Anxiety disorders
Terms
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- Types of anxiety disorders
-
Panic Disorder (with or w-out agoraphobia)
Specific phobia
Social phobia
GAD d/o
OCD d/o
Acute Stress d/o
PTSD
Anxiety due to medical condition
Substance-induced anxiety d/o
Somatoform d/o
? Eating d/o’s
? Hypochondriasis
? Body dysmorphic d/o - Anxiety
- Heightened arousal accompanied by apprehension, fear, obsessions or the like.
- Normal fears
- = appropriate emotional reactions to real, external threats
- Anxiety d/o
- occur without obvious external threat, or the response is excessive, and cause impairment.
- % of pop that will have anxiety disorder
- 15% - most common psychiatric d/o
- % of people w/ anxiety disorder that have comorbit depressive d/o
- 40%
- Panic d/o Criteria
-
Recurrent, unexpected panic attacks
At least 1 attack is followed by 1 month of 1 or more;
-Persistent concerns about having additional attacks
-Worry over consequences of the attack
-A change in behavior related to attack
With or without Agoraphobia
Attacks not due to med condition
Not better accounted for by other psych condition - Panic attack s/s
-
not a diagnosis = symptom complex
= discrete period of
intense fear or discomfort
develops abruptly, peaks within 10 min. With the following 4 or more s/s:
Palpitation
Sweating
Sensation of SOB, smothering
Choking
CP
Dizzy
Fear of dying
Derealization
Fear of going crazy or losing control
Numbness chills or hot flashes - A panic attack is considered an anxiety d/o T/F
- F--symptom complex
-
Which of the following are not considered panic symptoms?
Palp
Agoraphobia
Sweating
Fear of dying
All of the above are panic symptoms - agoraphobia
- Agora(phobia)
-
Anxiety about being in places or situation from which escape might be difficult (or embarrassing) or in which help may not be available in the event of a panic attack.
These situations are avoided or endured w marked distress (triggers)
This phobic avoidance is not due to another MI
Phobic avoidance is promoted by anticipatory anx. -
Panic
what percent of pop.?
m/f ratio?
mean age of onset? -
1-3%
1:2
20 - Specific phobia
- intense, irrational fear or aversion to a particular object or situation
- Specific Phobia criteria
-
Exposure to stimulus = immediate anxiety response
Person recognizes fear is excessive / unreasonable
Object / situation is avoided or endured
Behavior interferes w functioning
> 6 months
Not due to another MI - Social Phobia criteria
-
Marked, persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others
Exposure to feared situation provokes anxiety
Person recognizes fear excessive or unreasonable
Situation is avoided
Impairment in func
> 6 months
Not due to med condition or substance - what is the most common psych disorder
- specific phobia
- percent of people with social phobia
- ~3%
-
onset of phobia d/o?
duration?
cause -
early childhood
chronic
may be traumatic experience - Social phobia
- extreme anxiety response in situations in which the affected person may be observed by others, fear they will act in embarrassing or humiliating way
- GAD criteria
-
Excessive anxiety and worry more days than not > 6 months
Person finds it difficult to control the worry
Assc w >3;
-Restlessness, easily fatigued, poor conc, irritability, mm tension, sleep disturbance -
GAD
onset
gender
course
co-morbidity -
early adult
female more than male
chronic - pt's often resist treatment
often depression -
Pt do not recognize themselves as having a psychiatric disorder even in the face of disability
T/F - T
- PTSD
-
Exposed to traumatic event
Traumatic event is persistently re-experienced
Persistent avoidance
Persistent symptoms of inc arousal
Duration > 1 month
Significant impairment in functioning - Acute Stress d/o
- like PTSD but less than a month (>days<4 wks)
- OCD
-
Either obsessions or compulsions
Defined by
- Recurrent and persistent thoughts, impulses or images experienced as intrusive and inappropriate and cause marked anxiety or distress - Compulsions
-
Repetitive behaviors(hand washing, ordering, checking) or mental acts ( praying, counting, repeating wok silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly in order to avoid a dreaded consequence
The obs or comp cause marked distress, are time consuming (takes > 1 hour/day) or significantly interfere w the person’s normal routine, occupation or usual social activities - OCD w poor insight
- pt does not recognize that the ob or comp are excessive or unreasonable)
- OCPD
-
Pervasive pattern of preoccupation w orderliness, perfectionism and mental / interpersonal control at the expense of flexibility, openness and efficiency, beginning by early adulthood and present in a variety of contexts, indicated by 4 or more of;
Preoccupation w details, rules, lists, order organization or schedules to the extent that the major point of the activity is lost.
Shows perfectionism that interferes w task completion (unable to complete project because own overly strict standards are not met)
Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships
Is overly conscientious, scrupulous and inflexible about matters of morality, ethics or values
Unable to discard worn out or worthless objects even w no sentimental value
Reluctant to delegate tasks/work unless they submit to exactly his/her way of doing things
Adopts a miserly spending style, money is to be horded for future catastrophes
Shows rigidity and stubbornness - Obsessions
-
Unwanted aversive cognitive experiences usually assoc w feelings of dread
Recognized (at some point) that they are inapp in relation to reality
Pt will attempt to ignore or suppress them - Compulsions;
- Overt behaviors or covert mental acts, performed to reduce in intensity of the aversive obcesssions
-
percent of pop. w/ OCD
males vs. females
% onset before 25 -
2-3%
2:1
66% - etiology of OCD
- disfunction of basal ganglia