MH&W Test 2 - Anxiety Disorders and PTSD

when is anxiety considered an illness

when pt is overwhelmed to point that daily functioning is impaired

pairing of a stimulus that evokes a response with a neutral environmental object or event. repeated pairing of two stimuli would lead to ability of conditioned stimulus to elicit same response as unconditioned stimulus. this type of conditioning is

classical conditioning apart of the learning theory

views stimuli as series of either positive or negative events that influence behavior. there is both positive and negative reinforcement, where positive is a particular behavior that results in a reward and negative is where a certain behavior results in a bad event.

operant conditioning apart of the learning theory

this dz is more common in women than in en. its a panic related phenomenon like isolated panic attacks, limited sx attacks. Can be apparent in childhood and misdiagnosed as a conduct disorder

Panic disorder

what anxiety disorder has the strongest family linked history

panic disorder

pt has recurrent, spontaneous, unexpected anxiety attacks with rapid onset and short duration. Pt thinks that bc they feel like this that they’re having an MI or CVA. pt needs at least 4 of the following sx: SOB, tachypnea, tachycardia, tremor, dizziness, hot/cold sensations, chest discomfort. rapid onset of sx and max severity lasts about 10 mins. this d/o is

panic d/o

panic attacks can last for how long

10 minutes with quick onset

what can happen if panic attacks are left untreated

pt won’t want to leave their house in fear of having a panic attack outside of their home, leading to agoraphobia

pt notices that certain situations cause them panic so they avoid those situations. they find safe places like their home or with safe people like a spouse or parent.

agoraphobia

if you give a pt with panic d/o OR with a + FHx CO2 what happens

they have greater anxiety responses than in people with no hx

what makes panic disorder different than other disorders

spontaneous panic attacks

how to tx panic disorder

mild = psychotherapy. if functional impairment (agoraphobic, MD/personality d/o, suicidal, pt wants) = meds like TCAs (imipramine amitriptyline, clomipramine, rarely used), MAOIs like phenelzine (rarely used bc causes HTN), SSRIs/SNRIs (paroxetine, sertraline, venlafaxine, STANDARD), low dose benzos (alprazolam and clonazepam. also CBT, pts see relationship b/w thoughts and anxiety they produce and realize the relationship b/w in/external cues and their anxiety

benzos to tx panic disorder should be avoided in pts with what h/o

alc/drug abuse

pt has an intense irrational fear to a certain object or situation other than a social situation. ex are animals/insects, natural environment, blood or infection, or situations like heights, flying, roller coasters. this d/o is

specific phobia

this d/o is characterized by extreme anxiety i\n response to situations where the person can be seen by others. fear they will act in an embarrassing or humiliating way. social situations are avoided or endured with a lot of anxiety.

social phobia

what makes phobic disorder different than other diseases

restricted to a certain object or situation.

how to tx phobic d/o

psychotherapy, benzos to reduce anxiety, BB like propranolol can be used to reduce autonomic hyperarousal. antidepressants like SSRIs 

what is the treatment of choice for phobic d/o

behavioral or CBT psychotherapy. relaxation training, visualizing phobias to desensitize thru exposure.

complications of phobic d/o

occasionally disabling, behavioral tx can produce anxiety but yield results

this disorder is slightly more common in women, usually chronic. seen more in general medical practice than in psychiatry practice. constant worry of variable severity across time. also can get MDD

GAD

pt has constant worry with hyperarousal. they are restless, wound-up, easily fatigued, can’t concentrate, irritable, has muscle tension, hard to control feelings of worry. this dz is

GAD

how to tx GAD

benzos, used for sx control not to cure

adverse effects of benzodiazepines

daytime sedation, ataxia, accident prone, memory bad

what drug can be abused to counteract adverse effects of psychostimulants like cocaine, augment euphoric effects of other sedatives like alcohol, OR self medicate alcohol withdrawal. pts can get a physiologic dependence

benzos

pt has just been given an SSRI but they still have really bad sx. what else do you give them short term to hold them off until the effects of the SSRI kick in?

benzos

this drug is really similar to benzos. its a 5-HT1A partial agonist and anxiolytic. it doesn’t cause any motor, memory, or concentration imapirments, as well as no abuse potential, dependency or withdrawal from it. its an ideal anxiolytic but it takes 3 wks to show its effects. what is the drug

buspirone

what other meds besides buspirone can you take for GAD

TCA like imipramine, SNRI like venlafaxine. BB like clonidine. antipsychotics dec anxiety but cause TD which is bad. if you’re going to switch meds wait 2 weeks to avoid serotonin syndrome

how does psychotherapy help GAD

behavioral therapy to teach muscle relaxation, CBT to break down self distortions and misinterpretations of events. 

complications of GAD are

co morbid with MD, personality disorder, or other anxiety d/o like OCD and panic d/o. always look for other co morbid d/o when a pt has GAD

pt has a hx of trauma like sexual assault, mass political conflict, displacement, military combat, physical injury. pts may also have dissociative sx like depersonalization and derealization these pts see a traumatic situation of threatening or out of their control, which develops trauma related psychopathology then creating fear structures. you can also link amygdala hyperactivity and dorsal anterior cingulate cortex with inc fear response leading to this dz.

PTSD

what are some things that can protect you against PTSD episodes

optimism, humor, social support, active coping style. openness to change and extraversion allows for growth after a traumatic event.

must have exposure to a real or threatened death, injury, or sexual violence in one or more of the following ways: direct exposure, witnessing trauma, learning about a close person being exposure, indirect exposure to distressing details of traumatic event. this is NOT including exposure thru digital media

criterion A to diagnose PTSD

criterion a for ptsd is

stressor

presence of one or more sx related to the trauma that happened. recurrent involuntary and intrusive thoughts about it, nightmares that are repetitive, dissociative reactions like flashbacks, intense or prolonged psychological distress, marked physioloigcal reactivity.

criterion B to diagnose ptsd

criterion b for ptsd is

intrusion sx

avoiding distressing memories/thoughts, avoiding external reminders like people, places, activities, conversations, situations. this criterion for ptsd is

C

criterion c for PTSD is

avoidance

negative alterations in mood that began or worsened after the event plus 2 or more of the following. inability to recall important aspects of the event, constant distorted negative beliefs/expectations about oneself/world, constant distorted cognition leading to self blame, constant negative emotional state, dec interest in activities that were enjoyable before, alienated, can’t be positive. this criterion for ptsd is

D

criterion D for ptsd is

negative alterations in mood

criterion E of ptsd is

alterations in arousal and reactivity

trauma related changes in reactivity and arousal beginning or worsening after event shown by 2 or more of following. irritable or aggressive outbursts, reckless behavior, hypervigilance, exaggerated startle response, can’t focus, can’t sleep. this criterion of ptsd is

E

criterion F of ptsd is

Duration. B, C, D and E sx for more than 1 month.

criterion G of ptsd

disturbance causes functional impairment or distress in social occupational etc. life

criterion h of ptsd

disturbance isn’t bc of substances/meds or another mental illness.

this specification of PTSD is that the full criteria not satisfied until 6 months later from trauma. highest in military members.

delayed expression PTSD

this specification of PTSD is more in childhood or adult sexual assault. higher rates of functional impairment, psych comorbidities and suicidality

dissociative sx PTSD

how to tx PTSD without meds

eye movement desensitization and reprocessing therapy (EMDR) used to process and access unresolved trauma. eye movements can be voluntarily adjusted while thinking about a bad memory to then reduce the anxiety connect ed to it. EMDR is shown to desensitize traumatic memories.

how to tx PTSD with meds

SSRIs like sertraline and paroxetine. if bad sleep then prazosin or clonidine. quetiapine for military vets