Hbd2: Adjustment, Anxiety, And Trauma Related Disorders, Willsie

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criteria for diagnosis of an adjustment disorder

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identifiable stressor, leading to development of marked distress (reaction beyond normal)

when stressor is terminated, symptoms abate

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treatment for adjustment disorder

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psychotherapy w/ ID and removal of stressor

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the body's warning signal

inhibitor of ongoing behavior

persistent signal w/out threat leads to clinical disorder

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anxiety

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second most common psychiatric disorder (25% lifetime prevalence)

drug and alcohol abuse is #1

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anxiety

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"behavioral inhibition" associated w/ anxiety disorder in infants, toddlers, and schoolage children

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infants: irritable

toddlers: shy and fearful

school age: quiet and cautious

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types of anxiety disorders

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generalized anxiety disorder
social phobia
specific phobia
obsessive-compulsive disorder
panic disorder
post-traumatic stress disorder

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intense fear or discomfort w/ four or more symptoms (e.g. palpitations, sweating, dypnea, chest pain, derealization or depersonalization) that develop abruptly and peak at 10 minutes

SUBSTANCE ABUSE AND OTHER MEDICAL DISORDERS ARE RULED OUT

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panic attack (recurrent and unexpected)

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"fear of the marketplace"

anxiety being in places or situations

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agoraphobia

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condition often associated w/ panic disorder

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agoraphobia

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treatment of panic disorder

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stop stimulants

psychotherapy

medication (antidepressants(SSRI's are first line agents) and benzodiazepines, )

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marked and persistent fear (excessive and unreasonable) cued by specific object or situation causing immediate anxiety

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specific phobia

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treatment for specific phobia

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cognitive behavioral therapy (most effective treatment)

medication (prn)- benzodiazepines and beta blockers

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marked or persistent fear of social or perfomance situations

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social phobia (generalized or specific), average age of onset is 16

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treatment for social phobia

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cognitive behavioral therapy

social skills training

medications (SSRI's, benzodiazepines, and BB)

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excesive anxiety and worry for at least 6 months (rule out adjustment disorder)

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generalized anxiety disorder

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only type of anxiety disorders that is more common in men

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generalized anxiety disorder

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treatment for generalized anxiety disorder

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psychotherapy (CBT is the mainstay)

medication

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recurent, persistent, and intrusive thoughts, impulses, or images that are upseting and inappropriate

attempts to ignore

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obsessions (as part of OCD)

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repetitive behaviors or mental acts

person feels driven to perform them, according to rules (e.g. has to wash hands so many times after going to the bathroom)

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compulsions (as part of OCD)

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typical age of onset for OCD

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20-24 years (but many develop symptoms in childhood)

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patient w/ new onset of OCD w/ prior history of group A beta strep

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PANDAS

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treatment for OCD

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cognitive behavioral therapy
pharmacotherapy (most often SSRI's)

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occurs when a person has experienced a catastrophic event

following event, patient exhibits atitation, anger, fear, sadness, horror, or denial

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post-traumatic stress disorder

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risk factors for post-traumatic stress disorder

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seriousness
repetition of event
proximity to event
relationship to victim

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defense mechanism for people with post-traumatic stress disorder

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avoidance

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type of arousal that occurs w/ post-traumatic stress disorder

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autonomic arousal (difficulty falling asleep or staying asleep, irritability, difficulty concentrating...)

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treatment of post-traumatic stress disorder

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help patients differentiate past traumatic experiences from current reality, through:

cognitive behavioral therapy

medications for target symptoms (antidepressents, anticonvulsants for mood & rage, clonidine for ANS arousal, antipsychotics)

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phenomena that occurs in response to repeated trauma

leads to emotional numbing, disruption of integrating functions (e.g. memory, identity...), and disturbance

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dissociation

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treatment for dissociative disorders

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psychotherapy

little evidence that medication helps

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sudden, unexpected purposeful travel away from home

inability to recall some or all of one's past

confusion about identity

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dissociative fugue

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two or more of the following:

distinct identities/personalities
recurrently take control of behavior
inability to recall important information

onset in late adolescence or 3rd decade of life

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dissociative identity disorder

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Tachycardia, hyperventilation, uneasiness, panic, worry, apprehension, and avoidance or compulsivity are all manifestations of?

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ANXIETY

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Etiology of Anxiety

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1.genetic (emotional reactivity and CNS function)

2.dysfunctional thinking pattern - anxiety in response to innocuous events (e.g. overestimations - my plane will crash)

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Patient is afraid to use a public bathroom, what type of anxiety disorder is this?

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Socail phobia

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Whenever the patient sees blood they have immediate extreme anxiety and may even faint, what type of anxiety disorder is this?

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Specific phobia

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Possible etiologies for OCD?

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typically no idendifiable neuorolgical perecipitnat

Developmental abnormality in the CNS

PANDAS (physcological autoimmune disorder associated w/ group A beta strep)