Panic
1 in _____ ppl develop panic Disorder atg some point in their life
1 in _______ will have a panic attack
25
7
Name the differential dx of Agoraphobia
PTSD
Specific phobia
Social Anxiety Disorder
Specific phobias can develop following a _________ event or a ________ ___________
______ phobia start a childhood or a unique age of onset
True or false
Genetic component to development of a phobia, not necessarily a specific kind of phobia
traumatic or panic attack
Animal
True
Obsessions are not always present ________
Explain why OCD suffers do not seek help?
first
They have insight of their actions and they are embarrassed.
Explain ego-dystonic
it is not in line with the person's value system. The person would not thing of this on their own. it does not come natural to them
True or False
Anxious temperate is more likely to develop panic disorder
Panic disorder tends to occur around stressful
The relapse rate for panic disorder is ______ %
True
True
50%
Social Anxiety DSM 5 TR criteria?
pg 229
A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech).
Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.
B. The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
C.. The social situations almost always provoke fear or anxiety.
Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.
D. The social situations are avoided or endured with intense fear or anxiety.
E.The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.
F.The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
G.The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
H.The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
I.The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.
J. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.
Phobias with blood, injury, illness, needles, tend to present with ________ &__________
bradycardia and hypertension
median age for onset of OCD
rare for it to start after age
19
30
Explain YBOCs
Yale Brown Obsessive Compulsive Scale- Aides in dxing OCD.
start by reading the time occupied obsessive thoughts, how much interference it causes, and distress related, resistance against them, how much control the person thinks they have spent performing the behaviors.
Name the Agoraphobia specifiers
A. Marked fear or anxiety about 2 or more of the 5 situations
1. using public transportation
2. being in open spaces
3. being enclosed
4 standing in line or being in a crowd
5. being outside of the home alone
True or False
Social phobia is more common in women than men
Peak onset for social phobia is?
True
early teen years
What is the pharm treatment for anxiety disorders?
SSRIs citalopram, escitalopram,floxetine, fluvoxamine, paroxetine
SNRIs duloxetine venlafaxine, vilazodones, desvenlafaxine
TCAs
5HT1A- Buspirone
Benzodiazepines- (rescue med) DIAZEPAM, LORAZEPAM, OXAPAM, CHLORDIAZEPOXIDE CLORAZEPATE.
Gaba off label as an adjunct
Path for OCD
1. damage to the corticocortical thalamic circuitry
2. impairments in the reward circuit leading to increased sensitivity to feeling of disgust
3. hyperactivity of the orbital cortex which is thought to focus on reward/punishment values and responses
4. impaired executive fxning
rigidity
excessive habit formation
Cognitive inflexibility
Tx for OCD consist of
Tx is often difficult
***** if above FDA approvals site EBP
40% have poor treatment response with meds and therapy
SSRIs -***FLUVOXEMINE(CYP1A2,CYP3A4,C19) inhibitor) these are just as efficacious, FLUOXETINE,PAROXETINE, SERTRALINE, , citalopram, escitalopram, venlafaxine, vilazodone
TCAs CLOMIPRAZINE
Adjunct Atypicals (**aripiprazole, **haloperidol, risperidone Seroquel,& olanzapine (dopamine receptor against
CBT combined with ,meds
ex. sertraline and Haldol
Agoraphobia DSM 5 TR criteria?
pg 246
A. Marked fear or anxiety about 2 or more of the 5 situations
1. using public transportation
2. being in open spaces
3. being enclosed
4 standing in line or being in a crowd
5. being outside of the home alone
B. Individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic like sxms. or other embarrassing or incapacitating sxms. ( fear of falling in elderly fear of incontinence
C. The agoraphobic situation almost always provokes fear or anxiety
D. Agoraphobic behavior is actively avoided, requires presence of a companion, or endured with intense fear of anxiety
E. fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situation and to the sociocultural context
F. fear or anxiety is persistent last 6 months or more
G. causes distress or impairment in social occupational or other important areas of fxning
H if another medical condition ( IBS, Parkinson's) is present the fear, anxiety, or avoidance is clearly excessive.
I. can not be further explained by sxm of another MH disorder ex. not confirmed to be specific phobia, situational type, do not involve only social situations and are not related to OCD or body morphic disorders, reminders of trauma events or fear of separation
The risk factors of Social anxiety disorder are
True or False
Social Anxiety is linked to increased rates of Suicide
female, shy, childhood, family history (no specific gender link but is expected
True
Rationale: intense anxiety and avoidance about things that are social socialization is typically required in the world. ppl don't get well. vey hopeless condition
Psychological Treatment for Anxiety
CBT
Mindfulness
Exposure therapy
Interpersonal Skills training
**** plus medication
OCD NTS are
Explain Family Hx Component
OCD can be _________ consuming or cause _______ or ___________
5HT& DA, glutamate under investigation
some genetic suspicion
Time, distress and impairment
(not attributed to any other disorders)
Other OCD TX
Neurosurgery
Deep Brain Stimulation for non responder may inhibit corticostriatal thalamic circuitry
Agoraphobia peaks in late ________ and early _______
Agoraphobia usually comorbid with _______ ______ 50% of the time
Agoraphobia usually comorbid with _______ ______ 33-52v% of the time
teens, 20's
panic disorder
depression disorder
Specific Phobia DSM 5 TR criteria
pg 224
A. Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood).
Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, or clinging.
B. The phobic object or situation almost always provokes immediate fear or anxiety.
C. The phobic object or situation is actively avoided or endured with intense fear or anxiety.
D. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context.
****E. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
*****F. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
******G. he disturbance is not better explained by the symptoms of another mental disorder, including fear, anxiety, and avoidance of situations associated with panic-like symptoms or other incapacitating symptoms (as in agoraphobia); objects or situations related to obsessions (as in obsessive-compulsive disorder); reminders of traumatic events (as in posttraumatic stress disorder); separation from home or attachment figures (as in separation anxiety disorder); or social situations (as in social anxiety disorder).
***** consistent in Anxiety disorders
Obsessions are ________ & ________ thoughts
Compulsions are repeated _________ or mental _______ performed in response to obsessions
intrusive & unwanted
behaviors or acts
OCD DSM 5 TR criteria
pg 266
A. Presence of obsessions, compulsions, or both:
Obsessions are defined by (1) and (2):
1.Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
2.The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).
Compulsions are defined by (1) and (2):
1.Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
2.The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.
Note: Young children may not be able to articulate the aims of these behaviors or mental acts.
B.The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C.The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
D.The disturbance is not better explained by the symptoms of another mental disorder (e.g., excessive worries, as in generalized anxiety disorder; preoccupation with appearance, as in body dysmorphic disorder; difficulty discarding or parting with possessions, as in hoarding disorder; hair pulling, as in trichotillomania [hair-pulling disorder]; skin picking, as in excoriation [skin-picking] disorder; stereotypies, as in stereotypic movement disorder; ritualized eating behavior, as in eating disorders; preoccupation with substances or gambling, as in substance-related and addictive disorders; preoccupation with having an illness, as in illness anxiety disorder; sexual urges or fantasies, as in paraphilic disorders; impulses, as in disruptive, impulse-control, and conduct disorders; guilty ruminations, as in major depressive disorder; thought insertion or delusional preoccupations, as in schizophrenia spectrum and other psychotic disorders; or repetitive patterns of behavior, as in autism spectrum disorder).
Body Dysmorphic DSM 5 TR Criteria
pg 271
A. Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others.
B.At some point during the course of the disorder, the individual has performed repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing his or her appearance with that of others) in response to the appearance concerns.
C.The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D.The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder.
With muscle dysmorphia: The individual is preoccupied with the idea that his or her body build is too small or insufficiently muscular. This specifier is used even if the individual is preoccupied with other body areas, which is often the case.