Chap 10 - Anxiety

Qs

How can you distinguish hyperthyroidism from GAD?

• Persistent tachycardia

• Heat intolerance

How is medical PTSD different that rape?

• Threat arises from ones own body

• Instead of memory of the past, there is fear of recurrence

What endocrine and metabolic d/o can cause anxiety?

Endocrine

• Hyperthyroidism

• Hypoglycemia

• Hyperadrenalism

• Pheochromocytoma

Metabolic

• Hypercalcemia

What type of psychotherapies show benefit in treating anxiety in medically ill?

Supportive: Listen and provide reassurance and education. Therapist promote adaptive defense and only challenge clearly maladaptive defenses. Involving patient’s social and religious support.

CBT: Used to uncover misinterpretations and irrational thoughts that cause anxiety. (Include mindfullness)

Psychodynamic: Gains understanding from patient’s history, interpersonal dynamics, defense mechanism - this help to find healthier coping mechanism.

What changed in new DSM for somatic symptoms disorder and illness anxiety disorder?

Somatic symptoms d/o

• Only needs one bodily compliant

• No longer needs symptoms to be medically unexplained

• Inclusion of positive psychosocial behavior

Illness anxiety disorder

• Replaced hypochondriasis

What is pseudologica Fantastica?

• Pathological lying that portrays the storyteller as grandiose or victim

• Seen in Factious disorder

• Usually hx of cognitive dysfunction, learning disabilities, childhood trauma

Whats the difference between common factious and classic munchausen syndrome?

• Use of alias and travel from hospital to hospital (Peregrinating behavior) This is present in classic Munchausen

• Common factitious - single women, 30s, cluster B traits

• Classic munchausen - single, male, 40s, cluster B + antisocial personality traits

How best to identify Munchausen by proxy?

• Child improves when separated from parent

• Parents has 1) sign of Munchausen syndrome 2) Own psych hx, 3) hx of child abuse and 4) hx of signing child AMA or transferring hospital against medical advice