Term
|
Definition
s a discrete period in which there is the 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 fear of "going crazy" or losing control are present.
can occur in the context of any anxiety disorder as well as other mental disorders
must have 4 of 13 somatic or cognitive symptoms
Attacks that meet all other criteria but that have fewer than 4 somatic or cognitive symptoms are referred to as limited-symptom attacks.
Panic Attacks, over time the attacks typically become situationally bound or predisposed, although unexpected attacks may persist. |
|
|
Term
|
Definition
A. anxiety about, or avoidance of, places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having a Panic Attack or panic-like symptoms.
B. The situations are avoided (e.g., travel is restricted) or else are endured with marked distress or with anxiety about having a Panic Attack or panic-like symptoms, or require the presence of a companion.
Agoraphobic fears typically involve characteristic clusters of situations that include being outside the home alone; being in a crowd or standing in a line; being on a bridge; and traveling in a bus, train, or automobile.
Consider the diagnosis of Specific Phobia if the avoidance is limited to one or only a few specific situations, or Social Phobia if the avoidance is limited to social situations.
An attempt to deal with an anticipated panic attack |
|
|
Term
| panic disorder without agoraphobia |
|
Definition
| s characterized by recurrent unexpected Panic Attacks about which there is persistent concern. |
|
|
Term
| panic disorder with agoraphobia |
|
Definition
| is characterized by both recurrent unexpected Panic Attacks and Agoraphobia. |
|
|
Term
| agoraphobia without history of panic disorder |
|
Definition
| is characterized by the presence of Agoraphobia and panic-like symptoms without a history of unexpected Panic Attacks. |
|
|
Term
|
Definition
| s characterized by clinically significant anxiety provoked by exposure to a specific feared object or situation, often leading to avoidance behavior. |
|
|
Term
|
Definition
| s characterized by clinically significant anxiety provoked by exposure to certain types of social or performance situations, often leading to avoidance behavior. |
|
|
Term
| obsessive-compulsive disorder |
|
Definition
| s characterized by obsessions (which cause marked anxiety or distress) and/or by compulsions (which serve to neutralize anxiety). |
|
|
Term
| post traumatic stress disorder |
|
Definition
| is characterized by the reexperiencing of an extremely traumatic event accompanied by symptoms of increased arousal and by avoidance of stimuli associated with the trauma. |
|
|
Term
|
Definition
| is characterized by symptoms similar to those of Posttraumatic Stress Disorder that occur immediately in the aftermath of an extremely traumatic event. |
|
|
Term
| generalized anxiety disorder |
|
Definition
| s characterized by at least 6 months of persistent and excessive anxiety and worry. |
|
|
Term
| anxiety disorder due to a general medical condition |
|
Definition
| is characterized by prominent symptoms of anxiety that are judged to be a direct physiological consequence of a general medical condition. |
|
|
Term
| substance induced anxiety disorder |
|
Definition
| is characterized by prominent symptoms of anxiety that are judged to be a direct physiological consequence of a drug of abuse, a medication, or toxin exposure. |
|
|
Term
| anxiety disorder not otherwise specified |
|
Definition
| s included for coding disorders with prominent anxiety or phobic avoidance that do not meet criteria for any of the specific Anxiety Disorders defined in this section (or anxiety symptoms about which there is inadequate or contradictory information). |
|
|
Term
| separation anxiety disorder |
|
Definition
characterized by anxiety related to separation from parental figures) usually develops in childhood, it is included in the "Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence" section
children with this often have associated exaggerated fears of people or events (e.g., of muggers, burglars, kidnappers, car accidents, airplane travel) that might threaten the integrity of the family. A separate diagnosis of Specific Phobia would rarely be warranted. |
|
|
Term
| difference of panic attack and generalized anxiety |
|
Definition
| attack has discrete almost paroxysmal, nature and its typically greater severity. |
|
|
Term
|
Definition
1. unexpected (uncued)
2. situational bound (cued)
3. situationally predisposed |
|
|
Term
| external vs. internal triggers of attack |
|
Definition
external: elevator for claustrophobia brings on attack
internal:claustrophobic cognitions about the ramifications of heart palpitations |
|
|
Term
| unexpected (uncued panic attacks |
|
Definition
| those for which the individual does not associate onset with an internal or external situational trigger. "out of the blue" |
|
|
Term
| situationally bound (cued) panic attacks |
|
Definition
those that almost invariably occur immediately on exposure to, or in anticipation of, the situational cue or trigger.
ex: a person with social phobia having a panic attack upon entering into or thinking about a public speaking engagement |
|
|
Term
| situationally predisposed panic attacks |
|
Definition
| similar to situationally bound Panic Attacks but are not invariably associated with the cue and do not necessarily occur immediately after the exposure (e.g., attacks are more likely to occur while driving, but there are times when the individual drives and does not have a Panic Attack or times when the Panic Attack occurs after driving for a half hour). |
|
|
Term
| diagnosis of panic disorder |
|
Definition
*he occurrence of unexpected Panic Attacks is required for a diagnosis of Panic Disorder (with or without Agoraphobia).
At least two unexpected Panic Attacks are required for the diagnosis, but most individuals have considerably more.
The essential feature of Panic Disorder is the presence of recurrent, unexpected Panic Attacks (see page 430) followed by at least 1 month of persistent concern about having another Panic Attack, worry about the possible implications or consequences of the Panic Attacks, or a significant behavioral change related to the attacks (Criterion A). |
|
|
Term
| diagnosis for panic attack |
|
Definition
A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes:
(1) palpitations, pounding heart, or accelerated heart rate
(2) sweating
(3) trembling or shaking
(4) sensations of shortness of breath or smothering
(5) feeling of choking
(6) chest pain or discomfort
(7) nausea or abdominal distress
(8) feeling dizzy, unsteady, lightheaded, or faint
(9) derealization (feelings of unreality) or depersonalization (being detached from oneself)
(10) fear of losing control or going crazy
(11) fear of dying
(12) paresthesias (numbness or tingling sensations)
(13) chills or hot flushes |
|
|
Term
|
Definition
| The essential feature of Agoraphobia is anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having a Panic Attack (see page 430) or panic-like symptoms (e.g., fear of having a sudden attack of dizziness or a sudden attack of diarrhea) (Criterion A). |
|
|
Term
| problem with diagnosing agoraphobia |
|
Definition
| he differential diagnosis to distinguish Agoraphobia from Social and Specific Phobia and from severe Separation Anxiety Disorder can be difficult because all of these conditions are characterized by avoidance of specific situations. |
|
|
Term
|
Definition
|
|
Term
|
Definition
| The essential feature of Panic Disorder is the presence of recurrent, unexpected Panic Attacks (see page 430) followed by at least 1 month of persistent concern about having another Panic Attack, worry about the possible implications or consequences of the Panic Attacks, or a significant behavioral change related to the attacks (Criterion A). The Panic Attacks are not due to the direct physiological effects of a substance (e.g., Caffeine Intoxication) or a general medical condition (e.g., hyperthyroidism) (Criterion C). Finally, the Panic Attacks are not better accounted for by another mental disorder (e.g., Specific or Social Phobia, Obsessive-Compulsive Disorder, Posttraumatic Stress Disorder, or Separation Anxiety Disorder) (Criterion D). Depending on whether criteria are also met for Agoraphobia (see page 433), 300.21 Panic Disorder With Agoraphobia or 300.01 Panic Disorder Without Agoraphobia is diagnosed (Criterion B). |
|
|
Term
|
Definition
| an include stimuli that are either external (e.g., a phobic object or situation) or internal (e.g., physiological arousal) to the individual. In some instances, although a situational trigger may be apparent to the clinician, it may not be readily identifiable to the individual experiencing the Panic Attack. |
|
|
Term
| some characteristics of panic disorder |
|
Definition
| ndividuals with Panic Disorder display characteristic concerns or attributions about the implications or consequences of the Panic Attacks. Some fear that the attacks indicate the presence of an undiagnosed, life-threatening illness (e.g., cardiac disease, seizure disorder). Despite repeated medical testing and reassurance, they may remain frightened and unconvinced that they do not have a life-threatening illness. Others fear that the Panic Attacks are an indication that they are "going crazy" or losing control or are emotionally weak. Some individuals with recurrent Panic Attacks significantly change their behavior (e.g., quit a job, avoid physical exertion) in response to the attacks, but deny either fear of having another attack or concerns about the consequences of their Panic Attacks. Concerns about the next attack, or its implications, are often associated with development of avoidant behavior that may meet criteria for Agoraphobia (see page 433), in which case Panic Disorder With Agoraphobia is diagnosed. |
|
|
Term
| panic disorder comormidity with major depressive disorder |
|
Definition
| reported rates for comorbid Major Depressive Disorder vary widely, ranging from 10% to 65% in individuals with Panic Disorder. In approximately one-third of individuals with both disorders, the depression precedes the onset of Panic Disorder. In the remaining two-thirds, depression occurs coincident with or following the onset of Panic Disorder. A subset of individuals may treat their anxiety with alcohol or medications, and some of them may develop a Substance-Related Disorder as a consequence. |
|
|
Term
| comorbidity with panic disorder and other disorders |
|
Definition
omorbidity and symptom overlap with Hypochondriasis are common.
PTSD is also comorbid
in childhood separation anxiety is comorbid |
|
|
Term
| lab finding of those with panic disorder |
|
Definition
| ome individuals with Panic Disorder show signs of compensated respiratory alkalosis (i.e., decreased carbon dioxide and decreased bicarbonate levels with an almost normal pH). Panic Attacks in response to panic provocation procedures such as sodium lactate infusion or carbon dioxide inhalation are more common in individuals with Panic Disorder than in control subjects or individuals with Generalized Anxiety Disorder. |
|
|
Term
| panic disorder and comorbidity of GMCs |
|
Definition
Studies have identified significant comorbidity between Panic Disorder and numerous general medical symptoms and conditions, including, but not limited to, dizziness, cardiac arrhythmias, hyperthyroidism, asthma, chronic obstructive pulmonary disease, and irritable bowel syndrome. However, the nature of the association (e.g., cause-and-effect) between Panic Disorder and these conditions remains unclear.
during a panic attack HR raises and systolic BP rises. |
|
|
Term
| gender features of panic disorder |
|
Definition
2x more likely in women-panic disorder without agorabphobia
3x more in women - panic disorder with agoraphobia |
|
|
Term
| age of onset of panic disorder |
|
Definition
late teens to mid 30s after age 45 is unusual but can occur
Agoraphobia may develop at any point, its onset is usually within the first year of occurrence of recurrent Panic Attacks. The course of Agoraphobia and its relationship to the course of Panic Attacks are variable.
biological component especially when onset is prior to 20 |
|
|
Term
| GMC that can cause panic attacks |
|
Definition
| hyperthyroidism, hyperparathyroidism, pheochromocytoma, vestibular dysfunctions, seizure disorders, and cardiac conditions (e.g., arrhythmias, supraventricular tachycardia). Appropriate laboratory tests (e.g., serum calcium levels for hyperparathyroidism) or physical examinations (e.g., for cardiac conditions) may be helpful in determining the etiological role of a general medical condition |
|
|
Term
| signals that a GMC is causing the panic attacks |
|
Definition
| Features such as onset after age 45 years or the presence of atypical symptoms during a Panic Attack (e.g., vertigo, loss of consciousness, loss of bladder or bowel control, headaches, slurred spech, or amnesia) suggest the possibility that a general medical condition or a substance may be causing the Panic Attack symptoms. |
|
|
Term
| substance induced anxiety disorder |
|
Definition
| Intoxication with central nervous system stimulants (e.g., cocaine, amphetamines, caffeine) or cannabis and withdrawal from central nervous system depressants (e.g., alcohol, barbiturates) can precipitate a Panic Attack. However, if Panic Attacks continue to occur outside of the context of substance use (e.g., long after the effects of intoxication or withdrawal have ended), a diagnosis of Panic Disorder should be considered. In addition, because Panic Disorder may precede substance use in some individuals and may be associated with increased substance use for purposes of self-medication, a detailed history should be taken to determine if the individual had Panic Attacks prior to excessive substance use. |
|
|
Term
| four factors helpful in making anxiety diagnosis |
|
Definition
| the focus of anxiety, the type and number of Panic Attacks, the number of situations avoided, and the level of intercurrent anxiety. |
|
|
Term
| distinguishing factors between specific phobias and panic disorder |
|
Definition
specific phobias involve fear of something specific that may or may not bring about a panic attack when anything involving the feared thing is brought to attention.
Panic disorder can have panic attacks at specific times but the fear is of the panic attack itself and can be brought about even when alone or awaken the person from sleep. |
|
|
Term
| diagnostic criteria for panic disorder without agoraphobia |
|
Definition
A. Both (1) and (2):
(1) recurrent unexpected Panic Attacks (see page 432)
(2) at least one of the attacks has been followed by 1 month (or more) of one (or more) of the following:
(a) persistent concern about having additional attacks
(b) worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, "going crazy")
(c) a significant change in behavior related to the attacks
absence of agoraphobia
not due to drugs or alcohol |
|
|
Term
| diagnostic criteria for panic disorder with agoraphobia |
|
Definition
A. Both (1) and (2):
(1) recurrent unexpected Panic Attacks (see page 432)
(2) at least one of the attacks has been followed by 1 month (or more) of one (or more) of the following:
(a) persistent concern about having additional attacks
(b) worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, "going crazy")
(c) a significant change in behavior related to the attacks
agoraphobia
A. Anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having an unexpected or situationally predisposed Panic Attack or panic-like symptoms. Agoraphobic fears typically involve characteristic clusters of situations that include being outside the home alone; being in a crowd or standing in a line; being on a bridge; and traveling in a bus, train, or automobile.
not due to drugs or alcohol |
|
|
Term
| agoraphobia without history of panic disorder |
|
Definition
he essential features of Agoraphobia Without History of Panic Disorder are similar to those of Panic Disorder With Agoraphobia except that the focus of fear is on the occurrence of incapacitating or extremely embarrassing panic-like symptoms or limited-symptom attacks rather than full Panic Attacks.
Symptoms are any of the 13 in a list of them.
To qualify for this diagnosis, the full criteria for Panic Disorder must never have been met (Criterion B) and the symptoms must not be due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (Criterion C). |
|
|
Term
| differential diagnosis of agoraphobia without panic disorder |
|
Definition
absence of a history of recurrent unexpected Panic Attacks. The avoidance in Agoraphobia Without History of Panic Disorder results from fear of incapacitation or humiliation due to unpredictable, sudden, panic-like symptoms rather than from fear of a full Panic Attack as in Panic Disorder With Agoraphobia.
The diagnosis of Panic Disorder With Agoraphobia remains appropriate in cases in which Panic Attacks go into remission but Agoraphobia continues to be experienced. |
|
|
Term
|
Definition
| individuals avoid social or performance situations in which they fear that they might act in a way that is humiliating or embarrassing. |
|
|
Term
|
Definition
he individual avoids a specific feared object or situation.
The individual experiences a marked, persistent, and excessive or unreasonable fear when in the presence of, or when anticipating an encounter with, a specific object or situation.
focus may be:
fear of harm
fear of losing control
fear of somatic manifestation of the fear(increased HR, shortness of breath, fainting, losing control and screaming) |
|
|
Term
| separation anxiety disorder |
|
Definition
| children avoid situations that take them away from home or close relatives |
|
|
Term
| subtypes to specific phobias |
|
Definition
animal type
natural environment type
blood-injections type
situational type
other type
Having one phobia of a specific subtype tends to increase the likelihood of having another phobia from within the same subtype (e.g., fear of cats and snakes). When more than one subtype applies, they should all be noted (e.g., Specific Phobia, Animal and Natural Environment Types). |
|
|
Term
| rate of frequency of subtypes of specific phobia |
|
Definition
1. situational most frequent
2. natural environment
3.blood-injection-injury
4. animal |
|
|
Term
natural environment subtype
specific phobia |
|
Definition
| This subtype should be specified if the fear is cued by objects in the natural environment, such as storms, heights, or water. This subtype generally has a childhood onset. |
|
|
Term
other type
specific phobia |
|
Definition
| This subtype should be specified if the fear is cued by other stimuli. These stimuli might include the fear of choking, vomiting, or contracting an illness; "space" phobia (i.e., the individual is afraid of falling down if away from walls or other means of physical support); and children's fears of loud sounds or costumed characters. |
|
|
Term
situational type
specific phobia |
|
Definition
| This subtype should be specified if the fear is cued by a specific situation such as public transportation, tunnels, bridges, elevators, flying, driving, or enclosed places. This subtype has a bimodal age-at-onset distribution, with one peak in childhood and another peak in the mid-20s. This subtype appears to be similar to Panic Disorder With Agoraphobia in its characteristic sex ratios, familial aggregation pattern, and age at onset. |
|
|
Term
| physiological response to specific phobia |
|
Definition
| vasovagal fainting response is characteristic of blood-injection-injury type specific phobias. Initial brief acceleration of HR and elevation in BP followed by a deceleration of HR and a drop in BP with contrasts the usual acceleration of heart rate and elevation in BP in other specific phobias. |
|
|
Term
| occurrence of specific phobias |
|
Definition
| women 2:1 to men even among elderly |
|
|
Term
| specific phobia situational type |
|
Definition
| Specific Phobia, Situational Type, is characterized by situational avoidance in the absence of recurrent unexpected Panic Attacks. |
|
|
Term
| panic disorder with agoraphobia dx |
|
Definition
| the presence of pervasive apprehension about having a Panic Attack even when not anticipating exposure to a phobic situation also supports a diagnosis of... |
|
|
Term
|
Definition
| an individual has Panic Attacks only in elevators (even if the focus of fear is on the Panic Attack), then a diagnosis of... |
|
|
Term
| Panic Disorder Without Agoraphobia. |
|
Definition
| An individual has additional unexpected Panic Attacks in other situations but no additional avoidance or endurance with dread develops, then the appropriate diagnosis would be... |
|
|
Term
| diagnostic criteria for specific phobia |
|
Definition
1. persisten fear that is excessive or unreasonable cued by presence or anticipation of specific object or situation.
b. exposure to phobic stimulus provokes immediate response which may include a panic attack(children may show tantrum, crying,etc.)
C. person recognizes fear is excessive or unreasonable-kids don't
D. phobic situation is avoided or endured with distress or anxietyE. The avoidance, anxious anticipation, or distress in the feared situation(s) interferes significantly with the person's normal routine, occupational (or academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.
F. In individuals under age 18 years, the duration is at least 6 months.
G. The anxiety, Panic Attacks, or phobic avoidance associated with the specific object or situation are not better accounted for by another mental disorder, such as Obsessive-Compulsive Disorder (e.g., fear of dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., avoidance of stimuli associated with a severe stressor), Separation Anxiety Disorder (e.g., avoidance of school), Social Phobia (e.g., avoidance of social situations because of fear of embarrassment), Panic Disorder With Agoraphobia, or Agoraphobia Without History of Panic Disorder. |
|
|
Term
social phobia
(social anxiety disorder) |
|
Definition
| he essential feature of Social Phobia is a marked and persistent fear of social or performance situations in which embarrassment may occur (Criterion A). Exposure to the social or performance situation almost invariably provokes an immediate anxiety response (Criterion B). This response may take the form of a situationally bound or situationally predisposed Panic Attack (see page 430). Although adolescents and adults with this disorder recognize that their fear is excessive or unreasonable (Criterion C), this may not be the case with children.Most often, the social or performance situation is avoided, although it is sometimes endured with dread (Criterion D). The diagnosis is appropriate only if the avoidance, fear, or anxious anticipation of encountering the social or performance situation interferes significantly with the person's daily routine, occupational functioning, or social life, or if the person is markedly distressed about having the phobia (Criterion E). |
|
|
Term
| social phobia in children |
|
Definition
Transient social anxiety or avoidance is especially common in childhood and adolescence (e.g., an adolescent girl may avoid eating in front of boys for a short time, then resume usual behavior). In those younger than age 18 years, only symptoms that persist for at least 6 months qualify for the diagnosis of Social Phobia.
they must have at least one age-appropriate social relationship with someone outside the immediate family (e.g., a child who feels uncomfortable in social gatherings with peers and avoids such situations, but who has an active interest in and a relationship with one familiar same-age friend). |
|
|
Term
| general info of social phobia |
|
Definition
ndividuals with Social Phobia, Generalized, usually fear both public performance situations and social interactional situations.
When Panic Attacks do occur, they take the form of situationally bound or situationally predisposed Panic Attacks (e.g., a person with fear of embarrassment when speaking in public experiences Panic Attacks cued only by public speaking or other social situations). |
|
|
Term
| prevalence and lab findings of social phobia |
|
Definition
no lab test for this
conflicting info about mostly males/females
onset mid teens-can immerge from childhood shyness
may follow stressful or humiliating experience or it may be insidious.
Course usually continuous
strong association among first-degree relatives
To make the diagnosis in children, there must be evidence of capacity for social relationships with familiar people and the social anxiety must occur in peer settings, not just in interactions with adults. Because of the disorder's early onset and chronic course, impairment in children tends to take the form of failure to achieve an expected level of functioning, rather than a decline from an optimal level of functioning. In contrast, when the onset is in adolescence, the disorder may lead to decrements in social and academic performance. |
|
|
Term
| agoraphobia vs. social phobia |
|
Definition
When Panic Attacks do occur, they take the form of situationally bound or situationally predisposed Panic Attacks (e.g., a person with fear of embarrassment when speaking in public experiences Panic Attacks cued only by public speaking or other social situations).
The situations avoided in Social Phobia are limited to those involving possible scrutiny by other people.
The role of a companion also may be useful in distinguishing Social Phobia from Agoraphobia (With and Without Panic Disorder).
A person with Social Phobia who fears crowded stores would feel scrutinized with or without a companion and might be less anxious without the added burden of perceived scrutiny by the companion.
A person with Social Phobia who fears crowded stores would feel scrutinized with or without a companion and might be less anxious without the added burden of perceived scrutiny by the companion. |
|
|
Term
| specific key in social phobia |
|
Definition
| in Social Phobia the potential evaluation by others is the key to the anxiety. |
|
|
Term
| generalized anxiety disorder in children |
|
Definition
| have excessive worries about the quality of their performance, but these occur even when they are not evaluated by others, |
|
|
Term
key elements of pervasive developmental disorder
and schizoid personality disorder |
|
Definition
| social situations are avoided because of lack of interest in relating to other individuals. In contrast, individuals with Social Phobia have a capacity for and interest in social relationships with familiar people |
|
|
Term
| avoidant personality disorder |
|
Definition
| shares a number of features with Social Phobia and appears to overlap extensively with Social Phobia, Generalized. May be a more severe variant of Social Phobia, Generalized, that is not qualitatively distinct. For individuals with Social Phobia, Generalized, the additional diagnosis of Avoidant Personality Disorder should be considered. |
|
|
Term
| other disorders sharing charact. with social phobia |
|
Definition
| Major Depressive Disorder, Dysthymic Disorder, Schizophrenia, Body Dysmorphic Disorder). If the symptoms of social anxiety or avoidance occur only during the course of another mental disorder and are judged to be better accounted for by that disorder, the additional diagnosis of Social Phobia is not made. |
|
|
Term
|
Definition
Some individuals may experience clinically significant social anxiety and avoidance related to a general medical condition or mental disorder with potentially embarrassing symptoms (e.g., tremor in Parkinson's disease, Stuttering,). However, if social anxiety and avoidance are limited to concerns about the general medical condition or mental disorder, by convention the diagnosis of Social Phobia is not made.
If the social avoidance is clinically significant, a separate diagnosis of Anxiety Disorder Not Otherwise Specified may be given. |
|
|
Term
|
Definition
| persistent ideas, thoughts, impulses, or images that are experienced as intrusive and inappropriate and that cause marked anxiety or distress. |
|
|
Term
|
Definition
| he intrusive and inappropriate quality of the obsessions has been referred to as "ego-dystonic." This refers to the individual's sense that the content of the obsession is alien, not within his or her own control, and not the kind of thought that he or she would expect to have. However, the individual is able to recognize that the obsessions are the product of his or her own mind and are not imposed from without (as in thought insertion). |
|
|
Term
| most common obsessions in OCD |
|
Definition
repeated thoughts about contamination
repeated doubts
a need to have things in a particular order
aggressive or horrific impulses
sexual imagery |
|
|
Term
|
Definition
repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) the goal of which is to prevent or reduce anxiety or distress, not to provide pleasure or gratification.
are either clearly excessive or are not connected in a realistic way with what they are designed to neutralize or prevent. T |
|
|
Term
|
Definition
| his specifier can be applied when, for most of the time during the current episode, the individual does not recognize that the obsessions or compulsions are excessive or unreasonable. |
|
|
Term
|
Definition
In children, it may also be associated with Learning Disorders and Disruptive Behavior Disorders. There is a high incidence of it in children and adults with Tourette's Disorder. The incidence of Tourette's Disorder in Obsessive-Compulsive Disorder is lower Between 20% and 30% of individuals with it have reported current or past tics.
Children generally do not request help, and the symptoms may not be ego-dystonic. |
|
|
Term
|
Definition
equally common in males and females
childhood-onset is more common in boys
usually begins in adolescence or early adulthood
6-15 boys
20-29 females
chronic waxing, waning
symptoms may show more with stress
familial pattern with first degree biological relatives |
|
|
Term
| generalized anxiety disorder vs OCD |
|
Definition
GAD is excessive worry about real-life circumstances.
OCD-obsessions are inappropriate by the individual EX: intrusive distressing idea that GOD is dog spelled backward. |
|
|
Term
|
Definition
| individual's sense that the content of obsession is alien, not with in his or her own control and not the kind of thought that he or she would expect to have |
|
|
Term
|
Definition
| sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization |
|
|
Term
|
Definition
| repetitive, seemingly driven nonfunctional motor behavior |
|
|
Term
| Obsessive-Compulsive Personality Disorder (OCPD) |
|
Definition
no obsessions or compulsions
pervasive pattern of preoccupation with orderliness, perfectionism and control and must begin by early adulthood.
DX of both OCD and OCPD can be given |
|
|
Term
| superstitions and repetitive checking behaviors |
|
Definition
| A diagnosis of Obsessive-Compulsive Disorder should be considered only if they are particularly time consuming or result in clinically significant impairment or distress. |
|
|
Term
|
Definition
A. Either obsessions or compulsions:
Obsessions as defined by (1), (2), (3), and (4):
(1) recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress
(2) the thoughts, impulses, or images are not simply excessive worries about real-life problems
(3) the person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action
(4) the person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion)
Compulsions as defined by (1) and (2):
(1) repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly
(2) the behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive
B. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. Note: This does not apply to children.
C. The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person's normal routine, occupational (or academic) functioning, or usual social activities or relationships.
D. If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g., preoccupation with food in the presence of an Eating Disorder; hair pulling in the presence of Trichotillomania; concern with appearance in the presence of Body Dysmorphic Disorder; preoccupation with drugs in the presence of a Substance Use Disorder; preoccupation with having a serious illness in the presence of Hypochondriasis; preoccupation with sexual urges or fantasies in the presence of a Paraphilia; or guilty ruminations in the presence of Major Depressive Disorder). |
|
|
Term
|
Definition
| person does not recognize that the obsessions and compulsions are excessive or unreasonable. |
|
|
Term
|
Definition
should be used when the duration of symptoms is less than 3 months
chronic is 3 months or longer
delayed onset indicates at least 6 months have passed between the traumatic event and the onset of the symptoms. |
|
|
Term
|
Definition
| increased rates of Major Depressive Disorder, Substance-Related Disorders, Panic Disorder, Agoraphobia, Obsessive-Compulsive Disorder, Generalized Anxiety Disorder, Social Phobia, Specific Phobia, and Bipolar Disorder. These disorders can either precede, follow, or emerge concurrently with the onset of Posttraumatic Stress Disorder. |
|
|
Term
| lab findings and GMC with PTSD |
|
Definition
| Physical injuries may occur as a direct consequence of the trauma. In addition, chronic Posttraumatic Stress Disorder may be associated with increased rates of somatic complaints and, possibly, general medical conditions. |
|
|
Term
|
Definition
distressing dreams
repetitive play of event
should watch for diminished affect or loss of interest in activities
"omen formation"-belief in an ability to foresee future untoward events.
physical symptoms-stomachaches, headeaches |
|
|
Term
| most important factors in PTSD |
|
Definition
severity
duration
proximity
of exposure to the traumatic event |
|
|
Term
|
Definition
symptom pattern must occur within 4 weeks of the traumatic event and resolve within that 4 week period. If symptoms persist then it must be PTSD.
should only be considered if the symptoms last at least 2 days and cause clinically significant distress or impairment in social, occupational, or other important areas of functioning or impair the individual's ability to pursue some necessary task
he essential feature of Acute Stress Disorder is the development of characteristic anxiety, dissociative, and other symptoms that occurs within 1 month after exposure to an extreme traumatic stressor.
Either while experiencing the traumatic event or after the event, the individual has at least three of the following dissociative symptoms: a subjective sense of numbing, detachment, or absence of emotional responsiveness; a reduction in awareness of his or her surroundings; derealization; depersonalization; or dissociative amnesia
Following the trauma, the traumatic event is persistently reexperienced (Criterion C), and the individual displays marked avoidance of stimuli that may arouse recollections of the trauma |
|
|
Term
|
Definition
| a "lingering" of something for some benefit such as financial, benefit eligibility and forensic determinations play a role. |
|
|
Term
|
Definition
A. The person has been exposed to a traumatic event in which both of the following were present:
(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
(2) the person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior
B. The traumatic event is persistently reexperienced in one (or more) of the following ways:
(1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
(2) recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.
(3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.
(4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
(5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:
(1) efforts to avoid thoughts, feelings, or conversations associated with the trauma
(2) efforts to avoid activities, places, or people that arouse recollections of the trauma
(3) inability to recall an important aspect of the trauma
(4) markedly diminished interest or participation in significant activities
(5) feeling of detachment or estrangement from others
(6) restricted range of affect (e.g., unable to have loving feelings)
(7) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)
D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
(1) difficulty falling or staying asleep
(2) irritability or outbursts of anger
(3) difficulty concentrating
(4) hypervigilance
(5) exaggerated startle response
E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.
F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. |
|
|
Term
| generalized anxiety disorder |
|
Definition
The essential feature of Generalized Anxiety Disorder is excessive anxiety and worry (apprehensive expectation), occurring more days than not for a period of at least 6 months, about a number of events or activities (Criterion A)
The anxiety and worry are accompanied by at least three additional symptoms from a list that includes restlessness, being easily fatigued, difficulty concentrating, irritability, muscle tension, and disturbed sleep (only one additional symptom is required in children)
Children with Generalized Anxiety Disorder tend to worry excessively about their competence or the quality of their performance. During the course of the disorder, the focus of worry may shift from one concern to another. |
|
|
Term
| comorbidity of generalized anxiety disorder |
|
Definition
| frequently co-occurs with mood disorders and with substance-related disorders and other GMC that accompany stress |
|
|
Term
| occurrence of general anxiety disorder |
|
Definition
more in women
onset childhood or adolescence can occur after age 20
fluctuates
family heritage |
|
|
Term
| generalized anxiety on axis I |
|
Definition
hen another Axis I disorder is present, an additional diagnosis of Generalized Anxiety Disorder should be made only when the focus of the anxiety and worry is unrelated to the other disorder, that is, the excessive worry is not restricted to having a Panic Attack
For example, the anxiety present in Social Phobia is focused on upcoming social situations in which the individual must perform or be evaluated by others, whereas individuals with Generalized Anxiety Disorder experience anxiety whether or not they are being evaluated. |
|
|
Term
| dx of generalized anxiety disorder |
|
Definition
A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).
B. The person finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months). Note: Only one item is required in children.
(1) restlessness or feeling keyed up or on edge
(2) being easily fatigued
(3) difficulty concentrating or mind going blank
(4) irritability
(5) muscle tension
(6) sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep) |
|
|
Term
|
Definition
| apprehension of danger and dread accompanied by restlessness, tachycardia, and dyspnea unattached to a clearly identifiable stimulus |
|
|
Term
|
Definition
fear is an alerting response to a known external, definite threat
Anxiety is a response to a threat that is unknown, vague, internal and can lead to conflicted feelings. |
|
|
Term
| number of anxiety disorders in the DSM |
|
Definition
|
|
Term
| classification of anxiety disorders on Axis |
|
Definition
|
|
Term
|
Definition
irrational fears that lead individuals to often avoid certain objects and specific situations all together.
dx requires marked and persistent fear which is considered excessive or unreasonable in the face of the object or situation.
should see own fear as excessive or unreasonable
interferes with life
in kids under 18 must be present for at least 6 months |
|
|
Term
| condition similar to social phobia that must be closely viewed as well |
|
Definition
| avoidant personality disorder |
|
|
Term
| 5 ways of recurrence of events in PTSD |
|
Definition
1. intrusive, recurrent and distressing recollections of the event which may include images, thoughts or perceptions
2.recurrent dreams that cause distress
3. experiencing hallucinations, reliving the experience,illusions, or dissociative experiences
4. psych. distress that is intense when experiencing internal or external cues that are symbolic of or are similar to a part of the traumatic event
5. physiologic reaction upon exposure to internal or external cues that are symbolic of or are similar to a part of the traumatic event. |
|
|
Term
| characteristics of those with PTSD |
|
Definition
1. attempt to not think about, discuss fell anything related to trauma
2. avoidance of activities, locations or individuals who may facilitate recollection of the traumatic experience
3. inability to recall events or aspects of the trauma
4. significant decrease in interest or participation in activities that were once identified as meaningful
5. feelings of estrangement or detachment from other people
6. limitations in the individual's affective range
7. limited ability to view future or viewing the future as shortened
must demonstrate 3 of these |
|
|
Term
| symptoms that may present with PTSD |
|
Definition
*difficulty attaining or maintaining sleep
*irritability or angry outbursts
*concentration difficulties
*hyper vigilance
*startle response that is exaggerated |
|
|
Term
| characteristics of those with general anxiety disorder |
|
Definition
*feelings of being on edge, restless or keyed up
*becoming easily fatigued
*feeling as if his or her mind is going bland and difficulty with concentration
*irritability
*tension in muscles
*difficulty with sleep, which can include falling asleep, staying asleep or restless sleep |
|
|
Term
| high incidence of comorbidity |
|
Definition
general anxiety disorder with social phobia
social phobia with avoidant personality disorder
PTSD with mood disorders, another anxiety disorder and substance misuse
anxiety disorders can coexist with cancer and heart disease as well. |
|
|
Term
| three schools of psychosocial theory contributing to understanding anxiety |
|
Definition
psychoanalytic
behavioral
existential |
|
|
Term
| biological thought on anxiety disorders |
|
Definition
reduced GABA levels causes CNS hyperactivity.
decrease in serotonin
increased dopaminergic activity
decreased temporal activity
dysregulation of neurotransmitters esp. serotonin |
|
|
Term
| psychoanalytic perspective of anxiety disorders |
|
Definition
individual attempts to repress childhood fears and whe this fails other defense mechanisms take over ex: avoidance
traumatic experience reactivates an unresolved psychological conflict. This results in the use of defenses including repression, regression, denial, splitting, dissociation, guilt, reaction formation and undoing.
Have unresolved unconscious conflicts |
|
|
Term
| behavioral theory of anxiety disorders |
|
Definition
anxiety is a response that is learned from exposure to parental behavior or through the process of classical conditioning.
include faulty, distored or counterproductive thinking patterns.
Learned through classical conditioning and observational learning and maintained through operant conditioning.
This is significant in the treatment of phobias and provide clear explanation for many symptoms experienced by the phobic individual. |
|
|
Term
| OCD through learning theory |
|
Definition
obsessions are viewed as conditioned stimuli and are paired through fear and anxiety with an event that is noxious or anxiety producing.
Compulsions are viewed as mechanisms that reduce anxiety attached to an obsessive thought. Over time the compulsions become less effective in reducing the anxiety. |
|
|
Term
| cognitive behavioral perspective on PTSD |
|
Definition
| person can't process or rationalize the traumatic experience that caused the diagnosis. The individual continues to experience and re-experience the stress and ineffectively use avoidance as a mechanism for dealing with the stressful experience. |
|
|
Term
| cognitive behavioral view of general anxiety disorder |
|
Definition
person has an incorrect and inaccurate perception of danger.
This inaccuracy is facilitated by selective attention to negative info. within the environment, distortion in info. processing and an inability to cope. |
|
|
Term
| existential perspective of anxiety (general disorder) |
|
Definition
no one specifically identifiable stimulus that facilitates the feeling of chcronic anxiety in an individual. Anxiety, occurs when the individual becomes aware of profound feelings of a lack of meaning in their lives.
OTs are well suited to address anxiety from an existential perspective as we critically examine meaning and occupation in an person's life.
This is increasing with the threats of bioterrorism, nuclear attacks. |
|
|
Term
|
Definition
not just stress alone
biological
psychological factors before during and after |
|
|
Term
| number of people with anxiety that seek treatment |
|
Definition
|
|
Term
| gender diffs in panic disorder |
|
Definition
women 2-3x more likely to be diagnosed with this
male to female ration for panic disorder without agoraphobia 1:1
agoraphobia 1:2
mean age for panic disorder is 25
most common mental disorder in the US specific phobia 5-10% of pop |
|
|
Term
| work related issues with anxiety disorders |
|
Definition
annual incidence of GAD is 16%
costs to workplace are attributed to lost productivity rather than absenteeism |
|
|
Term
| most common mental disorder in women |
|
Definition
|
|
Term
| most common mental disorder in men |
|
Definition
| substance-related disorders with specfic phobia being second |
|
|
Term
|
Definition
20 but can occur at any age
singles affected more than married
less often in blacks then whites
male to female ratio 1:1
boys more affected in adolescence |
|
|
Term
|
Definition
1:2
lifetime prevalence of 5% |
|
|
Term
| increased risk for comorbidity of panic disorder |
|
Definition
| those who reported childhood physical abuse were more likely to have additional comorbid Axis I diagnoses including depression and higher likelihood of attempting suicide |
|
|
Term
|
Definition
|
|
Term
|
Definition
DSM-IV-TR
Rorschach
bender-gestalt draw a person
minnesota multiphasic personality inventory
state trait anxiety inventory
hamilton anxiety rating scale
There are no lab test |
|
|
Term
| increased risks with panic disorder |
|
Definition
depression and agoraphobia
higher risk if live alone
history of a recent divorce or separation
more common in young and middle adults
depression and substance abuse lead poor prognosis |
|
|
Term
| treatment of panic disorder |
|
Definition
considered chronic
panic disorder severity scale used to ID severity
responding to recurrence can prevent relapse
full remission of all symptoms is goal
6 mos+ symptom free considered to no longer have |
|
|
Term
| most common phobia among women |
|
Definition
|
|
Term
| most common phobia among men |
|
Definition
| fear of heights (acrophobia) |
|
|
Term
| phobias that peak at childhood |
|
Definition
animal
natural environment
blood-injection
others peak in early adulthood |
|
|
Term
| main concerns with social phobia |
|
Definition
public and professionals tend to trivialize
comorbity with depression, substance abuse, avoidant personality disorder, panic dis. and GAD |
|
|
Term
| 4 categories for treatment of severe mental illness |
|
Definition
recommendations
comprehensive treatment options
algorithms
expert consensus guidelines |
|
|
Term
| most stringent treatment options |
|
Definition
patient outcomes research team (PORT)
contain very specific evidence of efficacy of treatment interventions that supported the utilization of these interventions
APA did not require the evidence considered for inclusion
PORT endorse use of SREIs as a first line medication for the treatment of PTSD |
|
|
Term
|
Definition
single set of rules used used when solving a problem
provide practitioners a step by step approach to clinical decisions
Texas Medication Algorithm project has the most extensive collection of medication algorithms for persons with mental illness |
|
|
Term
|
Definition
|
|
Term
| expert consensus guidlelines |
|
Definition
recommendations based upon surveys completed by a comprehensive array of experts in the treatment of identified conditions.
exist for OCD and PTSD
guidelines do not rely on critical analysis of research lit. |
|
|
Term
| anxiety patient statistics |
|
Definition
3-5x more likely to seek care of physician
6x more likely to be hospitalized for a psychiatric disorder |
|
|
Term
| ultimate goal of treatment |
|
Definition
|
|
Term
| treatments for anxiety disorder |
|
Definition
pharmacologic and psychological interventions
Except phobia- no known meds for treatment |
|
|
Term
|
Definition
| we work with them to relieve the anxiety and to reestablish meaningful daily routines-this can lead to adaptation-improved health and wellness |
|
|
Term
cautions with benzodiazepines
treat anxiety disorders |
|
Definition
pts on these can:
become addicted
higher risk of falls-side effects affect balance
sedation
fatigue
cogn. and memory impairments
delayed reactions
impaired balance and coordination
hangover effects
withdrawal
abuse potential |
|
|
Term
| cognitive behavioral interventions by APA suggested for panic disorder |
|
Definition
psychoeducation
panic monitoring
breathing monitoring
anxiety management skill development
cognitive restructuring
vivo exposure |
|
|
Term
| ots assist those with Panic Disorder |
|
Definition
in area of IADLs
leaving the house
relaxation techniques taught |
|
|
Term
| 5 cognitive behavioral treatments for social phobia |
|
Definition
exposure therapy
cognitive restructuring
exposure therapy coupled with cognitive restructuring
social skills training
relaxation
no diffs found between treatments-effectiveness |
|
|
Term
| obstacles to treatment of phobias |
|
Definition
*individual avoids treatment due to fear, shame,stigma
*limited screening to dx
*treatment ends up being directed toward somatic complaints instead of phobic syndrome
*physicians lack knowledge of treatment options or trivialize concerns |
|
|
Term
| most effective treatments for phobia |
|
Definition
cognitive behavior
and exposure therapy together highest success |
|
|
Term
| treatment guidelines for OCD |
|
Definition
cognitive behavioral strategies
medications
maintenance of treatment
treatment of comorbidiities
minimizing side effects |
|
|
Term
| Most useful intervention in treating OCD |
|
Definition
| exposure and response prevention |
|
|
Term
treatment used for intrusive thoughts
both PTSD and OCD |
|
Definition
|
|
Term
| focus of cognitive therapy |
|
Definition
| focus on assisting people in modifying their unrealistic assumptions, beliefs and automatic thoughts. |
|
|
Term
| effective intervention for PTSD |
|
Definition
exposure therapy
play therapy
psychoeducation |
|
|
Term
|
Definition
8 weeks of cogn. behavioral
focusing on education, lifestyle alterations focusin on how the external environmental influences internal feelings. |
|
|
Term
| areas affected by global mental functions |
|
Definition
|
|
Term
| areas of specific mental functions affected |
|
Definition
attention
reduced recall (memory)
impaired ability to make associations
time management
problem solving
decision making
emotional functions in the area of self control |
|
|
Term
|
Definition
client motivation is huge factor
ADLs, IADLs all affected
Performance Patterns affected |
|
|
Term
|
Definition
adl
iadl
roles
routines and habits
process skills
denial is common and refusal of assistance |
|
|
Term
|
Definition
all domains
ADL
IADL
Perfornance patterns
performance skills
context
see framework |
|
|
Term
|
Definition
Panic Disorder Without Agoraphobia
Panic Disorder With Agoraphobia
Agoraphobia Without Hx of Panic Disorder
Specific Phobias
Social Phobias
Obsessive Compulsive Disorders
Posttraumatic Stress Disorder
Acute Stress disorder
Generalized Anxiety Disorder
Anxiety Disorder Due To General Medical Condition
Anxiety Disorder NOS |
|
|
Term
| panic attack mary's slide |
|
Definition
“sudden onset of intense apprehension, fear terror or impending doom accompanied by increased autonomic nervous system activity and by various constitutional disturbances, depersonalization, and derealization”
Discrete period
Not a psychiatric diagnosis
Building block of disorders
Unrealistic fear of “going crazy”, choking, smothering sensations, etc. |
|
|
Term
|
Definition
| experiencing something that is OK with you. |
|
|
Term
|
Definition
|
|
Term
|
Definition
Biologic
Psychodynamic-childhood, unconscious
Behavioral-paired an event and feeling inappropriately-faulty learning
Cognitive Behavioral-faulty thoughts that lead to the behavior |
|
|
Term
|
Definition
Medications
Teaching Breathing Techniques
Encouraging avoidance of caffeine
Facilitation of regular exercise
Values exploration
Teaching assertive refusal of requests
Assisting with time management
Identifying antecedent events and changing patterns to avoid anxiety
Teaching progressive muscle relaxation and relaxation techniques using imagery
Using distraction
Engaging in occupations
Decrease catastrophic interpretations
Increase self esteem
Help to identify the earliest signs of stress and anxiety and intervene before it builds to dysfunctional levels
Direct anxiety to socially acceptable outlets such as repetitive crafts
Identify and build on strengths
Help to tolerate imperfection
Explore control issues
Help to resume ADL
Help to resume IADL
Help to resume work tasks
Help to resume or develop leisure skills
Help to build social support system |
|
|
