Final: Anxiety + OCD

levels of anxiety

mild: enhances perception, effective problem solving

moderate: perception narrows, selective attention

severe: reduced perceptions, inability to problem solve, confusion, behavior aimed at reduction

panic: completely unable to process info, behavior erratic + impulsive, can have hallucinations/delusions

symptoms of anxiety

• tachycardia

• shallow breathing/SOB

• muscle tension

• sweating

• dizzy

• n/v

• difficulty concentrating

• easily startled

• hypervigilant

• pit in stomach

parts of brain impacted

• amygdala: fear

• hippocampus: memory

• thalamus: sensory input

• hypothalamus: stress response

• brain stem: RR and HR

• frontal cortex: cognition (decreases as it gets worse)

generalized anxiety disorder (GAD)

• definitions and criteria

• excessive anxiety and worry

• more days than not for 6 months

• 3 or more:

  • restless

  • easily fatigued

  • difficulty concentrating

  • irritability

  • muscle tension

  • sleep disturbances

• most common + likely to be chronic

seperation anxiety

• inappropriate concern over being separated with significant persons (caregivers)

  • fear of permanent separation

  • mot common in children

social anxiety

• excessive fear of embarrassment and humiliation, wont go in public dt (think everyone looking and judging)

• avoid situations or endure which causes panic

• chronic social isolation

panic disorder

• definition and criteria

• recurrent, unexpected panic attacks, 4 or more of:

  • palpitations, increased HR, sweating, trembling/shivering, SOB, feeling of choking CP, nausea/GI distress, dizzy/lightheaded, chill or hot flash, numbness/tingling, derealization/depersonalization, fear of losing control/going crazy, fear of dying

• at least 1 panic attack followed by 1 month of:

  • persistent worry about additional panic attacks

  • significant change in behavior as result

• feeling impending doom in situations that are not dangerous

• can happen for many reasons and out of nowhere

agoraphobia

• intense, excessive fear/anxiety about being in situations/places for which there is no escape or help accessible

• avoidance of places/situations to manage anxiety (stay home)

  • fear of panic attack/losing control

phobias

• persistent, irrational fear of objects or situations

• recognize irrational

• causes anxiety, panic attacks

• leads to avoidance

assessment

• substance use and other medical cause

• insight, mood

• symptom reduction and strategies used

• safety

interventions

• patience

• Assist in identifying other anxiety-reducing techniques

• small changes/goals

• panic: SAFTEY

  • direct, simple statements

  • talk softly

  • present focus

obsessive compulsive disorder

• recurrent persistent thoughts, urges, or images that are intrusive or unwanted and cause anxiety + distress (think evil person)

• attempts to ignore/suppress by some other thought or action

  • repetitive behavior or mental act

  • aimed at reducing anxiety, may not be connected in rational way

  • attempts to dismiss unsuccessful

  • compulsions are temporarily relief

body dysmorphic disorder

• obsessional thinking: behavioral compulsions

• may or may not have insight

• poor response to tx

• preoccupation w/ imagined defective body part

• may have a lot of plastic surgery (can make worse)

hoarding disorder

• accumulation and inability to part w/ objects w/ little to no value

• idea of parting causes extreme anxiety

• tends to exacerbate with age

trichotillomania disorder

• compulsive removal of body hair

  • including eyelashes and eyebrows

• pain decreases anxiety

excoriation disorder

• compulsive picking at skin (altered appearance)

• co-occurig OCD or trichotillomania

therapy

• CBT

• behavioral: goal to desensitize them

  • modeling

  • systematic desensitization

  • flooding

  • thought stopping

pharmacology

• benzo’s

  • increase GABA

  • short term

• non-benzo’s:

  • anti-depressants

  • alpha agonist

  • buspirone

  • B blockers

  • anticonvulsants

  • antihistamines

  • antipsychotics