Anxiety
Name & Define 3 Phobia Disorders
A phobia is a persistent, intensely felt, and irrational fear of a specific object, activity, or situation that results in a compelling desire to avoid the feared stimulus.
1. Agoraphobia: Fear of being in places or situations from which escape might be difficult or in which help might not be available in the event.
Ex- Fear of using public transportation.
2. Social anxiety disorder (social phobia): Excessive fear of situations in which the affected person might do something embarrassing or be evaluated negatively by others.
Example: Fearful of going to work, class, or any specific event/situation.
3. Specific phobia: Fear of specific objects or situations that could conceivably cause harm, but the person’s reaction to them is excessive and irrational.
Example: Fear of flying, small spaces, animals, public speaking, etc.
Define OCD, and what compulsions are - give examples.
The manifestations of OCD include the presence of obsessions, compulsions, or both, the severity of which is significant enough to cause distress or impairment in social, occupational, or other important areas of functioning. The individual recognizes that the behavior is excessive or unreasonable but is compelled to continue the act.
Common compulsions include hand washing, ordering, checking, praying, counting, and repeating words silently.
What is Acute Stress Disorder, and how does it differ from PTSD?
There are similarities between this and PTSD in terms of precipitating traumatic events and symptomatology, but in ASD, the symptoms are time limited, up to 1 month following the trauma.
If the symptoms last longer than this, the diagnosis would be PTSD.
Dissociative Fugue
Dissociative fugue is characterized by sudden, unexpected travel away from a customary place of daily activities, or by bewildered wandering, with the inability to recall some or all of one’s past. An individual in a fugue state may not be able to recall personal identity and sometimes assumes a new identity.
Anxiolytics
What to rule out when working up anxiety disorders.
Anxiety may be associated with intoxication or withdrawal from any of the following substances:
•Alcohol, sedatives, hypnotics, or anxiolytics
•Amphetamines or cocaine
•Hallucinogens
•Caffeine
•Cannabis
•Others
Medical conditions that may produce anxiety symptoms include:
•Cardiac
•Endocrine
•Respiratory
•Neurological
Name & define 3 OCD related disorders
•Obsessive Compulsive Disorder – intrusive thoughts of unrealistic obsessions and tries to control these thoughts with behaviors
•Hoarding Disorder – difficulty parting with possessions, resulting in extreme stress and functional impairments
•Body Dysmorphic Disorder – preoccupation with perceived flaws or defects in physical appearance
•Hairpulling disorder, or trichotillomania, the recurrent pulling out of one’s hair that results in hair loss. The impulse is preceded by an increasing sense of tension and results in a sense of release or gratification from pulling out the hair.
Define PTSD, and list major characteristic symptoms.
- A reaction to an extreme trauma, which is likely to cause pervasive distress to almost anyone, such as natural or man-made disasters, combat, serious accidents, witnessing the violent death of others, being the victim of torture, terrorism, rape, or other crimes
- A reaction to an extreme trauma, which is likely to cause pervasive distress to almost anyone, such as natural or man-made disasters, combat, serious accidents, witnessing the violent death of others, being the victim of torture, terrorism, rape, or other crimes
- Symptoms may begin within the first 3 months after the trauma, or there may be a delay of several months or even years.
Symptoms include reexperiencing the traumatic event (flashbacks), a sustained high level of anxiety or arousal, a general numbing of responsiveness, intrusive recollections or nightmares. Some may experience amnesia or develop problems with substances or in relationships.
Name & Define three somatic symptom disorders.
- Illness anxiety is an unrealistic or inaccurate interpretation of physical symptoms or sensations, leading to preoccupation and fear of having a serious disease. The fear becomes disabling and persists despite reassurance that no organic pathology can be detected.
- Conversion disorder is a loss of or change in body function that cannot be explained by any known medical condition or mechanism. There is most likely a psychological component involved in the symptoms, though it may or may not be obvious or identifiable.
- Factitious disorders involve conscious, intentional feigning of physical or psychological symptoms. Individuals with factitious disorder pretend to be ill in order to receive emotional care and support commonly. To accomplish this, they may aggravate existing symptoms, induce new ones, or even inflict painful injuries on themselves.
Antihypertensives
--> useful in AS/PTSD
--> useful with panic disorders and generalized anxiety disorder, phobic disorders, ASD & PTSD
Name & define three anxiety disorders
•Separation Anxiety Disorder – excessive fear when separated from an individual to which they are emotionally attached
•Specific Phobias – irrational fear of a certain object and situation
•Agoraphobia – extreme fear of certain places (bridges, outdoors)
•Social anxiety disorder – excessive fear of social or performance situations
•Panic disorder – recurrent panic attacks
•Generalized anxiety disorder (GAD) – uncontrollable excessive worry ongoing for >6 months
Which medications are useful in treating OCD disorders?
SSRI Antidepressants (sertraline, fluoxetine, paroxetine) – first line treatment of anxiety and OCD
Clomipramine (Anafranil) and fluoxetine (Prozac) for body dysmorphic disorder.
Amitriptyline, Chlorpromazine, Olanzepine, Pimozide, Lithium carbonate: hair pulling disorder
What is adjustment disorder?
An adjustment disorder is characterized by a maladaptive reaction to an identifiable stressor or stressors that results in the development of clinically significant emotional or behavioral symptoms. This response occurs within 3 months after onset of the stressor and has persisted for no longer than 6 months after the stressor has ended.
There are six types including: with depressed mood (most common), with anxiety, with mixed anxiety and depressed mood, with disturbance of conduct, with mixed disturbance of emotions and conduct, unspecified.
Dissociative Amnesia Definition & 3 Types
Amnesia is partial or total, permanent or transient loss of memory. The term is often applied to episodes during which patients forget recent events although they may conduct themselves appropriately and after which no memory of the period persists.
Dissociative amnesia is an inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness and is not due to the direct effects of substance use or a neurological or other medical condition.
Localized and selective amnesia are related to a specific stressful event that has occurred.
1. Localized amnesia - individual is unable to recall all incidents associated with a stressful event. It may be broader than just a single event, however, such as being unable to remember months or years of child abuse.
2. Selective amnesia - the individual can recall only certain incidents associated with a stressful event for a specific period after the event.
3. Generalized Amnesia: the individual has amnesia for their identity and total life history. Clients suffering from amnesia are often brought to general hospital emergency departments by police who have found them wandering confusedly around the streets.
Antidepressants
Name 3 therapeutic treatments for anxiety disorders (including OCD)
•Individual psychotherapy
•Cognitive therapy
•Behavior therapy
•Systematic desensitization (treatment for phobias)
•Implosion therapy
•Other nonpharmacological treatments for anxiety (mindfulness, meditation, guided imagery, exercise, etc)
What are the two best medications for OCD treatment?
Drugs that have been used successfully in alleviating the symptoms of OCD are clomipramine and the selective serotonin reuptake inhibitors, which are believed to block the neuronal reuptake of serotonin, thereby allowing for increased serotoninergic activity in the central nervous system.
Name 3 non pharmacological treatments of acute stress disorder and PTSD.
•CBT
•Prolonged exposure therapy
•Psychodynamic psychotherapy
•Eye movement desensitization and reprocessing
•Family or group therapy
•Crisis intervention
•Biofeedback/neurobiofeedback
Dissociative Identity Disorder
Dissociative identity disorder (DID) was formerly called multiple personality disorder. This disorder is characterized by the existence of two or more personalities in a single individual. These different personality states are sometimes referred to as alter identities. Only one of the personalities is evident at any given moment, and one of them is dominant most of the time over the course of the disorder. Transition from one personality state to another may be sudden or gradual and can be dramatic - often precipitated by stress.
Treatments for Dissociative Disorders
•Individual psychotherapy
•Hypnosis
•Supportive care
•Cognitive behavioral therapy
•Psychoeducation
•Group therapy
•Integration therapy (dissociative identity disorder)
•Psychopharmacology
•Reattribution treatment
Medications for anxiety disorders
SSRI Antidepressants (sertraline, fluoxetine, paroxetine) – first line treatment of anxiety and OCD
SNRI Antidepressants (venlafaxine, duloxetine): anxiety disorders
Mirtazepine (norepeniphrine and serotonin specific antidepressant – tetracyclic antidepressant): ASD & PTSD
Benzodiazepines - alprazolam, lorazepam, diazepam, and clonazepam: Panic disorder - PRN ideally
Buspirone: Anxiety disorders
Hydroxyzine: Anxiety disorders
Anticonvulsants (gabapentin): Anxiety disorders
What are some common compulsions manifested in clients with OCD?
Common compulsions include hand washing, ordering, checking, praying, counting, and repeating words silently.
Name three ways PTSD symptoms be prevented.
•During the incident, be aware of need for breaks, rest, adequate water, and nutrition.
•Provide emotional support for those involved in the incident.
•Encourage staff to support one another.
•Debrief with others following the incident.
•Encourage expression of feeling by all involved.
•Use offered counseling services.
Trauma informed care involves care management that regards the impact of trauma for the client, and addresses emotional, psychological, and physiological needs.
Depersonalization - Derealization Disorder
Depersonalization-derealization disorder is characterized by a temporary change in the quality of self-awareness, which often takes the form of feelings of unreality, changes in body image, feelings of detachment from the environment, or a sense of observing oneself from outside the body.
•Depersonalization is defined as a disturbance in the perception of oneself.
•Derealization is described as an alteration in the perception of the external environment.
Treatments for Somatic Disorders
•Individual psychotherapy
•Group psychotherapy
•Cognitive behavior therapy and psychoeducation
•Psychopharmacology
•Reattribution Treatment
•Medication treatment is not effective unless it is being used to treat underlying depression or anxiety. When antidepressant therapy is warranted, selective serotonin reuptake inhibitors are generally preferred. Anxiety may be treated in the short term with antianxiety agents such as benzodiazepines, but long-term use should be avoided because of the potential for addiction.