro), -venlafaxine(Effexor), -fluvoxamine(Luvox) |
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What are some advantages to SSRIs?
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-anticholinergic, orthostatic and sedative effects
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What are some SE to SSRIs?
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s/e: sexual dysfxn, nervousness, nausea, insomnia, anxiety, no with other antidep (serotonin syndrome)
-->seratonine syndrome: restlessness, confusion, agitation, hyperreflexia, diaphoresis, shivering, tremors, muscle rigidity, also can happen with addition of herbal and food supplements |
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T/F: the use of a benzo during the 4-6 wks if reaching SSRI maintence is not needed.
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-False.
-->Benzo's reaches their therapeutic level faster than SSRIs so the clt should recieve benzo's untill the SSRIs kick in, then taper the benzo's gradually |
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What is a positive feature that Benzodiazepine's have?
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-Rapid onset & high-tolerability
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What are some disadvantages of benzodiazepines?
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-risk of physical dependence & high potential for abuse, abrupt discontinue can trigger severe w/drawal symptoms and intense rebound anxiety
-Potentiate effects of alcohol and other sedative hypnotics, commonly abused |
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What are some SE of benzodiazepines?
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: risk of physical dependence & high potential for abuse, abrupt discontinue can trigger severe w/drawal symptoms and intense rebound anxiety
Potentiate effects of alcohol and other sedative-hypnotics, commonly abused s/e: sedation, ataxia, impaired coordination, slurred speech, memory impairment, paradoxical agitation, dizziness, psychomotor impairment (no driving), cog disturbances interrupt with CBT |
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What are benzodiazepines indicated for?
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-: panic disorder, no experience response to other meds/therapies, or those needing to reduce anxiety while waiting for other meds to have a therapeutic effect
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What are some examples of benzodiazepines?
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-Alprazolam(Xanax),
-diazepam(Valium), -lorazepam(Ativan), -clorazepate(Tranxene), -oxazepam(Serax) |
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What are some properties of Buspirone (BuSpar)?
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-Lacks anticonvulsant, muscle relaxant and hypnotic properties
-non addictive, works in 1-2weeks, maximal therapeutic level is 6weeks so give benzos during meantime |
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T/F: BuSpar is good for GAD.
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-True
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What are some SE of BuSpar?
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-nausea,
-dizziness, -headache, -insomnia, -agitation, -drowsiness, -dysphoria |
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T/F: TCA's are affective for GAD c/out co-morbid major depression
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-True
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T/F: TCAs are highly effective for PTSD
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-True
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What are some ex of TCAs?
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-Imipramine(Tofranil),
-clomipramine(Anafranil), -amitriptyline(Elavil), -deispramine(Norparmin), -nortiptyline(Pamelor) |
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How should a clt take TCAs?
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-Easy to dose & conveniently administered at bedtime once daily
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What are some SE of TCA?
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-sedation,
-orthostatic hypotension, -anticholongeric effects |
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When is TCA's contraindicated?
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-clients with cardiac disorders, on SSRIs or MAOIs
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