Term
| What are the basic classifications of anxiety? |
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Definition
| It is universal, normal and adaptive; it is hardwired - separation, strangers, falling, typical threats; it is acquired - conditioned responses; it is linked to two systems: fight flight freeze and vigilance, persistent arousal |
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Term
| How do we deal with a stimulus? |
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Definition
| notice (alert), assess, and react |
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Term
| Where does anxiety happen in the brain? |
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Definition
| Perception: periphery to frontal cortex; evaluation: subcortical structures (amygdala, hippocampus); reaction: brain stem centers |
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Term
| What is paroxymal anxiety? |
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Definition
| SNS revs up, PNS turns off; cortisol produced; regulated by serotonin |
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Term
| What is persistent anxiety? |
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Definition
| low grade elevation of SNS, often with low cortisol |
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Term
| How is anxiety regulated? |
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Definition
| cortisol reduces central NE, negative auto feedback, GABA, serotonin, cortical modulation (thought, defenses) |
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Term
| What is the "end organ" anxiety symptomatology? |
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Definition
| Brainstem is telling organs that something is wrong, so patients complain of heart, lung, or gi system problems. |
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Term
| What can persistent stress cause? |
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Definition
| ulcers, arteriosclerotic cardiovascular disease (ASCVD), immune mediated disorders (lupus), depression |
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Term
| What are the psychological aspects of stress? |
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Definition
Sudden or unrelenting demand
Subjective helplessness
Ominous meaning
Anticipation of negative
consequences
Lack of coping skills, immature
defenses
Both triggers for and manifestations
of stress responses |
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Term
| What are the common elements of DSM anxiety disorders? |
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Definition
| anticipation, arousal, and avoidance |
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Term
|
Definition
Uncued panic,
catastrophic interpretation of
physical sensation, anticipation and
agoraphobic avoidance |
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Term
|
Definition
panic + blushing,
expectation of humiliation or hurt,
yearning and social isolation |
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Term
| What needs to be right in the anxiety disorder diagnosis? |
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Definition
| patient, symptoms, genes, right back story, natural history, typical response to treatment, no medical reason |
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Term
| What are the validators of social phobia? |
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Definition
Sensitizing social experiences
Discipline through humiliation
Rejection by peers
Disfigurement
Interpersonal victimization or
trauma |
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Term
| What are the social phobia pearls? |
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Definition
Unusual sex ratio—men seek
treatment more than women
Related to cultural pressure to be
gregarious or sequestered
May be a problem in professional
training
Risk factor for Alcohol abuse |
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Term
| What are the validators for panic disorder? |
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Definition
Less clear role of development
Rely more on full symptom picture,
demographics, family history
Agoraphobic avoidance and
relational behavior |
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Term
| What are the panic disorder pearls? |
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Definition
Accounts for enormous unnecessary
medical expense
Not clearly associated with suicide
EXCEPT when panic attacks occur
with depression
Panic+Depression:Malignant suicide
predictor |
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Term
| What are some general characteristics of PTSD? |
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Definition
Combat, rape, accident and natural
disaster
Exposure: equal but sequelae seen
in women slightly more than men
Triad of intrusive, numbing and
arousal symptoms
Physical symptoms often less
patterned than those of panic,
medically unexplained physical symptoms (MUPS) |
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Term
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Definition
| this element is cognitive, and involves the affected individual as judging a particular situation as frightening or dangerous |
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Term
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Definition
| this is the panic one feels in response to the scary/dangerous situation. |
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Term
|
Definition
| This is the behavioral component to anxiety |
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Term
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Definition
| discrete period in which there is a sudden onset of intense apprehension, fearfulness, or terror, often associated with feelings of impending doom. During these attacks, symptoms such as shortness of breath, palpitations, chest pain or discomfort, choking or smothering sensations, and a fear of “going crazy” or losing control are present |
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Term
| What is a panic disorder (with and without Agoraphobia) |
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Definition
| characterized by recurrent panic attacks about which there is persistent concern. May be present in the context of Agoraphobia – meaning that the fear of having a panic attack in public becomes so great that the individual is afraid to leave “comfortable” situations (i.e. the home, may be afraid to go places alone, etc) |
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Term
| What is a specific phobia? |
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Definition
| characterized by clinically significant anxiety provoked by exposure to specific fear object of situation, often leading to avoidance behavior. |
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Term
| What is generalized anxiety disorder (GAD)? |
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Definition
| characterized by at least 6 months of persisent and excessive worry and anxiety. It is not limited to any one aspect of individual’s life…rather it is generalized |
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Term
| How does one evaluated PTSD? |
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Definition
Social history should include enquiry
about stress and trauma, esp if person
describes functional symptoms (cardiac,
GI, pain, respiratory and dizzyness)
Specific symptom enquiry: nightmares,
forced recollection, amnesia, distance,
loss of future orientation, startling,
irritability, disrupted sleep |
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Term
| What should happen in primary care in respect to paroxysmal anxiety disorders? |
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Definition
recognize, educate, encourage,
self-help. Monitor outcome and refer if higher
level of care needed |
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Term
| What drugs are good for paroxysmal anxiety disorders? |
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Definition
antidepressants and antianxiety
medications in particular. |
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Term
| What should be counseled against in paroxysmal anxiety disorder? |
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Definition
| substance abuse and avoidance |
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Term
| What is non-paroxysmal anxiety disorder? |
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Definition
Generalized anxiety
Persistent arousal: Tension, disrupted
sleep, appetite and gi disturbance, aches
and pains, sighing, jumpiness
Promiscuous worry: everything is
threatening, catastrophic interpretations
Negative expectations
Helplessness
High comorbidity with depression
Panic if present not prominent |
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Term
| What does treatment of generalized anxiety disorder look like? |
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Definition
| some different meds than paroxysmal, tries to enhance sense of control, confronts catastrophic thinking, extends range of function, uses psychotherapy and support |
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Term
|
Definition
Bodily manifestations of emotion
Worldwide, taken for granted
European cultures, more psychologizing
May prompt request for relief
Relief of symptom vs addressing cause
Context affects emotional expression,
often hard to change |
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Term
| What are the DSM somatoform disorders? |
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Definition
Somatizaton disorder
Conversion disorder
Factitious disorder
Malingering
Body dysmorphic disorder
Pain disorder |
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Term
| What is somatization disorder? |
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Definition
* Polysymptomatic disorder that begins before 30 that is characterized by a combination of pain, GI, sexual, & pseudoneurologic symp. That cannot be explained fully by any known general medical condition or substance
Pt. has:
* 4 pain symptoms (history of pain related to 4 diff. sites of function)
* 2 GI symptoms (e.g. nausea, diarrhea, food intolerance)
* 1 sexual symptom (e.g. sexual dysfunc., menstrual abnormalities)
* 1 pseudoneurologic symptom (e.g. impaired coordination, localized weakness, double vision) |
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Term
| What is conversion disorder? |
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Definition
* Unexplained symptoms affecting voluntary motor or sensory function that suggest a neurological or other general medical condition
* Psychological symptoms are associated with symptoms
* Clear relationship found between stressor & the initiation of symptom |
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Term
| What is factitious disorder? |
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Definition
| A self inflicted illness for "primary" (unconscious) gain |
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Term
|
Definition
Feigned illness for “secondary” gain
Escape
Disarm aggression, prevent abandonment, elicit
care, compensation
Drug seeking
Common in military and prison populations |
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Term
| What are known stress related syndromes? |
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Definition
Migraine Headaches
Irritable bowel
Fibromyalgia/chronic fatigue
Pelvic pain
Obesity
Major depression |
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Term
| What is the epidemiology of stress syndromes? |
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Definition
Female predominance 2:1
Early age of onset
Extensive comorbidity
Role of stress, both current and
prior
Social roles that discourage open
expression of emotion |
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Term
| What is the Dx, Tx, and referral for stress syndromes |
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Definition
Any suspected symptom or disorder
should prompt search for others (add
mood, energy to review of systems)
Genetic/family history of depression,
anxiety or substance use
Evaluate of current stress (cause and
consequence of symptoms)
Evaluate of sensitizing experiences: loss,
trauma, illness in self or family |
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Term
| What are bad reasons for testing? |
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Definition
Anger, frustration on part of HCP
Desire to prove others wrong
Cultural insensitivity
Patient demand without other grounds for test |
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Term
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Definition
* Preoccupation with the fears of having or the belief that one has a serious disease as a result of misinterpreting bodily symptoms & functions
* Fear or idea of having a disease despite medical reassurance; the belief is NOT of delusional intensity |
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Term
| What is body dysmorphic disorder? |
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Definition
* Preoccupation w/an imagined or exaggerated defect in physical appearance
* Non-delusional, however, in that they can acknowledge that their concerns may be exaggerated
* If delusional intensity pt. may be diagnosed with Delusional Disorder Somatic Type |
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Term
|
Definition
* Pain in one or more sites is the predominant focus of the clinical presentation
* Psychological factors have important role in the onset, severity, exacerbation, or duration of the pain
* Three subtypes: pain assoc. psychological factors, with psychological factors & medical condition, and with a General Medical Condition (not a mental disorder) |
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Term
| Obsessive-Compulsive Disorder |
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Definition
| characterized by obsessions (persistent ideas, thoughts, impulses, or images that are experienced as intrusive and which cause marked anxiety or distress) and/or by compulsions (repetitive behaviors of which the goal is to prevent or reduce anxiety or distress – NOT to provide pleasure or gratification). It is important to note that the obsessions and compulsions may be related (i.e. obsessions of cleanliness/germs, compulsion of handwashing) or not related (i.e. obsessions of blasphemous thoughts; compulsions of counting to ten forwards and backwards) |
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Term
| Undifferentiated Somatoform Disorders |
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Definition
Same as somatization disorder, but less stringent criteria
3 pain symptoms instead of 4 |
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Term
| Somatoform Disorder Not Otherwise Specified |
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Definition
Somatoform disorders that do not meet criteria for other diagnosis
E.g. Pseudocyesis: false belief of being pregnant that is assoc. w/signs of pregnancy (including abdominal enlargement, reduced menstrual flow, amenorrhea, etc.) |
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Term
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Definition
| the inability to express emotion |
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