what is the PHQ-9?
self-administered tools for assessing depression. They incorporate DSM-IV depression criteria with other leading major depressive symptoms into a brief self-report instruments that are commonly used for screening and diagnosis, as well as selecting and monitoring treatment.
what does a phq-9 score >9 mean>
Patient has screened positive and requires further assessment by a certified professional
for diagnosis and treatment. Notify attending, consider consulting psychiatry or psychology.
Communicate results to the team and any referral sites.
what is The main difference between stress and anxiety?
stress has a discernible source; anxiety does not.
A metaphor to illustrate the difference:
Stress is felt when the lion is chasing you;
Anxiety is the feeling of being chased when there is no lion, or the lion is long gone.
separation anxiety and simple phobias age of onset:
age 1-6
Any anxiety, Social phobia age of onset:
7-15
Obsessive compulsive disorder, Agoraphobia age of onset:
age 18-20
PTSD, Panic disorder age of onset:
age 20-25
The main criteria for making a diagnosis of an anxiety disorder is:
hat fear/anxiety/worry felt by a person is excessive and persists for more than six months. Anxiety is associated with a sympathetic nervous system response.
GAD age of onset:
> 25
Suspect and screen for GAD in primary care clients who present more subtly; for example, those who:
- Frequently want reassurance about their health
- Come in with a wide variety of somatic symptoms (particularly older adults and some cultural groups)
- Have chronic health problems
what is the GAD diagnostic criteria?
- excessive worry or anxiety lasting > 6 months
- anxiety/worry difficult to the control
- associated with 3 or more of the following:
-Feeling tense, keyed up or on edge
-Being easily fatigued
-Difficulty concentrating
-Irritability
-Muscle tension
-Sleep disturbances - Feelings or physical manifestations cause significant distress or impairment in functioning
- The condition is not based in physical pathology, nor a result of medication or substance use/abuse.
what tool is used to screen for GAD?
GAD-7
how is the GAD-7 scored?
This is calculated by assigning scores of 0, 1, 2, and 3 to the response categories, respectively,
of “not at all,” “several days,” “more than half the days,” and “nearly every day.”
GAD-7 total score for the seven items ranges from 0 to 21.
0–4: minimal anxiety
5–9: mild anxiety
10–14: moderate anxiety
15–21: severe anxiety
Panic Disorder Diagnostic Criteria – DSM-5
Recurrent unexpected panic attacks occurring from a calm or anxious state.
A: Four of the following symptoms must be present for a diagnosis of panic attack:
Palpitations, racing or pounding heart rate
Sweating
Shaking or trembling
Sensations of shortness of breath or of being smothered
Choking sensations
Chest pain or discomfort
Chills or heat sensations
Nausea or any abdominal distress
Dizziness or light-headedness
A sense of things being unreal or feeling detached from oneself
Numbness or tingling sensations
Fear of losing control or “going crazy”
Fear of dying
Some cultural responses may include screaming, crying, and other physical symptoms like headache, tinnitus, sore neck, etc. These other signs and symptoms are NOT included in the four required symptoms of panic attacks.
B: For at least one episode in the following period of one month the individual will:
Continue to worry about a re-occurrence of the episode
Demonstrate maladaptive changes to avoid a recurrence of another attack
C: Not be due to a physical cause like adrenal tumor, or substance use
D: Not be attributable to another mental health disorder
what is social anxiety disorder? SAD
Social anxiety disorder (SAD) is defined as an intense fear of being negatively judged by others.
when does SAD typically present & why?
adolescence, because the brain is still developing.
who is at risk for SAD?
those who have personality traits that “…include behavioral inhibition and fear of negative evaluation” (APA, 2013, p. 205.). Other risk factors include early childhood adverse experiences, and those who have anxious parental role models. There is a strong familial association between any anxiety disorder and SAD development. Inquiring about family history is an important part of assessment for SAD.
what is the relation to SAD & parenting?
The risk of developing SAD is increased by over-controlling, critical and cold parenting, an insecure attachment style, aversive social/peer experiences, emotional maltreatment, and to a lesser extent other forms of childhood maltreatment and adversity.
these factors may lead to posttraumatic reactions, distorted negative self-imagery, and internalized shame-based schemas that subsequently maintain SAD symptomatology.
Diagnostic Criteria for SAD – DSM-5
Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others.
The individual fears that he/she will act in a way or show anxiety symptoms that will be negatively evaluated and therefore will be humiliating or embarrassing.
The social situations almost always provoke fear or anxiety.
The social situations are avoided or endured with intense fear or anxiety.
The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.
The fear, anxiety, or avoidance is persistent, typically lasting for six months or more.
The fear, anxiety, or avoidance causes clinically significant distress or impairment in social,occupational, or other important areas of functioning.
The fear, anxiety, or avoidance is not due to substance use or abuse, medications, or another medical condition.
If combined with another medical condition, the fear or anxiety is unrelated or is excessive.
what is acute stress disorder?
Acute stress disorder occurs after a significant traumatic event. The shock of the event is such that it can result in a period of disruption in functioning and in feelings of feeling unsafe, experiencing flashbacks or dissociation, and intrusive thoughts or memories, and sometimes somatic sensations. Anxiety and distress predominate and sleep is affected. The expression of acute stress disorder is variable person to person but generally the symptoms are temporary. When they persist, PTSD may develop.
Diagnostic Criteria for Acute Stress Disorder – DSM-5
- Exposure to actual or threatened death, serious injury or medical crisis, sexual violation in one or more of the following ways:
- Directly experiencing the traumatic event
Witnessing, in person, the events as they occur to others
- Learning that the violent or accidental life-threatening event occurred to a close family member or close friend
- Experiencing repeated or extreme exposure to averse details of the traumatic events (common in first responders, jurors, sexual crimes police, etc) - Presence of nine or more of the following symptoms:
- Intrusion of recurrent, involuntary, distressing memories or dreams of the event, or flashbacks
- Intense or prolonged psychological distress or marked physiological reactions to internal or external cues that represent some aspect of the trauma (like a car backfiring and responding as if it was gunfire)
- Persistent inability to experience positive emotions
- An altered sense of reality of one’s surroundings or oneself
- Experiencing a sense of time standing still or slowing
- Dissociative amnesia
- Efforts are made to avoid distressing memories, thoughts or feelings about the event or associated with the event
- Efforts are made to avoid distressing external reminders of the events (places, people, activities, etc)
- Sleep disturbances
- Irritable or angry outbursts
- Hypervigilance
- Problems with concentration
- Exaggerated startle response - Duration of the symptoms is three days to one month after trauma exposure. Most people will react immediately but the criteria for a disorder does not begin until day three.
- The disturbance causes significant distress and impairs functioning in any or all domains.
The disturbance is not due to a medical condition or substance and is not better described by another diagnosis.
Diagnostic Criteria for PTSD – DSM-5
PTSD Criteria Summary
Exposure to Trauma:
1. Directly experiencing the event.
2. Witnessing the event as it occurred to others.
3. Learning about violent or accidental death of a loved one.
4. Repeated or extreme exposure to aversive details of the event (work-related only).
Intrusive Symptoms:
1. Recurrent, involuntary distressing memories.
2. Dreams related to the event.
3. Flashbacks or dissociative reactions.
4. Intense psychological distress when exposed to cues related to the event.
Avoidance Symptoms:
1. Avoidance of thoughts or feelings about the event.
2. Avoidance of people, places, or things associated with the event.
Negative Alterations in Cognitions and Mood:
1. Inability to remember important features of the event.
2. Persistent negative beliefs about oneself or the world.
3. Distorted self-blame or blaming others.
4. Persistent negative emotional states (fear, guilt, etc.).
5. Diminished interest in significant activities.
6. Feelings of detachment from others.
7. Inability to experience positive emotions.
Alterations in Arousal and Reactivity:
1. Irritable or angry outbursts.
2. Reckless or self-destructive behavior.
3. Hypervigilance.
4. Exaggerated startle response.
5. Concentration problems.
6. Sleep disturbances.
Duration and Impact:
- Symptoms last more than one month.
- Cause significant distress or impairment in functioning.
- Not attributable to other conditions or substance use.
Onset:
- Symptoms may be delayed, appearing six months after the event (PTSD with delayed expression).
what is dissociation?
a self-protective mechanism defined as a mental process that causes a lack of connection in a person’s thoughts, memory and sense of identity
what is the definition of derealization?
A sensation of unreality or detachment from the external world. People experiencing derealization may feel as if their surroundings are distorted, dreamlike, or lacking in significance. They might perceive the world as unreal or alien, making it difficult to connect with their environment.
