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M6 13-005

Exam 18: Anxiety Disorders

Anxiety A normal response to stress or threat. A state or feeling of apprehension, uneasiness, agitation, uncertainty and fear resulting from the anticipation of some threat or danger
Types of anxiety Signal Anxiety. Free-floating Anxiety. Anxiety Trait.
Signal Anxiety A learned response to an event such as test taking.
Free-floating Anxiety Associated with feelings of dread that are not possible to identify.
Anxiety Trait A learned aspect of personality. Anxious reactions to relatively non-stressful event.
Types of Anxiety Disorders Generalized Anxiety Panic Phobias Obsessive-Compulsive Post-traumatic Stress Disorder
Generalized Anxiety: Characterization Steady, high degree of anxiety and/or avoidance of behavior. Tends to worry over many things and find it difficult to concentrate on the task at hand. Possible at any age, commonly occurs around ages 20-30. Lasts 6 months or longer.
Generalized Anxiety: Treatment and Prognosis Relaxation Techniques and massage. Exercise. Visual and biofeedback imagery. Anti-anxiety drug therapy. Prognosis is variable; condition sometimes lasts 6 months or longer.
Panic Attack of an acute, intense and overwhelming anxiety accompanied by a degree of personality disorganization.
Severe anxiety, intense fear symptoms can occur abruptly and peak within 10 minutes. Lasts minutes to hours and can possibly recur several times a week.
Panic exhibits physical manifestation suddenly without apparent reason heart palpitations, sweating, trembling, feelings of dyspnea, chest pain, nausea, feeling dizzy/faint, fear of losing control, fear of dying, paresthesias, chills, hot flashes
Panic is more common in ____ than ____. Women, men
Panic: Treatment and Prognosis Use treatments for generalized anxiety disorders. Focus on educating on the nature of the disorder. Assist to develop better coping mechanisms with anxiety, blocking attacks pharmaceutically. Emotional support and reassurance.
Phobias (1) Characterized by persistent and irrational fear of a specific object, situation, or activity
Phobias: S&S Avoid people, places, or events that have potential to trigger an attack. More common in women.
Agoraphobia high anxiety brought on by situations in which a panic attack is possible
Phobias: Treatment and Prognosis With desensitization, patient learns to relax while reentering phobia situation in imagination and then in real life. Prognosis is variable and depends on response treatment.
Obsessive-Compulsive (1) Characterized by inability to stop persistent, irrational and uncontrollable acts (compulsions) or thoughts (obsessions) contrary to person’s standards or judgment
Obsessive-Compulsive thoughts anxiety producing and distressful in that they are uncontrollable
Obsessive-Compulsive behavior Person recognizes the behavior as absurd but is still compelled to perform the ritual to relieve tension. Person is usually orderly, meticulous, dependable and scrupulous Has tendency to be rigid and stubborn.
Obsessive-Compulsive: Treatment and Prognosis Psychotherapy to uncover the basic fears and to help distinguish objective dangers from imagined dangers. Drug therapy using clomipramine (Anafranil). Prognosis is more severe than with other anxiety disorders. Complete recovery is rare.
Post-traumatic Stress Disorder (1) A response to an intense traumatic experience that is beyond the usual range of human experiences that evoke feelings of terror and helplessness i.e. war, rape, major car accident, observing tortures, witnessing a violent death.
Post-traumatic Stress Disorder: Experience often relived in dreams or flashbacks that arise in response to a stimulus that resembles the experience
Post-traumatic Stress Disorder: Flashbacks include hallucinations and illusions: The false interpretation of extreme sensory stimulus, usually visual or auditory i.e. mirage in the desert, voices in the wind.
Post-traumatic Stress Disorder: Avoidance behaviors Emotional detachment, guilt about being a survivor, amnesia of the event, insomnia, irritability, difficulty concentrating and wariness
Types of post-traumatic stress disorder are Acute. Chronic. Delayed.
Acute PTSD Occurs within 6 months of event
Chronic PTSD Lasts more than 6 months
Delayed PTSD Starts 6 months or more after the event
Benzodiazepines and Miscellaneous Agents: Use Management of various forms of anxiety, including generalized anxiety disorder (GAD)
Meds for intermittent or short-term use Benzodiazepines
Meds for Long-term Buspirone, Paroxetine, Venlafaxine
Benzodiazepines and Miscellaneous Agents: Action Exert a tranquilizing effect by potentiating the effects of gamma-aminobutyric acid (GABA), an inhibitory transmitter, by binding to specific benzodiazepine receptor sites, such as the limbic system, thalamus and hypothalamus in the brain.
Benzodiazepines and Miscellaneous Agents: Cause Generalized CNS depression
Benzodiazepines produce a ____ with long-term use and have a potential for ____ or ____ dependence. Tolerance, psychological or physical
Do Benzodiazepines and Miscellaneous Agents have analgesic properties? No
Benzodiazepines and Miscellaneous Agents: Category Anti-anxiety
Benzodiazepines (examples) Alprazolam (Xanax) Chlordiazepoxide (Librium) Diazepam (Valium) Lorazepam (Ativan) Midazolam (Versed) Oxazepam (Serax)
Buspirone (BuSpar): Class Anti-anxiety
Doxepin (Sinequan, Zonalon): Class Tricyclic anti-depressants
Hydroxyzine (Atarax, Hydroxine-50, Vistaril): Class Sedative/hypnotics
Meprobrate (Equanil, Miltown): Class Carbamates
Paroxetine (Paxeva, Paxil, Paxil CR): Class Selective Serotonin Re-uptake Inhibitor (SSRI)
Venlafaxine (Effexor, Effexor XR): Class Anti-Depressant
Benzodiazepines and Miscellaneous Agents: Contraindications Hypersensitivity Comatose patients Pre-existing CNS depression Uncontrolled severe pain Pregnancy Lactation
Benzodiazepines and Miscellaneous Agents: Precautions Hepatic dysfunction Severe renal impairment. Severe pulmonary disease (Benzodiazepines only). Suicidal patients. Previous drug addictions. Sensitivity to CNS depressants: Dosage reduction may be required.
Created by: jtzuetrong