anxiety disorders

anxiety disorders

• feelings of the core of one’s personalities threatened when there is no actual danger. 

• mild, moderate, severe, panic

• most common of all psychiatric illnesses

• more common in women than men

psychosomatization

physiologic expression of anxiety

Neurobiologic theories of anxiety disorders

• runs in the family

• genetic mutation w development of OCD

• body’s ability to regulate serotonin and GABA

• hippocampus

  • processing threatening stimuli and encoding information into memories. 

• locus coeruleus

  • initiates responses to danger- could be overactive for PTSD

panic

• intense apprehension, terror without any real threat accompanied with somatic or cognitive symptoms

• over response to stressors

• incorrectly perceive circumstances

• can feel depersonalized, derealization

• chest pain, choking, dizziness, sweating, vertigo, fainting, hot and cold flashes, fear of dying, going crazy

• attack lasts 10-30 min, or up to 1 hr

panic disorder

• recurrent panic attacks

• onset is unpredictable

• manifested by intense apprehension, fear, or terror

• feelings of impending doom and accompanied by intense physical discomfort. 

agoraphobia

• same symptoms of panic disorder, but with additional fear

• fear of being in places or situations from which escape might be difficult or embarrassing or in which help might not be available in the event of a panic attack

• diminishes quality of life and leads to depression. 

generalized anxiety disorder

• chronic, unrealistic, and excessive anxiety and worry for at least 6 months

• interferes with ADLs and relationships

• s/s of muscle tension, autonomic hyperactivity, apprehension

• feeling “on edge”

• unable to concentrate, chronic fatigue, impaired sleep patterns, depression

phobia

• persistent irrational fear attached to an object or situation that objectively does not pose a danger. 

• always anticipated and never unexpected. 

• may be simple and specific to certain situations, events, objects

• when accompanied with panic attacks- considered a panic disorder

• social phobia

  • compelling fear and desire to avoid situations that involve strangers or scrutiny from others. 

  • fear of speaking in front of others, eating, and using public bathrooms

• examples

  • acro (heights), claustro (closed spaces).

Obsessive-Compulsive Disorder (OCD)

• significant impairment that consumes more than 1 hr a day 

• obsessions

  • recurrent, intrusive, persistent ideas, thoughts, impulses, cognitively invasive

  • seen as repugnant, meaningless thoughts, but remains preoccupied with them. 

• compulsions

  • ritualistic behaviors clients are compelled to perform to prevent/reduce anxiety

  • mild or severe- untreated can lead to depression or suicide.

acute stress disorder

• occurs within the first month of exposure to extreme trauma (combat, rape, physical assault)

• dissociation- state of detachment, dream state, poor memory r/t event

  • dissociative amnesia

• usually resolves within 2-28 days

Post-Traumatic Stress Disorder (PTSD)

• stress symptoms continue for greater than 1 month

• functional impairment of stress

• generalized anxiety, intrusive thoughts, flashbacks, nightmares, sleep disturbances, need to avoid triggers

• after 3 months- considered chronic. 

Cognitive Behavioral Therapy (CBT)

• recognize thoughts that cause anxiety

• gain insight and learn new responses