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Define Anxiety
Future oriented mood state characterized by marked negative affect and apprehension about future danger or misfortune. Somatic symptoms of tension.
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Define Fear
Present oriented mood state, immediate fight/flight response to danger or threat, strong avoidance/escape tendencies. Abrupt activation of sympathetic nervous system.
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Characteristics of Anxiety disorders
- Pervasive and persistent symptoms of anxiety and fear.
- Excessive avoidance and escapist tendencies.
- Clinically signif. distress.
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Define Panic Attack
- Abrupt experience of intense fear/discomfort, accompanied by several physical symptoms.
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- -Situational bound (cued) panic
- -Unexpected (uncued) panic
- -Situationally predisposed panic
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Biological Contributions to Anxiety and Panic
Diathesis-Stress: inherit vulnerabilities for anxiety and panic. Stress and life circumstances activate.
- Biological Causes:
- -Anxiety and Brain circuits-GABA, Nonadrenergic& Serotonergic systems
- -Corticotropin releasing factor (CRF) and the HPAC axis
- -Limbic (amygdala) and the septal-hippocampal systems
- Behavioral inhibition (BIS) and fight/flight (FF) systems
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Psychological Contributions to anxiety and fear
- Freud- psychic reaction to danger, involves reactivation of an infantile fear situation.
- Behavioristic-result from classical and operant conditioning and modeling
- Psychological- early experiences w/ uncontrollability/unpredictability
- Social-stressful life events trigger, many stressors are familial and interpersonal
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Integrative Model of Anxiety and Fear
Bio. vulnerability interacts with psychological, experiential, and social variables to produce an anxiety disorder.
- Common Processes:
- -Comorbidity common
- -1/2 patients have 2+ secondary diagnoses
- -Major depression most common secondary
- -Comorbidity suggests common factors across anxiety
- -anxiety and depression closely related
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Generalized Anxiety Disorder (GAD)
- -Excessive uncontrollable anxious apprehension & worry, coupled w/strong persistent anxiety, somatic symps. such as muscle tens., fatigue, irritability. Persists for 6 mth or more.
- -Affects 4% of pop., Females outnumber, onset is often subtle begin in early childhood, runs in families.
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GAD Features
- -Fail to process emotional component- thoughts/images
- -Treatment:
- -Benzos
- -Psych. Interventions/ Cognitive-Behavioral therapy
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Panic Disorder w or w/out Agoraphobia
- -Experience of unexpected panic attack, Anxiety/Worry of another attack, Agoraphobia, symptoms persist for 1+ months.
- -Affects 3.5% of pop., 2/3 are female, onset is acute and begin between 25-29.
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Panic Disorder: Associated Features
- Assoc. Feat.:
- -Nocturnal panic attacks: 60% panic during non-REM sleep
- -Extreme avoidance, catastrophic misinterpretation of symptoms
- Med. Treat.:
- -SSRI's, Benzos, any to target serotonergic, nonadrenergic GABA systems.
- Psych.Treatment:
- -Cognitive-behavior are highly effective
- -No long term advantage for combined treatment
- -Best long term outcome is Cognitive-Behavior alone.
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Specific Phobias
Extreme and irrational fear of specific object or situation, markedly interferes w/ functioning, recognizes fears are irrational, but still avoids at all costs. Affects 11% of pop, most females, chronic, onset between 15-20.
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Specific Phobias: Associated Features
- Causes: Bio. and Evolutionary vulnerability, direct conditioning, observational learning, info. transmission.
- Psychological Treatments: Cognitive-behavior therapy, structured and consistent graduated exposure.
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Social Phobia
Extreme and irrational shyness/fear, social/performance situations, marked interference w/functioning. Affects 13% of pop., females more, onset during adolescence w/peak at about 15.
Causes: Bio.& Evo. vulnerability. Direct conditioning, observational learning, info. transmission.
Medical Treatment: Tricyclic antidepressants, MAOI, SSRI.
Psych. Treatment: Exposure, rehearsal, role play in group--Highly effective.
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PTSD
- Exposure to traumatic event, experience extreme fear, helplessness or horror, continue to re-experience (nightmares, flashbacks), avoidance of reminders, emotional numbing, interpersonal probs. common, marked interference in functioning, Only 1 month or more past trauma.
- -Affects 7.8% of pop.
- -Most common for sexual assault victims, Accident victims, or Combat.
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PTSD Associated Features
- Acute PTSD-1-3 months post trauma
- Chronic PTSD-After 3 months post trauma
- Delayed onset PTSD-After 6 months or more
- Acute stress disorder-Immediately post trauma
Causes: Intensity of trauma, Uncontrolability and unpredictability, Extent of or lack of social support, Direct conditioning and observational learning
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PTSD Treatment
- -Cognitive-behavioral treatment involving graduated or massed imaginal exposure (highly effective)
- - Increase positive coping skills and social support
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OCD
- -Obsessions
- -Compulsions
- -Most persons display multiple obsessions (most w/cleaning, washing, checking rituals)
- -Affects 2.6% of pop., mostly female, tends to be chronic, onset in early adolescence or adulthood.
- -Causes: Parallel to anxiety disorders, Early life experiences and learning, Thought-Action fusion (the thought is like the action.
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OCD Treatment
- Meds:
- -Clomipramine or other SSRI's (benefit about 60%)
- - Psychosurgery (cingulotomy)- used in extreme cases
- -Relapse is common
- Psychological Treatment:
- -Cognitive-behavioral therapy (most effective)-Involves exposure and response prevention
- -Combined treatments-Not better than CBT alone
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Somatoform Disorders
-Meaning overly preoccupied with body or health, physical complaints w/out a medical condition.
- -Hypochondriasis
- -Somatization disorder
- -Conversion disorder
- -Pain disorder
- -Body dysmorphic disorder
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Hypochondriasis
- -Severe anxiety over possibility of disease or contracting a disease/illness, strong conviction, med. reassurance does not help.
- -Onset at any age, runs chronic courses
- Causes:
- -Cognitive perceptual distortions (distort normal body sensations), familial history.
- Treatment:
- -Challenge illness related misinterpretations
- -Provide substantial and sensitive reassurance
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Define Depersonalization
Distortion in perception of reality
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Define Derealization
Losing a sense of the external world
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Define Dissociative Amnesia
Inability to recall anything, including identity/Failure to recall specific (traumatic) events.
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Define Dissociative Fugue
- -Related to dissociative amnesia
- -Take off to new place
- -Unable to remember the past
- -Unable to remember how they arrived at new location
- -Often assume a new identity
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Define Alters
The different identities of DID
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Define Host
The identity that keeps other identities together in DID.
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Define Switch
The quick transition from one personality to another.
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Define Reintegration
Sqeezing all the alters back into one identity.
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Define Malingering
Deliberately faking symptoms
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Define Conversion Disorder
Physical malfunction of the body with no known cause.
Ex: New mom, one morning wakes up and arm is numb, can't pick up baby.
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Define Body Dysmorphic Disorder
Preoccupation with imagined defect in appearance.
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