Term
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Definition
| emotional pain due to "fear" of something not immediately identifiable (though it potentially may be). however the physiologic rxn is same as if there was an obvious external threat (classic fear). |
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Term
| what is "free floating anxiety"? |
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Definition
| anxiety experienced but lacking an identifiable source. |
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Term
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Definition
| (actual) fear of a specific situation |
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Term
| is anxiety always abnormal? |
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Definition
| no, it can be adaptive/helpful |
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Term
| what characterizes pathological anxiety? |
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Definition
| it has its own autonomy (it can be triggered w/minimal external triggers), a higher intensity, longer duration, and pathological behaviors (compulsive/avoidance) are associated w/it. |
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Term
| what were symptoms of anxiety originally ascribed to? |
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Definition
| cardiac disease. in 1863, dr. decosta treated people for "irritable hearts" (tachycardia, palpitations and chest pain) which became associated w/civil war veterans = "decosta's syndrome". |
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Term
| who developed the terms “anxiety neurosis” or “neurasthenic” symptoms? |
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Definition
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Term
| what was the still-hildreth sanitarium? |
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Definition
| a osteopathic psychiatric hospital which became successful based on the idea that the mind and body were interconnected. |
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Term
| how does anxiety manifest itself somatically? |
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Definition
| via the sympathetic system, affecting the GI, causing diaphoresis, hyperreflexia (tremors/shakes), and HTN |
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Term
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Definition
| yes, it can affect concentration and memory |
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Term
| what is "panic disorder"? |
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Definition
| a sense of *sudden, *intense, and *severe anxiety (often misconstrued as an MI). 2-3x more common in women ~25 y/o. it is often triggered by an abrupt flow of NE typically from the locus coeruleus (has the highest level of NE-secreting neurons over any other part of the brain). serotonin and GABA are also likely involved. often runs in families. |
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Term
| what is panic disorder w/agoraphobia? how does this lead to avoidance behavior? |
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Definition
| literally "fear of the marketplace", the sense that the pt has to get out of wherever they are at that moment. pts start avoidance behavior of places which trigger this rxn. |
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Term
| why does panic disorder become more disabling when associated w/agoraphobia? |
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Definition
| the pt can’t control/predict when the panic will surface, they just know its coming |
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Term
| how is panic disorder treated? |
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Definition
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Term
| what organic syndromes can mimic panic disorders? |
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Definition
| migraines, paroxysmal atrial tachycardia, seizures, addisons, cushings, and carcinoid syndrome |
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Term
| what drugs can mimic panic disorders? |
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Definition
| dexmethylphenidate, cocaine, amphetamines, etc |
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Term
| how are anxiety disorders treated? |
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Definition
| BDZs (acutely) and desensitization (cognitive behavioral therapy - gradual exposure to the anxiety stimulus) |
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Term
| what is the relationship between anxiety and physical relaxation? |
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Definition
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Term
| what part of the US population is affected by phobias? |
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Definition
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Term
| what is a phobia? who has them more commonly? |
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Definition
| fear of a very specific object (not disabling as long as the pt can avoid the object), phobias are more common in women (2nd only to substance abuse in men). |
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Term
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Definition
| through a process of desensitization - but the pt must be motivated to participate |
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Term
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Definition
| the fear of being observed - different than schizoid/avoidant personality disorder pts, b/c they don’t have the cold, aloof distancing feelings of schizoids; they’d respond very well, as long as they know they’re not being in a situation where they’re being judged/evaluated. |
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Term
| what is generalized anxiety disorder (GAD)? |
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Definition
| constant anxiety for 6 mos+ often associated w/somatic symptoms: muscle tension, myofascial discomfort, headaches, insomnia, irritable mood, easily irritated, sense of restlessness, and constant need for movement. this common and involves GABA/serotonin and is thus treatable w/benzocarbalines, buspirone, and anti-depressants (tricyclic, MAO inhibitors, serotonin reuptake inhibitors, or combo meds) - all of which have the effect of blunting the GAD. |
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Term
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Definition
| autonomic overactivity, motor tension, and a sense of vigilance (not relaxed, anything which decreases awareness causes apprehension) |
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Term
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Definition
| w/medication and CBT = find time of day when pt is relatively more relaxed and try to amplify that using logic. challenge the pt's negative thoughts and examine them in connection to what they are experiencing emotionally (these negative thoughts are not delusional but maladaptive). |
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Term
| what are clues that something appearing like GAD might be organic (endocrinopathy: hyperthyroidism, parathyroidism, carcinoid syndromes)? |
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Definition
| abrupt start w/previous ability to relax |
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Term
| what is obsessive compulsive disorder (OCD)? |
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Definition
| a disorder where the symptoms (obsessive/compulsive behavior) are distressing to the pt. *obsessions are recurring intrusive thoughts which come into the pts mind unpredictably and are hard to eradicate. *compulsions are ritualized nonsensical behavior, which if the pt doesn't carry out will cause anxiety (become problematic [anxiety] when disrupts other relationships/activities in pt's life). this is more rare than GAD and phobias (probably 4th – after phobias, substance abuse, and major depression). equal amongst men/women. symptoms usually present around 20 y/o (if in younger children, often comorbid w/other issues like asperger's/autism). OCD is very often comorbid w/depression (may be the depression that drives the person to tx). |
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Term
| what is pediatric autoimmune neuropsychiatric disorder associated w/streptococcal infections (PANDAS)? |
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Definition
| when OCD is suddenly developed in children following a beta hemolytic streptococcal infection |
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Term
| do obsessive compulsive personality disorder pts also have OCD? |
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Definition
| one does not usually follow the other |
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Term
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Definition
| psychotherapy (delinking obsessions and anxiety) and medication (similar spectrum w/anxiety meds) |
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Term
| what is a common obsession found in OCD? |
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Definition
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Term
| what is a symmetry compulsion (part of OCD)? |
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Definition
| everything needs to be balanced and precise |
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Term
| what is tourette's disorder? |
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Definition
| a disorder similar to OCD, consisting of compulsive/ritualistic vocal and motor tics which the pt cannot stop. tx is similar to OCD. |
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Term
| what is post traumatic stress disorder (PTSD)? |
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Definition
| a syndrome where a pt is involved in some major traumatic stressor (life-threatening/harmful) where the pt felt fearful/helpless and then after, the pt constantly relives that experience (even in dreams). this is common in combat veterans (30% vietnam vets), MVAs, natural disasters, rape, assault or robbing. it may take some time to resurface and the trauma then becomes very unregulated and reinforcing. |
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Term
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Definition
| controlled 24/7 environment w/other pts who have experienced the *same trauma. education on coping mechanisms, deep relaxation, and self-hypnosis. medications can blunt the symptoms, but are usually not successful in eliminating all symptoms. |
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Term
| who might have symptoms of PTSD? (*test question*) |
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Definition
| a military veteran, child raised in a violent neighborhood, someone robbed at gunpoint, someone who was rear ended |
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Term
| what does it mean to say dissociative disorders have a degree of consciousness/matter of identity? |
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Definition
| conscious in the sense of being tuned in to the reality of yourself and your environment |
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Term
| how long have dissociative phenomena been observed and questioned? |
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Definition
| 18th-19 century - time of anton mesmer |
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Term
| what did freud say about dissociation issues? |
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Definition
| they represent an impairment of ego function. he felt that the ego has to fight against some powerful and intrusive elements that come from w/in the psyche and sometimes the ego is not strong enough to resist the pressure of these intrusive thoughts and forces and the ability to have an integrated consciousness becomes impaired. |
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Term
| what characterizes the incidence of dissociative disorders? |
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Definition
| these may occur w/trauma, often in children. dissociation can be promoted w/hypnosis or can occur following a partial complex seizure (temporal lobe). they occur equally in men and women, and more often in younger pts. |
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Term
| what is dissociative amnesia (psychogenic amnesia)? |
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Definition
| when this occurs, the pt has an inability to recall personal data/information about themselves. this may be localized to a particular traumatic event or the pt can have a total loss of any auto-biographical data (global form: don't know name, age, location - rxn to severe stress). this can occur in M/F and peak incidence in 3rd+4th decades. dissociative amnesia responds well and rapidly to tx. |
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Term
| what is a dissociative fugue? |
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Definition
| a rare dissociative amnesia disorder where the pt has a sudden, unplanned, unexpected, excursion from their usual location and activities - and the pt is unable to recall any personal information. this can occur after any kind of trauma. this is considered an impairment of consciousness as the pt looses their perception of identity and recall (lack of ability to integrate mental function). |
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Term
| what is dissociative identity disorder (multiple personality disorder)? |
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Definition
| pts w/this have 2+ distinct identities/personality states, each of which react differently to their environment or personal situation. switching between these can occur in hours or days and the different personality types are called "alters". usually one alter is more dominant, but they can be totally different including opposite sexes, suicidal, etc. |
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Term
| what is tx for dissociative identity disorder (multiple personality disorder)? |
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Definition
| explore the different alters, find the one which is healthiest/best able to cope and bring this one out to be the predominating personality. pts will however be subject to relapse. |
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Term
| what is depersonalization disorder? |
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Definition
| a periodic sense of detachment/estrangement from oneself w/o expectance. pts see themselves in the 3rd person for periods of time (hours-weeks) according to stress levels - but do not lose their identity. certain seizure disorders present very similarly and should be in the ddx (think of w/any behavior that is episodic, stereotypic, recurring, and inappropriate). |
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Term
| what is a factitious dissociative disorder? |
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Definition
| people who fake having a dissociative disorder = malingering where the pt reports from one episode to the next are very inconsistent and usually the pt has something to gain from the behavior. |
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