3320 anxiety, obsessive-convulsive, and related disorders

anxiety

emotional response, doesn't dissipate when stressor is no longer there

fear

cognitive response

mild anxiety

occurs in everyday life, perceive reality in sharp focus, effective problem-solving, motivating, education best when calm

moderate anxiety

perceptual field narrows, about to perceive less, thinking is hampered, physiological symptoms

severe anxiety

perceptual field greatly reduced, increased somatic symptoms

panic

most extreme, unable to process, may lose touch with reality

anxiety epidemiology

most common psychiatric illness, results in functional impairment and distress F:M 2:1, familial pattern (genetics, anxiety prenatal, how they were raised)

NTs involved in anxiety

decreased 5HT and GABA

increased NE

panic disorder

unpredictable onset, recurrent panic attacks, intense apprehension/fear/terror, accompanied by feelings of impending doom and physical discomfort, can happen weekly/monthly, possibly accompanied by agoraphobia

physiological symptoms of panic

sweating, tachycardia, SOB, trembling, nausea, chest pain, choking feeling, paresthesia, derealization, depersonalization

generalized anxiety disorder

persistent unrealistic excessive anxiety/worry

GAD criteria

occurs more days than not for >6mo, impairs social/occupational/other areas of functioning

GAD associated symptoms

HTN, tachycardia, exhaustion/fatigue, muscle tension, feeling on edge, trouble falling asleep, depressive symptoms (negative self-talk, ruminations), overprepare or procrastinate

anxiety disorder due to another medical condition/medication

cardiac and endocrine conditions, CHF, COPD, intoxication (CNS stimulants), withdrawal (opioids, alcohol, benzodiazepines)

anxiety interventions

co-regulation, calm nonthreatening manner, reassurance of safety, low stimuli, explore reasons for anxiety, teach symptoms of escalating anxiety and ways to interrupt progression, recognize triggers

fear interventions

explore perception of threat, discuss reality of situation and what can/cannot be controlled

treatment modalities

individual psychotherapy, cognitive therapy, behavior therapy, flooding (exposure, may cause panic)

OCD obsessions

recurrent intrusive thoughts, stressful, person realizes they are irrational, cause anxiety

OCD compulsions

actions/rituals to decrease anxiety from obsession, fear that something bad will happen if they don’t do action/ritual

OCD interventions

determine situations that increase anxiety and result in ritualistic behaviors, meet dependency needs, provide structured schedule to gradually limit time for rituals, positive reinforcement for nonritualistic behaviors, explain ways of interrupting obsessive thoughts

body dysmorphic disorder

exaggerated belief that body is deformed or defective in specific way, imagined or slight flaws, unrealistic

different from somatic delusion (fixed false belief about body)

body dysmorphic disorder interventions

establish trust, correct inaccurate perceptions in a matter of fact and nonthreatening manner, withdraw attention when preoccupation with distorted image persists, positive reinforcement for client’s expressions of realistic bodily perceptions

trichotillomania

recurrent pulling out of hair (eyebrows, eyelashes, scalp, arms), preceded by increasing tension, results in release or gratification from pulling hair, usually begins in childhood

trichotillomania interventions

support efforts to stop behavior, awareness training, competing response training, stress management techniques

hoarding disorder

persistent difficulties discarding/parting with possessions regardless of value, excessive need for acquiring items

M>F, more severe with age

hoarding disorder associated symptoms

perfectionism, indecisiveness, anxiety, depression, difficulty planning tasks

hoarding disorder interventions

change has to be slow, person must feel like they are in control

sanitation is a priority

treatment modalities

individual psychotherapy, cognitive therapy, behavior therapy, flooding (exposure, may cause panic)

benzodiazepines- alprazolam, lorazepam, diazepam, clorazepate

short-term use, intermittently used to prevent dependence and tolerance

withdrawal is life-threatening, causes worse anxiety

buspirone- Buspar

works on 5HT receptors, taken bid or tid

tricyclic antidepressants- clomipramine

especially effective drug for OCD

SSRIs- sertraline, paroxetine, fluoxetine, fluvoxamine, escitalopram, citalopram

gold standard drugs for anxiety

SNRIs

duloxetine, venlafaxine

beta blockers- propranolol

used to treat/prevent physiological symptoms

centrally acting bp meds- clonidine

used to treat/prevent physiological symptoms in pediatrics

hydroxyzine PRN

can be used long-term, does not cause tolerance or dependence