1
Q
Anxiety Disorders
Experience of anxiety: where does it come from?
A
- Genes & Environment
2
Q
Anxiety Disorders
Trauma Related (PTSD)
A
- traumatic events disrupt a person’s homeostasis
3
Q
Anxiety Disorders
Homeostasis
A
- principle by which our bodies function
- drive to keep in balance
- mechanisms to correct that which goes awry
- when person experiences stress, homeostasis goes out and physical things will change
- heart rate will accelerate, temperature will increase, glucose levels rise, etc.
- Body seeks to re-stabilize and does so by secreting two hormones:
- Epinephrine/adrenaline
- Gluco-cortical/Cortisol
4
Q
Anxiety Disorder
“Fight or flight” response engages these hormones in response to a traumatic event, or for anticipation of one.
A
- Epinephrine/adrenaline
- Gluco-cortical/Cortisol
5
Q
Anxiety Disorders
Anticipatory anxiety
A
- is most common of all anxiety and releases these hormones
- (adrenaline and Cortisol)
- spilled into the brain without actual danger
- (This is the biological basis of anxiety)
- this anxiety exists in anticipation of an event(s)
- (i.e. anxiety over whether or not my car will start when I leave class even though nothing is wrong with my car at all)
6
Q
Anxiety Disorders
Psychological experience of person in anxiety…
A
- overestimate the danger; tense
7
Q
What is the most common of all disorders we deal with?
A
- Anxiety
8
Q
Fear
A
- emotional response to real or perceived effects
9
Q
Anxiety
A
- anticipation of future threats causing you vigilance, caution, hypertension, and the tendency to avoid places where the fear would be even worse
- Runs in families like mood disorders
- Frequently misdiagnosed and/or ignored by physicians (especially in women)
10
Q
Panic Attacks
A
- short periods of intense fear; last approx. 10 minutes
11
Q
Epidemiology
A
- Up to 3% of the population have a lifetime anxiety
- It is the primary symptom of up to 25% of all psychiatric disorders
- Up to 70% of patients who visit physicians for treatment have anxiety and stress as significant factors (may go for other things but this is something that is going to be a problem)
12
Q
Comorbid Conditions
A
- Major depressive disorder (depression often co-occurs with anxiety)
- Substance use disorder (often people attempt to self-medicate)
- Hypertension (common; known as “elevated blood pressure”)
13
Q
Onset
A
- (don’t say “when it started” – use the term “onset”)
- Often preceded by:
- Marital disruption
- Death, crisis
- Financial upheaval, etc.
14
Q
Why is anxiety often misdiagnosed?
A
- it can be overlooked and if you have an addictive behavior also that will be picked up first.
15
Q
Statement to remember Generalized Anxiety diagnosis
A
- JJ has all the worries all the time
16
Q
What is the difference btw fear and anxiety?
A
- Fear happens when something is imminent or happening
- anxiety is in anticipation of something
17
Q
Statement to remember Specific Phobia diagnosis
A
- Jessica is afraid of the specific thing, spiders
18
Q
Statement to remember social anxiety diagnosis
A
- Fear of being in front of people and getting judged
19
Q
Symptoms of Panic Attack
(Always present with panic disorder)
A
- Palpitations or racing heart
- Sweating
- Trembling
- Shortness of breath or smothering sensation
- Choking sensation
- Chest pain or discomfort
- Abdominal discomfort
- Dizziness or fainting sensation
- Derealization
- [feeling as though people and world around you are not real or move in slow motion]
- depersonalization
- [see self as outside of your own body; observing self]
- Fear of losing control or “going crazy”
- Fear of dying
- Numbness or tingling sensation
- Chills or hot flashes
20
Q
Uncued Panic Attack
A
- nothing is causing panic attack
- (comes from nowhere)
21
Q
Cued (or expected) Panic Attack
A
- developing panic attack in presence of something
- they are in response to something
22
Q
Agoraphobia and sentence to remember the diagnosis
A
- the experience of anxiety in a specific situation from which you do not feel you can escape easily
23
Q
What are the four types of Specific Phobia?
A
- Animal
- natural environment
- blood/injection/injury
- situational
24
Q
Symptoms of Specific Phobia
A
- Excessive fear of specific object or situation
- Exposure to stimulus almost invariably causes anxiety
- Person recognizes anxiety is excessive
- could lead to client feeling excessive guilt, or others making that person feel guilty
- Stimulus is avoided or endured with great anxiety
- Avoidance or the distress interferes in functioning
25
What needs to be ruled out before diagnosing **specific phobia**?
* OCD,
* PTSD,
* Panic Disorder,
* Agoraphobia,
* Social Phobia,
* Separation Anxiety Disorder
26
Treatment Planning considerations for **Specific Phobia**
* Anti-depressants
* Systematic Desensitization
* Exposure to the object of the phobia or the situation
27
Symptoms of **Social Phobia**
* Fear of social or performance situations (being evaluated or judged) in which person is exposed to either unfamiliar people or scrutiny of others
* Exposure to social situation almost invariably causes anxiety
* Person recognizes fear is excessive
* Situations are either avoided or endured with great anxiety
* Avoidance or distress interferes in functioning
28
What needs to be ruled out before diagnosing **Social Phobia**?
* Medical condition or substance use,
* Panic Disorder,
* Agoraphobia,
* Separation Anxiety Disorder,
* Eating Disorder,
* Body Dysmorphic Disorder
29
What does JCAHO stand for and what does it do?
30
What do Common Clinic Commitees do?
* Continuous quality improvement
* utiliztiation review
* safety
* infection control
* clinic privileges and credentialing
31
# BPS DD
What is a mental disorder?
* Clinically significant behavioral or psychological syndrome or pattern that occurs and is associated with present distress or disability in important areas of functioning
* psychological
* social
* occupational
32
What makes something clinically significant?
* Must have some for of physical, social or occupational impairment that causes distress in one’s life
33
# DIDU
What are the Features of a Diagnosis?
* Must cause distress, must show impairment in functioning, and must be a clear deviation of usual roles.
34
What does a Master Treatment Plan Consist of?
* A master treatment plan consists of the problem, the goal, and between 8-10 objectives.
35
# CS PSO CD
What Three Distinct Features Define Psychopathology?
* Clinically significant impairment of psychological, social or occupational functioning that causes distress to individual.
36
What Three Things are Looked at in order for a Person to Meet the Criteria of a Diagnosis?
* 3 s’s
* Signs - objective, Symptoms- subjective, Syndromes – combination of the two
37
# OCD and Related Disorder
How common is OCD?
* 4th most common disorder in U.S.
38
What are **OCD** and other **Related Disorder**?
* Either obsessions or compulsions (cleaning, checking, repeating, organizing)
* At some point the person has recognized that the obsessions or compulsions are excessive
* Symptoms cause marked distress, are time consuming (hour or more per day) or interfere in daily functioning
* Not due to substance or medical condition
39
# OCD and Related Disorder
What do we rule out before Diagnoses?
* Eating Disorder,
* Hypochondriasis,
* Body Dysmorphic Disorder,
* Major Depression, and PTSD
40
# OCD and Related Disorder
obsessions
* unwanted thoughts that are intrusive and do not seem to want to go away
* recurrent thoughts
* they are **unwanted** and **intrusive**
41
# OCD and Related Disorder
compulsions
* behaviors that a person engages in to manage the anxiety caused by the thoughts
* compulsive behavior is driven by obsessions
* the repetitive behaviors
42
Generalized Anxiety Disorder
* Excessive/Over-the-top worry and anxiety over a number of events that persist for at least 6 months (can’t eat, can’t sleep, racing thoughts, etc.)
* Difficulty controlling the worry
* Three or more anxiety symptoms with at least some persisting for at least 6 months (restlessness, fatigue, going “blank,” muscle tension, disturbed sleep…)
* Clinically significant distress or impairment in functioning
43
# Generalized Anxiety Disorder
Rule out before diagnosis?
* Panic Disorder,
* Social Phobia,
* OCD,
* Hypochondriasis,
* PTSD,
* Eating Disorder
* Medications
* medical conditions
44
Acute Stress Disorder
* Exposed to traumatic event which:
* Involves actual or threatened death or serious injury to self or others
* Is responded to with intense emotion
* Person develops dissociative symptoms (3) during event or immediately after (dissociative symptoms = feeling detached, feeling dazed, depersonalization, derealization etc.)
* Event is **persistently re-experienced** with all physiological experiences of the actual event (ex. dreams)
* Avoidance of reminders of event
* Overall increased anxiety or arousal
* Causes impairment in social or occupational functioning or impairment in completing necessary tasks
45
# Acute Stress Disorder
Duration of Symptoms
* Two days- four weeks
* **if lasts longer, it’s PTSD**
46
Physical disorders that may cause anxiety
* Adrenal tumor (kidney)
* Alcoholism
* Coronary insufficiency (inadequate blood flow)
* Delirium
* Hypoglycemia [hypo = too little]
* Hyperthyroidism [hyper = too much]
* Mitral valve prolapse
47
General Approach to Treatment of Anxiety
* Behavioral and cognitive approaches preferred
* other approaches can create too much focus on the anxiety
* Rule out (R/O) medical conditions – have a physical exam
* **Focus on cognitions – “cognitive restructuring”**
48
# General Treatment Issues with Anxiety
Understand the cause
* What is the client telling himself?
* most of the time anxiety comes from the things that you tell yourself
* self-talk is what maintains the tension
* examine what the client is telling themselves
* Is it valid?
49
# General Treatment Issues with Anxiety
Stress management
* manage stress or stress will manage you.
* Stress exacerbates anxiety
50
# General Treatment Issues with Anxiety
Eliminate alcohol
* (also for people with zero problems with alcohol)
* caffeine
* get to a moderated place.
* Make contract with patient about no alcohol or caffeine as part of the treatment process for the duration of therapy.
51
# General Treatment Issues with Anxiety
Self-talk skills,
* “coach” self; track positive self-talk
52
# General Treatment Issues with Anxiety
Ego strengthening
* (aka assertiveness training)
* teaching a sense of possibility. Use ego-strengthening instead because BCBS won’t pay for assertiveness training.
53
# General Treatment Issues with Anxiety
Time structuring
* (big problem for people with anxiety because they are always behind where they are supposed to be)
* set them on a schedule for time management.
54
# General Treatment Issues with Anxiety
Anger management
55
# General Treatment Issues with Anxiety
Nutrition and exercise
* (send them to a physician)
* **NEVER** tell a client to exercise
* (you don’t know their cardiac state, physical fitness, etc.)
56
# General Treatment Issues with Anxiety
Self-esteem enhancement
* a resulting consequence of the other actions above: don’t start here.
57
Panic Disorder
* Must have had panic attacks in order to be diagnosed w/ this disorder
* Treatment Considerations
* Rule out substance abuse- self-medicating
* 33% spontaneously remit - testimonials?
* Deal with the shame
58
# Panic Disorder: Treatment Planning
Cognitive Behavioral Therapy
* Cognitive
* Teach about panic itself
* Learn positive self-talk
* Behavioral
* Breathing exercises (teaching them how to relax)
* Deep muscle relaxation
DSM
flashcards
Decks in class (7)
# Cards
