Hehi Test #2 - Anxiety Disorders

Front 1

Biological Findings for Anxiety and Panic disorders

Back 1

Associated with epinephrine, NE, dopamine, serotonin, and GABA

Benzodiazepine receptors are linked to a receptor for inhibiting the neurotransmitter GABA, binding on these sites facilitates the release of GABA (GABA calms)

Front 2

Biological findings for phobias

Back 2

increased epinephrine

Front 3

Biological findings for OCD

Back 3

orbitofrontallimbic-basal ganglia circuit dysfunction; decreased serotonin

Front 4

Biological findings for PTSD

Back 4

reduced hippocampus

physical, sexual, or psychological abuse is associated with damaging effects to the brain.

Front 5

Behavioral/ Learning Theory

Back 5

All behaviors including anxiety are learned

Front 6

Cognitive Theory

Back 6

Anxiety is the result of distorted or faulty thinking patterns

Front 7

Diagnostic criteria for Panic disorder (distinguish between 'panic disorder with agoraphobia' and 'panic disorder without agoraphobia')

Back 7

a. recurrent episodes of panic atakcs
b. at least one of the attacks has been followed by one month (or more) or the following:
1. Persistent concern about having additional attacks
2. Worry about consequences of another attack
3. Significant change in behavior

Front 8

Diagnostic criteria for Phobia

Back 8

1. Irrational fear of an object or situation that persists although the person may recognize it as unreasonable

Front 9

Agoraphobia

Back 9

fear of being alone inopen o public places where escape might be difficult - may not leave home

Front 10

Social phobia

Back 10

Fear of situations where one might be seen and embarrassed or criticized; speakcing to authority figures, public speaking, or performing

Front 11

Specific Phobia

Back 11

Fear of a single object, activity, or situation (snakes, closed spaces, flying)

*Anxiety is severe if the object, situation, or activity cannot be avoided.

Front 12

Diagnostic criteria for Obsessive Compulsive Disorder

Back 12

Either obsessions or compulsions
A. repoccupation with persistent intrusive thoughts, impulses, or images (obsession)
B. Repetitive behaviors or mental acts that athe person jeels driven to perform in order to reduce distress or prevent a dreaded event or situation (compulsion).

2. Person knows the obsessions/ compulsions are excessice and unreasonable.
3. The obsession/ compulsion can cause increased distress and is time consuming

Front 13

Diagnostic Criteria for Generalized Anxiety Disorder

Back 13

1. A. Excessive anxiety or worry more day than not over 6 months
B. Cannot control the worrying

2. Anxiety and worry associated with 3 or more of:
A. restlessness
B. easily fatigued
C. Difficulty concentrating, mond goes blank
D. Irritability
E. Muscle tension
F. Sleep dsturbance

3. Anxiety or worry of physical symptoms cause significant impairment in social, occupational, or other areas of important functioning.

Front 14

Physical Effects of Anxiety - sympathetic activation

Back 14

1. Sweating
2. Chest pain
3. Dizziness
4. Decreased sex drive
5. Irritability
6. Increased muscle tension
7. Rapid breathing and breathlessness
8. Heart palpitations
9. Increased blood pressure
10. Nausea/ Diarrhea

Front 15

Therapeutic Management: Behavioral Therapies

Back 15

1. Systematic Desensitization
2. Flooding
3. Aversion Therapy - sidetracking
4. Thought Stopping
5. Structure and routine
6. Relaxation training
7. Modeling techniques
8. Positive reinforcement

Front 16

Define Obsession

Back 16

Thoughts, impulses, or images that persist and recur, so that they cannot be dismissed from he mind.

Front 17

Define Compulsion

Back 17

Ritualistic behaviors that an individual feels driven to perform in an attempts to reduce anxiety.

Front 18

What are some common obsessions/ compulsions?

Back 18

1. Doubt/ need to check
2. Sexual imagery or ideation
3. Need for order
4. Violence
5. Germs/dirt
6. Illness or death
7. Counting
8. Touching
9. Washing or cleaning
10. Avoidance
11. Doing or undoing
12. Symmetry

Front 19

Therapeutic Management: Cognitive Approaches

Back 19

1. journal keeping
2. Priority restructuring
3. Cognitive reframeing
4. Assertiveness training

Front 20

What are some medical conditions that could cause symptoms similar to an anxiety disorder?

Back 20

1. pheochromocytoma - tumor within the endocrine system
2. pulmonary embolism
3. cardiac dysrhythmias
4. COPD
5. Mitral Valve prolase - presents just like a panic attack

Front 21

Therapeutic Management: Lifestyle (self-care)

Back 21

1. Nutrition and fluid intake
2. Hygiene and grooming
3. Elimination
4. Sleep and exercise

Front 22

Pharmacological interventions for Anxiety Disorders

Back 22

1. Benzodiazepines
2. Tricyclic Antidepressants (TCA)
3. Selective Serotonin Reuptake Inhibitors (SSRI)
4. Buspirone
5. Others

Front 23

Benzodiazepine

Back 23

Used in treatment of anxiety

Advantages: Rapid, few cardiac effects, cheap

Disadvantages: side effects, abuse potential (only used short term)

Front 24

Tricyclic Antidepressants

Back 24

Used in treatment of panic attacks, phobias, and PTSD

Advantages: single dosing, antidepresant

Disadvantages: delayed onset, anticholinergic effects - SLUD, decreased heart rate

Front 25

Selective Serotonin Re-uptake Inhibitors

Back 25

Used in treatment of OCD, panic, agoraphobia, GAD, mixed anxiety and depression

Advantages: single dosing, antidepressnat

Disadvantages: delayed onset, insomnia/ irritability

Front 26

Buspirone

Back 26

Used in treatment of anxiety

Advantages: no dependence, few side effects, no sedation, slow onset

Disadvantages: cost

Front 27

DSM-IV-TR criteria for all anxiety disorders

Back 27

1. Prominent: anxiety, panic attacks, or obsessions/ compulsions
2. Not directly due to medical condition
3. Not exclusive to delirium episode
4. Not better accounted for by another mental disorder
5.SIGNIFICANT distress or impairment

Front 28

Panic Disorder

Back 28

* 50% develop before age 24
* Twice as many women than men
* Comorbidity with depression and substance abuse - 30% abuse ETOH, 17% abuse cocaine, marijuana and other
* 1/3 develop agorophobia
* Decreased NE, decreased GABA

Front 29

Treatment of choice for Panic Disorder

Back 29

1. Cognitive-Behavioral therapy - sytematic desensitization and thought stopping
2. Decrease anxiety - relaxation
3. TCA (possibly with short-acting bezo- combo) or SSRI
4. MAOI

Front 30

Phobias

Back 30

* Affects twice as many women than men
* Higher propotion of men seek help
* Onset in childhood and adolescence - rarely after age 25
* Comorbid with depression (upto 25%) substance abuse in this population

Front 31

Social Phobias

Back 31

1. Speaking in public
2. Eating in front of others
3. Using a public bathroom
4. Writing in front of others
5. Answering questions

Front 32

Specific Phobia Criteria

Back 32

1. A marked and persistent fear that is excessive or unreasonable, that is cued by a specific object or situation
2. Exposure to the phobic stimulus almost invariably provokes immediate anxiety response
3. The object or situation is avoided or endured with intense anxiety

Front 33

Treatments for specific phobias

Back 33

In addition to basic anxiety reducing interventions
1. Systematic desensitization
2. Flooding
3. PRN beta blockers (specific: social)
4. SSRI's

Front 34

Obsessive Compulsive Disorder

Back 34

* 10-30% of population
* Men and women effected equally
* One of the top 10 leading causes of diability in established marker economies worldwide
* Up tp 67% have comorbid depression
*increased serotonin
*Decreased size caudate
*basal ganglia and cingulum

Front 35

OCD treatment

Back 35

1. Behavioral therapy
2. Pharmacological: Luvox (fluvoxamine) - SSRI
3. TCA's: anafranil, Imipramine
4. Surgical - rare, cingulotomy

Front 36

Generalized Anxiety Disorder Treatment

Back 36

1. Cognitvie-Behavioral therapy
2. Cognitive reframing
3. Stress management
4. Lifestyle modification
5. Support groups
6. Buspirone
7. Valium (diazepam)
8. TCA's (impipramine)
9. SSRI's

Front 37

Post-Traumatic Stress Disorder

Back 37

* More likely in women
* Can develop in childhood
* 30% of combat veterans
* Persons sujected to: natural and man-made disasters, violence, and terrorism
*Comorbid diagnosis - depression, sustance abuse, other anxiety disorders
*Can be prevented through crisis intervention

Front 38

Risk factors for developing PTSD

Back 38

1. Very young/ very old
2. Assault/ witness to assault
3. History of abuse
4. Sustance abuse (or other poor coping strategies)
5. Pre-existing emotional/ behavioral difficulties

Front 39

Diagnostic Indicators and Symptoms of PTSD

Back 39

PERSISTENT:
1. re-experiencing of trauma
2. Avoidance
3. Numbing of responsiveness
4. Symptoms of increased arousal

Front 40

PTSD long-term interventions

Back 40

1. Grief therapy
2. Support groups
3. Cognitive-Behavioral combination
4. TCA's and MAOI's = most helpful
5. SSRI's (last choice)
6. Benzo's not recommended because of risk of dependency