what are characteristics of normal anxiety
- a diffuse, unpleasant, vague sense of apprehension
- often accompanied by autonomic symptoms
- stomach pains, , etc..
what distinguishes pathological anxiety from normal anxiety
- distress with a minimal realation to an external cause
- highlevel of dicomfort and severity of symptoms
- persistence of symptoms over time
- development of disabling behavioral strategies (avoidant or compulsive behaviors)
therapy for panic disorder
- CBT is most effective
- event better than drugs alone, but when combined is best
- Focus on instruction about false beliefs
- info about panic epsiodes
therapy for social phobia
- cognitive retraining
- rehearsal during sessions
- homework assignments
therapy for OCD
- behavior therapy as effective as drugs
- exposure and resposne prevention
- thought stopping
- implosions therapy
- aversive conditioning
what is systematic desensitations
patient exposed serially to a predetermined lsit of anxiety provoking stiumuli
graded in a hierarchy from least to most frightening
process of systematic desensitization
- patien tries to relax muscles via:
- anti-anxiety drugs
taught how to mentally and and pysically induce the state
taught to induce state when faced with each stimuli.
what is systematic desensitization used for
socail and specific phobias
- regression uncovers early modes of thought - not impulses
- ego and id functions are affected by regression
Freud's theory for OCD behavior
inherent magical thinking
- omnipotence of thinking
- believe that thinking about event in external world will cause event to occur w/o physical action
may fear having aggressive though - believe thought is equal to deed.
Medication for panic D/O
Xanex and Paxil
SSRIs and Anafranil are best in effectiveness and tolerance of side affects
meds for social phobia
SSRI's and benzodiazepines
meds for OCD
SSRI or anafranil
use of benzodiazepines in anxiety D/O's
- most rapid action against panic (even in 1st week)
- potenetial for:
- (especially after long term use)
use of anafranil for anxiety disorders
is a TCA that offers best selective uptake of serotonin and not norepinephine.
dosing titrated upward over 2-3wks to avoid GI issues and orthostatic hypotension
best to combine drug with behavioral therapy
what are the cogntitive components of anxiety?
- thought about emotional or bodily damage
phsycial symptoms of anxiety
- upset stomach
- tingling in extremities
what is mixed anxiety and depression
- both anxiety and depressive symptoms but don't meet criteria for a d/o.
- combo of symptoms causees significant funcitonal impairment
what neurotransmitter is most involved in anxiety disorders?
GABA - calmer downer. lack of it causes you not to be calm.
what is role of basal ganglia in anxiety d/o's?
- may be casued by strep (OCD)
- area allows us to react quickly.
- message may get stick like broken record
neurotransmitter responsible for physiological signs of anxiety?
survivors of trauma have braing changes related to norep.
chronic symptoms of people w/ anxiety d/o - panic attacks, insomnia, startle, hyperarousal - all caused by increased norepinephrine.
occasional bursts of activity
neurotransmitter in panic d/o
brain issues in anxiety d/o's
right hemisphere - cerebral assymmetty may cause anxiety do
amygdale - ptsd
temperal lobes- pathology (esp in hippocampus and amygale) with panic d/o
brain areas inplicated in OCD
- increased activity in:
- frontal lobes
- basal ganglia
what are obessions
- recurrent and intrusive thought
what are compulsions
conscious, standardized, recurrent behavior
act in attempt to reduce anxiety associated with obsession
but doesn't affect anxiety and may increase it
details on panic attacks?
unexpected - occur at any time - not associated w/ any identifiable situation stimulus - but not always unexepcted
not a codeable disorder by itself, but can go under another disorder
what is a panic attack?
- discrete fear or discomfort
- 4 or more symptoms develop rapidly
- reach a peak witing 10 minutes
- shortness of breath
- feeling of choking
- chest pain
what is panic disorder?
acute intense attack of anxiety accompanies by feelings of impending door.
- 2 Diagnotistic criteria:
- w/ agoraphobia
- w/o agoraphobia
differential diagnosis for panic disorder
differentiated from medical and mental d/o (hypoglycemia, endocrine d/o, MS, or anxiety d/o)
- course and prognsis
- onset in late adolescence/early adulthood
- increased risk for suicide and substance dependence
what is agoraphobia
fear of being in places or situaitons from which escape might be difficult, embarassing, or help may be unavailable in event of a panic attack.
avoidance of feared places or situaitons.
interferes w/ ability to function in work and social situations outside home.
not a codeable d/o - goes in another.
therapy for agoraphobia
- beahvioral therapy - reduces symptoms
- CBT and drugs are most affective
separation anxiety d/o
developmetnally inapproritate and excessive anxiety concerning seeparation from home or attachment figure
- 3 or more recurrent and excessive: distress when separation anticipted
- worry a.f. will be lost or harmed
- worry event will lead to separation
- fear of being along w/o a.f.
- reluctance or refusal to sleep away from home or w/o being near to af
- at least 4 weeks
- onset before 18
- distress and impairmine in funcitoing
- pysical symptoms
what is social phobia?
- marked and persistent fear of socail or performace situaitons.
- concerned about negative eval or scrutiny of others.
- fears humilation or embarassment, even by manifesting anxiety symptoms
- feared situations are avoided or endured w/ intesne anxiety or distress
clinical features of social phobia
- muscle twitching
- anxiety about scrutiny
course and prognosis
- different than major depressive d/o
- scizoid personality d/o
- other anxiety do
onset in late childhood or early adolescence. tends to be chrnoic
best tx is behvaior therapy
clinical features of PTSD
- development of symptoms after exposure to traumatic life events.
- reaction of fear and helplessness, persistentely relives event, tries to avoid being reminded of it.
- feelings of guild, rejection, and humiliation.
- dissociateve staets and panic attacks
- illusions and hallucinations may be present.
- Imparied memoy and attention.
difference between Acute Stress D/o and PTSD?
- ASD must be at least 2 days and max of 4 weeks and occurs w/i 4 weeks of event
- PTSD lasts more than a month
what is dissociation?
- persons seen as dramatizing and emotionally shallw.
- may be labled as histrionic
- behave like anxious adolescents
- expose self to exciting dangers to erase anxiety
what is egosyntonic?
denoting aspects of a personality that are viewed as acceptable and consistent with that person's total personality.
personality traits are susually ego-syntonic. also acceptable to the ego
what is ego-dystonic?
- aka ego alien
- denoting aspects of a person's personality that are viewed as repugnant, unacceptable or inconsistent with the rest of the personality
what is fantasy?
- seen in persons labeled schizoid
- seek solace and satisfaction w/i themselves by creating imaginary lives, especially imaginary friends.
what is isolation?
- characteristic of the overly controlled persons who are often labeled OCPD.
- under stress show intensified self restraint, overly formal social behavior and obstinacy.
what is projection?
- displaces outward all that becomes troublesome from within.
- externalization of an internal menace
- attributing their own unacknowleged feelings to others
what is splitting?
- a person's feelings are directed out as all good or all bad
- paited may idealize some people while disparaging others.
clincal characterisitcs of Cluster A
- more inward and predominatnly male
- eccentric in bad way
- don't want friends/relationships
- don't have interpersonal needs
- no psychotherapies seem to work
- will not come in willingly
- expression of self is odd and reclusive
clinical characteristics of Cluster B
- attentions seeking
- want to be linked and impressive
- act out and throw tantrum
- excessive emotionality
- self-injurious behavior
- grandiose behaviors
- angry outbursts
clinical characterisitcs of Custer C
- low selfesteem
- lack self confidence and assertiveness but want it
- good followers
- responsibly and conscientous
- both male/female
- turned in - shy and anxious
personality d/o NOS
- passive aggressive
- personality changes due to a GMC
- resist demand for adequate performance
- excuses for delays
- find fault with those they depend on
- refuse to remove self from dependent relationships
- expect others to do their errands and carry out routine responsibilities
treatment for passive aggressice
- constantly down
- may be dysthymic
- may lack insight into the problem
- chronic and lifelon
treatment of depressive
doesn't respond to meds b/c it's a way they look at life, not a brain problem.
- insight oriented therapy
- (long term treatment)
- depressed as long as they remember
- metaphoical language - shades of grey
- mood d/o characterized by greater influcitaitons in mood and may be epsiodic
- can occur anytime and usually has a precipitation stressor
- not an offical diagnostic catefory
- but NOS
- desire to cause pain to toehrs by being some form of abusive
- not included in the DSM
- pervasice aggressive pattern of cruel demeaning and aggrtessive behavior that is directed towards others.
personality change due to GMC
- head trauma
- cerebrovascular diseases
- cerebral tumos
- huntington's disease
- endocrine do
- heavy metal poisoning
def of personality change due to GMC
change in personality from previous patterns of habiro or an exacerbation of pervious personality characterisists is notable
impaired control of expression of emotions and impulses
have a clear sensorium
comorbidity of anxiety d/o
- often are co-morbid.
- practically always have mroe than one together, and also mixed with depression
GAD with dysthymia
GAD w/ depressive features
GAD and MDD
Mixed Anxiety and Depression
Sub-syndromal anxiety and MDD
sub-syndromal anxiety and dsthymia
5 commonalities of anxiety dos
- anticipatory anxiety
- cognitive misperceptions
- socially cued panic
- degree of avoidance behavior
- substance misuse
"tricks" or elements of CBT
- Distraction - journaling
- supportive counseling
- problem solving
- graduated exposures
- social training
meds for acute short term anxiety
benzos or lyrica
meds for chronic anxiety with depression
meds for social anxiety disorder
meds for specific phobias
- betta blockers
- cardiac meds like
meds for GAD
- must be more than 6 months
differntial diagnosis process for anxiety do's
- 1. rule out GMC
- 2. rulte out substance abuse
- 3. chose which d/o it is
patterns of patients and Tx in Panic Disorder
- low quality of life
- 3-5% of pop. only 1/3 seek tx
- feel they are being follished/ashamed
- go to MD or specialist
- highest use of ER's.
- often can't drive or work
most common preoccupations in OCD
- Dirt or contamination
- checking things
- belief that thoughts are unnacceptable
elements of PTSD
- physical sensations
- visual kinesthetic dissociation
- Thought-feel therapy