Your SlideShare is downloading. ×
Anxiety disorders in  adults 2005
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Anxiety disorders in adults 2005

2,045

Published on

This is a PowerPoint presentation on Anxiety Disorders.

This is a PowerPoint presentation on Anxiety Disorders.

0 Comments
3 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
2,045
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
144
Comments
0
Likes
3
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 61 PSYCHIATRIC DISORDERS IN PRIMARY CARE
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 58 PSYCHIATRIC DISORDERS IN PRIMARY CARE
  • 59 PSYCHIATRIC DISORDERS IN PRIMARY CARE
  • 60 PSYCHIATRIC DISORDERS IN PRIMARY CARE
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 02/24/11
  • 62 PSYCHIATRIC DISORDERS IN PRIMARY CARE
  • 8 PSYCHIATRIC DISORDERS IN PRIMARY CARE
  • 9 PSYCHIATRIC DISORDERS IN PRIMARY CARE
  • 10 PSYCHIATRIC DISORDERS IN PRIMARY CARE
  • Transcript

    • 1. ANXIETY DISORDERS IN CHILDREN & ADULTS THEORY DIAGNOSIS TREATMENT
    • 2. Pharmacological response to medications designed to treat anxiety disorders is NOT evidence or proof of ETIOLOGY.
    • 3. FEAR VERSUS ANXIETY
      • FEAR
      • OBJECTIVE
      • PAST EXPERIENCE WITH STRESSOR
      • KNOWN PROBALITY OF HARM
      • ANXIETY
      • SUBJECTIVE
      • FUTURE ORIENTED
      • UNKNOWN HOW ONE WILL BE HARMED
    • 4. NORMAL VERSUS ABNORMAL ANXIETY
      • LEVEL OF ANXIETY
      • SOME LEVEL OF ANXIETY NECESSARY TO CREATE MOTIVATION
      • HIGH LEVELS OF ANXIETY RESULT IN INTERFERENCE WITH PERFORMANCE
      • HIGH LEVELS OF ANXIETY RESULT IN HIGH LEVEL OF COGNITIVE & PHYSIOLOGICAL AROUSAL
    • 5. NORMAL VERSUS ABNORMAL ANXIETY
      • JUSTIFICATION
      • ANY LEVEL OF ANXIETY WOULD BE CONSIDERED ABNORMAL IF NO RATIONAL JUSTIFICATION EXISTS FOR THE SITUATION TO TRIGGER ANXIETY.
      • PERCEPTION OF THE EVENT AS THREATENING TO THE INDIVIDUAL’S SAFETY IS KEY .
    • 6. NORMAL VERSUS ABNORMAL ANXIETY
      • INTERFERENCE IN FUNCTIONING
      • ANXIETY IS ABNORMAL IF IT CAUSES ANY
      • IMPAIRMENT IN FUNCTIONING IN ANY LIFE AREA:
      • (1) SOCIAL
      • (2) OCCUPATIONAL
      • (3) PHYSICAL
      • (4) RECREATIONAL
    • 7. PREVALENCE & INCIDENCE OF ANXIETY DISORDERS
      • MOST COMMON MENTAL DISORDER IN UNITED STATES.
      • 15%-TO-17% OF ADULT POPULATION SUFFER FROM 1 OR MORE ANXIETY DISORDERS.
      • 23 MILLION HAVE ONE FORM OF THE 6 ANXIETY DISORDERS
      • 5% -TO-10% OF SCHOOL AGE CHILDREN HAVE AN ANXIETY RELATED DISORDER.
    • 8. PREVALENCE & INCIDENCE OF ANXIETY DISORDERS
      • 26% SUFFER FROM 2 OR MORE INDEPENDENT ANXIETY DISORDERS.
      • 19% SUFFER FROM ONLY 1 ANXIETY DISORDER.
      • 55% SUFFERED FROM MULTIPLE DISORDERS, ONE OF WHICH HELPED CAUSE THE OTHERS.
    • 9. ANXIETY DISORDERS
      • Generalized Anxiety Disorder
      • Panic Disorder
      • Obsessive-Compulsive Disorder
      • Post-Traumatic Stress Disorder
      • Specific Phobia
      • Social Phobia
      • Agoraphobia w/o Panic Attacks
      • Agoraphobia with Panic Attacks
    • 10. ANXIETY DISORDERS
      • Anxiety Disorder Due to a General Medical Condition
      • Substance Induced Anxiety Disorder
      • Anxiety Disorder NOS
      • Mixed Anxiety-Depressive Disorder
    • 11. GENERALIZED ANXIETY DISORDER THEORY DIAGNOSIS TREATMENT
    • 12. Epidemiology of Generalized Anxiety Disorder
      • One-year prevalence rate is approximately 3% of adults.
      • Life-time prevalence rate approximately 5%.
      • 25% of GAD patients present with comorbid condition:
      • Depression
      • Panic Disorder
      • Substance abuse
      • Hypochondriasis
      • Personality Disorder
    • 13. Epidemiology of Generalized Anxiety Disorder
      • Half of pts presenting for treatment report onset in childhood or adolescence.
      • In children, Over-anxious Disorder of Childhood
      • Gender ratio is approximately 2-to-1 females
      • Course of disorder is CHRONIC but fluctuates & often WORSENS during periods of stress.
      • familial association
    • 14. PSYCHOANALYTIC EXPLANATION OF GAD & PANIC DISORDERS
      • INTERNAL CONFLICTS ARE SOURCE OF BOTH DISORDERS
      • UNCONSCIOUS IMPULSES THREATEN EXPRESSION
      • ANXIETY IS ALARM THAT DEFENSES ARE ABOUT TO BREAK DOWN.
      • SINCE NO FOCUS FOR DEFENSE, ANXIETY SYMPTOMS ARE RESULT OF UNSUCCESSFUL DEFENSE AGAINST ANXIETY PROVOKING IMPULSES .
    • 15. COGNITIVE THEORY OF GENERALIZED ANXIETY DISORDER
      • Beck (1991) - People with GAD constantly make unrealistic assumptions that they are in imminent danger :
      • a. ANY STRANGE SITUATION SHOULD BE REGARDED AS DANGEROUS .
      • b. A SITUATION OR PERSON IS UNSAFE UNTIL PROVEN SAFE.
      • c. IT IS ALWAYS BEST TO ASSUME THE WORST .
      • d. MY SECURITY & SAFETY DEPEND ON ANTICIPATING & PREPARING MYSELF AT ALL TIMES FOR ANY POSSIBLE DANGER.
    • 16. GABA & ANXIETY DISORDERS
      • Research points to a problem in feedback system can cause fear or anxiety to go unchecked (Lloyd, 1992).
      • GABA is released to exert inhibitory action on excitatory activity of neurons.
      • A second site on GABA A receptor binds with benzodiazepines.
      • People with GAD may have ongoing problems with anxiety feedback system.
    • 17. GABA A Receptor with Binding Sites
    • 18. GABA & GENERALIZED ANXIETY DISORDER
    • 19. GABA & ANXIETY DISORDERS
      • Brain supplies of GABA too low.
      • May have too few GABA A receptors.
      • GABA A receptors do not readily bind neurotransmitter.
      • Brain may be releasing an excess of other chemicals reducing GABA activity at receptor sites.
    • 20. ASSESSMENT OF GAD
      • SCREENING TOOLS
      • Anxiety Screening Questionnaire (15 items)
      • Primary Care Evaluation of Mental Disorders
      • (PRIME-MD)
      • Hamilton Anxiety & Depression Scale
      • Beck Anxiety Scale
      • Center for Epidemiological Studies Depression Scale
      • (CESD)
      • Hospital Anxiety & Depression Scale
    • 21. ASSESSMENT OF GAD
      • INTERVIEWING QUESTIONS:
      • “ During the past 4 weeks, have you been bothered by feeling worried, tense, or anxious MOST of the time?”
      • “ Are you frequently tense, irritable, and have trouble sleeping?”
      • If either answered YES, further investigation is warranted.
    • 22. TREATMENT OF GAD IN PRIMARY CARE
      • Treatment options – Most efficaciously treated by combination of CBT & Pharmacotherapy
      • Cognitive-Behavior Therapy
      • Reframing
      • Cognitive Restructuring
      • Identifying Anxiety Triggers
      • Cognitive Rehearsal
      • Stress-Inoculation
    • 23. TREATMENT OF GAD IN PRIMARY CARE
      • Pharmacotherapy
      • SSRI
      • Paroxetine (Paxil) only FDA for GAD
      • Fluoxetine (Prozac)
      • Sertraline (Zoloft)
      • Citalopram (Celexa)
      • Fluvoxamine (Luvox)
      • See Table 11.4 in Kaplan & Saddock for dosing.
    • 24. TREATMENT OF GAD IN PRIMARY CARE
      • Pharmacotherapy – SSRI
      • Advantages of SSRI
      • Few side effects
      • Not addictive/dependence liability
      • Treats co-morbid depression
      • Once daily dosing
      • Low sedation effect
    • 25. TREATMENT OF GAD IN PRIMARY CARE
      • Pharmacotherapy – SSRI
      • Disadvantages of SSRI
      • Patient does not experience symptom attentuation with single dose
      • Several weeks to full therapeutic effects
      • Gastrointestinal and Sexual side-effects common
    • 26. TREATMENT OF GAD IN PRIMARY CARE
      • SNRI Venaflaxine Hydrochloride (Effexor XR)
      • Approved by FDA
      • Reduces symptoms of:
      • anxious mood
      • excessive motor tension
      • restlessness
      • insomnia
      • irritablility
      • poor concentration
    • 27. TREATMENT OF GAD IN PRIMARY CARE
      • SNRI Venaflaxine Hydrochloride (Effexor XR)
      • Common side effects:
      • asthenia somnolence
      • nausea tremor
      • constipation abnormal ejaculation/orgasm
      • Patient does not experience symptom attentuation with single dose
      • Several weeks to full therapeutic effects.
    • 28. TREATMENT OF GAD IN PRIMARY CARE
      • Nonbenzodiazepine agent – Buspirone (Buspar)
      • It is a 5-HT 1A receptor partial agonist.
      • More effective in reducing cognitive symptoms than somatic symptoms of GAD.
      • Less addictive potential associated with its use.
      • Indicated if patient has co-morbid substance use disorder.
    • 29. TREATMENT OF GAD IN PRIMARY CARE
      • Nonbenzodiazepine agent – Buspirone (Buspar)
      • Patients who had used benzodiazepines are not likely to respond to Buspirone.
      • Lack or absence of anxiolytic effects (muscle relaxation & sense of well being) may be contributing factor.
      • Effects take 2-to-3 weeks to become evident.
    • 30. Treatment of GAD
      • BENZODIAZEPINES
      • ALPRAZOLAM XANAX
      • CHLORDIAZEPOXIDE LIBRIUM
      • CLONAZEPAM KLONOPIN
      • CLORAZAPATE TRANZENE
      • DIAZEPAM VALIUM
      • LORAZEPAM ATIVAN
      • OXAZEPAM SERAX
      • PRAZEPAM CENTREX
    • 31. TREATMENT OF GAD IN PRIMARY CARE
      • Pharmacotherapy – Benzodiazepines
      • Advantages
      • Therapeutic effect in single dose
      • Time to full therapeutic effect in days.
      • Anxiolytic effect of medications helps reduce somatic symptoms of GAD
    • 32. TREATMENT OF GAD IN PRIMARY CARE
      • Pharmacotherapy – Benzodiazepines
      • Disddvantages
      • Impaired alertness & motor performance
      • High addictive or dependence liability
      • Does not treat co-morbid depression
      • Requires several doses per day
      • High sedation effect
      • Memory impairment
    • 33. TREATMENT OF GAD IN PRIMARY CARE
      • Pharmacotherapy – Benzodiazepines
      • Most common clinical mistake is to routinely continue treatment INDEFINITELY.
      • Treatment may be minimum of 6 months-to-1 year so consideration of other medications who seem warranted.
      • Start treatment with benzodiazepine & buspirone & taper off benzodiazepine when buspirone reaches maximum effect ( 2-to-3 weeks).
    • 34. PANIC DISORDER THEORY DIAGNOSIS TREATMENT
    • 35. Epidemiology of Panic Disorder
      • One-year prevalence rate is approximately 1.5% of adults.
      • Life-time prevalence rate approximately 3.5%.
      • Panic Disorder patients present with comorbid condition:
      • Major Depression GAD
      • Substance abuse OCD
      • Specific Phobia Agoraphobia
      • Social Phobia PTSD
    • 36. Epidemiology of Generalized Anxiety Disorder
      • Typically onset between adolescence & mid-30’s.
      • Females 3X more likely to have PD with agoraphobia
      • Males 2X more likely to have PD W/O agoraphobia
      • Course of disorder is CHRONIC but waxing & waning.
      • 1 st degree biological relatives are 8 times more likely to develop panic disorder.
      • If onset before age 20, 20 times more likely
    • 37. NOREPINEPHERINE & PANIC DISORDERS
      • Research has focused upon abnormal norepinepherine activity in locus coeruleus.
      • Function of locus coeruleus is to send messages to amygdala (limbic system) that is known to trigger emotional reactions.
      • Studies have indicated that locus coerulus is involved in activating certain behaviors such as increased vigilance.
    • 38. NOREPINEPHERINE & PANIC DISORDERS
      • Over-activity in nordrenergic system has been linked to panic disorder.
      • Stimulation of locus coerulus in both animal & human studies trigger panic symptoms.
      • Noradrenergic over-activity may be result of fewer GABA A receptor sites and lower GABA levels in occipital cortex of panic disorder patients. (Malizia, 1998; Goddard, 2001)
    • 39. NOREPINEPHERINE & PANIC DISORDERS
      • Anti-depressant drugs act to restore appropriate norepinepherine activity in locus coerulus & helps to reduce symptoms of disorder.
      • 80% will experience some significant improvement.
      • 40% reach full recovery or improve markedly; 20% show NO improvement .
    • 40. LOCUS COERULUS & PANIC DISORDER
    • 41. ASSESSMENT OF PANIC DISORDER
      • SCREENING TOOLS
      • Anxiety Screening Questionnaire (15 items)
      • Primary Care Evaluation of Mental Disorders
      • (PRIME-MD)
      • Hamilton Anxiety & Depression Scale
      • Beck Anxiety Scale
      • Center for Epidemiological Studies Depression Scale
      • (CESD)
      • Hospital Anxiety & Depression Scale
      • Panic Disorder Self-Test (www.adaa.org)
    • 42. TREATMENT OF GAD IN PRIMARY CARE
      • Cognitive Behavior Therapy
      • Stress-inoculation
      • Reframing
      • Cognitive Restructuring
      • Relaxation Training
      • Progressive Relaxation
      • Deep breathing
      • Positive Imagery
    • 43. TREATMENT OF GAD IN PRIMARY CARE
      • Pharmacotherapy
      • SSRI
      • Paroxetine (Paxil) only FDA for GAD
      • Fluoxetine (Prozac)
      • Sertraline (Zoloft)
      • Citalopram (Celexa)
      • Fluvoxamine (Luvox)
      • See Table 11.4 in Kaplan & Saddock for dosing.
    • 44. Pharmacotherapy of Panic Disorder
      • SSRI
      • Paroxetine (Paxil)
      • Fluvoxamine (Luvox)
      • Sertraline (Zoloft)
      • DOSE
      • 5-10 mg start
      • 20-60 mg maintenance
      • 12.5 mg start
      • 50-125 mg maintenance
      • 12.5 – 25 mg start
      • 100-150 mg maintenance
    • 45. Pharmacotherapy of Panic Disorder
      • TCA
      • Clomipramine (Anafrinil)
      • Imipramine (Tofranil)
      • DOSE
      • 5-12.5 mg start
      • 50-125 mg maintenance
      • 10-12.5 mg start
      • 150-500 mg maintenance
    • 46. Pharmacotherapy of Panic Disorder
      • Benzodiazepines
      • Alprazolam (Xanax)
      • Clonazepine (Klonopin)
      • Lorazepam (Ativan)
      • DOSE
      • .25-.5 mg tid start
      • .5-2 mg tid maintenance
      • .25 -.5 mg bid start
      • .5-2 mg bid maintenance
      • 25 -.5 mg bid start
      • .5-2 mg bid maintenance
    • 47. OBESSIVE-COMPULSIVE DISORDER THEORY DIAGNOSIS TREATMENT
    • 48. OBSESSIONS
      • INTRUSIVE THOUGHTS WISHES THAT CANNOT BE IGNORED, DISMISSED OR RESISTED.
      • COMMON THEMES :
      • CONTAMINATION ORDERLINESS
      • VIOLENCE SEXUALITY
    • 49. COMPULSIONS COMMON FORMS
      • 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:
      • cleaning hand washing
      • ordering checking
      • touching counting
      • repeating words silently praying
    • 50. COMMOM OBSESSIONS & COMPULSIONS
    • 51.  
    • 52. ASSESSMENT OF OCD
      • SCREENING TOOLS
      • Yale-Brown Obsessive Compulsive Scale (YBOCS)
      • Anxiety Screening Questionnaire (15 items)
      • Primary Care Evaluation of Mental Disorders
      • (PRIME-MD)
      • Hamilton Anxiety & Depression Scale
      • Beck Anxiety Scale
      • Center for Epidemiological Studies Depression Scale
      • (CESD)
      • Hospital Anxiety & Depression Scale
    • 53. PSYCHOANALYTIC VIEW OF OBSESSIVE-COMPULSIVE DISORDER
      • OCD develops when child comes to fear his own ID impulses & uses EDMs as counter-thoughts or compulsive actions to lessen resulting anxiety.
      • Three ego-defenses are common in OCD:
      • isolation - isolates & disowns undesirable/unwanted thoughts & experiences them as intrusions
      • undoing - Individual engages in acts that implicitly cancel out their undesirable impulses.
      • reaction formation - Takes on lifestyle that directly opposes their unacceptable impulses.
    • 54. SEROTONIN & OBSESSIVE-CONPULSIVE DISORDER
      • Serotonin plays role in operation of orbital region & caudate nuclei.
      • Low levels of serotonin disrupts functioning.
      • Research has found:
      • Reducing serotonin activity results in an increase of OCD symptoms.
      • Low levels of serotonin are related to high levels of OCD symptoms.
      • Increasing serotonin levels reduces symptoms .
    • 55.  
    • 56.  
    • 57.  
    • 58. PHOBIC DISORDERS: SPECIFIC PHOBIA SOCIAL PHOBIA AGORAPHOBIA THEORY DIAGNOSIS TREATMENT
    • 59. SPECIFIC PHOBIA
      • A. Marked & persistent fear that is excessive or unreasonable, cued by presence or anticipation of a specific object or situation.
      • B. Exposure to phobic stimulus almost invariably provokes an immediate anxiety response
      • C. Person recognizes that the fear is excessive or unreasonable.
    • 60. SPECIFIC PHOBIA
      • .
      Animal Type Natural Environment Type (heights, storms, water) Blood Injection Injury type Situational Type (airplanes, elevators, enclosed places)
    • 61. AGE OF ONSET OF PHOBIA
    • 62. PSYCHOANALYTIC MODEL OF PHOBIC REACTIONS
      • PHOBIAS ARE EXPRESSIONS WISHES/ FEARS WHICH ARE UNACCEPTABLE TO EGO
      • UNCONSCIOUS CONFLICT IS DISPLACED TO EXTERNAL OBJECT OR SITUATION
      • PHOBIA IS LESS THREATENING TO PERSON THAN THE RECOGNITION OF THE UNCONSCIOUS IMPULSE
    • 63. PSYCHOANALYTIC MODEL OF PHOBIC REACTIONS
      • PHOBIA IS ONLY A SYMPTOM OF UNDERLYING CONFLICT.
      • LEVEL OF PHOBIC FEAR INDICATES STRENGTH OF CONFLICT.
      • ONCE UNDERLYING CONFLICT IS DISPLACED ONTO EXTERNAL SITUATION, CONFLICT CAN BE CONTROLLED SIMPLY THROUGH AVOIDANCE.
    • 64. SOCIAL PHOBIA
      • LIFE TIME PREVALENCE 11% MALES
      • 15% FEMALES
      • ONSET IN ADOLESCENCE
      • COMMON IN FAMILIES WHO :
      • USE SHAME AS CONTROL TECHNIQUE
      • STRESS IMPORTANCE OF OPINIONS OF OTHERS
    • 65. SOCIAL PHOBIA
      • CAN BE DIVIDED INTO 3 TYPES:
      • PERFORMANCE
      • LIMITED INTERACTIONAL
      • GENERALIZED
    • 66. SOCIAL PHOBIA
      • PERFORMANCE
      • EXCESSIVE ANXIETY OVER ACTIVITIES
      • PLAYING INSTRUMENT
      • SPEAKING IN PUBLIC
      • EATING IN RESTAURANT
      • USING PUBLIC RESTROOM
    • 67.
      • LIMITED INTERACTIONAL
      • EXCESSIVE FEAR ONLY IN SPECIFIC SOCIAL or VOCATIONAL SITUATIONS
      • ex. INTERACTING WITH AUTHORITY FIGURE
      • GOING OUT ON A DATE
      SOCIAL PHOBIA
    • 68. SOCIAL PHOBIA
      • GENERALIZED
      • EXTREME ANXIETY DISPLAYED IN MOST SOCIAL SITUATIONS
      • MAY RESULT IN AVOIDANCE OF ALL SOCIAL INTERACTION
    • 69. AGORAPHOBIA
      • Anxiety about being in places or situations from which:
      • escape might be difficult (or embarrassing)
      • OR
      • help may not be available in the event of having an unexpected or situationally predisposed Panic Attack or panic like symptoms.
    • 70. AGORAPHOBIA
      • Agoraphobic fears typically involve characteristic clusters of situations that include:
      • being outside home alone
      • being in a crowd or standing in line
      • being on bridge
      • traveling in bus, train, or automobile .
    • 71. AGORAPHOBIA
      • LIFE TIME PREVALENCE 5% OF MALES & 12% OF FEMALES.
      • DEVELOPS IN 50% OF PANIC DISORDERS
      • FAMILY & TWIN STUDIES INDICATE 3-TO-5 TIMES GREATER RISK FOR PANIC DISORDER/ AGORAPHOBIA THAN IN GENERAL POPULATION
    • 72.
      • AFFECTS 1/2 OF VICTIMS BY AGE 8
      • SOME MAY HAVE BEEN BORN WITH TENDENCY TOWARDS EXTREME SHYNESS
      • 1-IN-5 DEMONSTRATED CONSISTENT FEAR & DISTRESS IN NOVEL SITUATIONS AS EARLY AS 8 WEEKS OF AGE.
      • DISORDER THOUGHT TO OCCUR MORE OFTEN IN FEMALES BUT MALES
      POST-TRAUMATIC STRESS DISORDER IN CHILDREN
    • 73. POST-TRAUMATIC STRESS DISORDER
      • MUST EXPERIENCE TRAUMATIC EVENT
      • INTRUSIVE RE-EXPERIENCING OF EVENT
      • (DREAMS, FLASHBACKS, IMAGES,
      • THOUHGTS, RECOLLECTIONS)
      • AVOIDANCE OF STIMULI ASSOCIATED WITH EVENT
    • 74. PERCENTAGE OF INDIVIDUALS DX WITH PTSD
    • 75. POST-TRAUMATIC STRESS DISORDER
      • NUMBING OF RESPONSIVENESS TO THE WORLD & RESTRICTION OF AFFECT
      • SYMPTOMS OF INCREASED AROUSAL
      • EXAGGERATED STARTLE REACTION
      • HYPERVIGILANCE
      • DIFFICULTY CONCENTRATING
      • INSOMINIA
      • NIGHTMARES
    • 76. POST-TRAUMATIC STRESS DISORDER
      • PTSD can occur at any age even childhood.
      • In young people, the response may be expressed as agitated behavior.
      • Most young people with PTSD avoid things that remind them of what happened.
      • Many have physical symptoms as well, such as startling easily.
    • 77. PTSD IN CHILDREN ETIOLOGICAL FACTORS
      • Certain PREMORBID personality profiles & attitudes are more likely to develop PTSD.
      • Pre-morbid personality or psychological difficulties are associated with increase risk & more severe ASD & PTSD symptoms:
      • poor interpersonal relationships
      • external locus of control
      • pessimism
    • 78. ETIOLOGICAL FACTORS
      • NATURE & QUALITY OF SOCIAL SUPPORT SYSTEM
      • Person with a strong social support system after a traumatic event less likely to develop an extended disorder.
      • If feels loved/accepted/valued, will be more likely to recover.
      • Societal support for appears to be important in lessening severity & duration of symptoms.
    • 79. ETIOLOGICAL FACTORS
      • DEGREE OF EXPOSURE & SUBJECTIVE EXPERIENCE OF THREAT PLAYS CRITICAL ROLE IN DEVELOPMENT OF PTSD & ASD.
      • DURATION OF THE EXPOSURE
      • LEVEL OF INVOLVEMENT
      • SALIENCE
      • DEGREE OF HARM EXPERIENCED
    • 80. MIXED ANXIETY & DEPRESSION
      • SHARED SYMPTOMS
      • EXCESSIVE WORRY
      • MOTOR TENSION
      • EASY FATIGABILITY
      • DIFFICULTY CONCENTRATING
      • SOMATIC COMPLAINTS
    • 81. MIXED ANXIETY & DEPRESSION
      • ANXIETY
      • SHORTNESS OF BREATH
      • CHEST PAIN
      • NERVOUSNESS
      • IRRITABILITY
      • BURNING STOMACH
      • DIFFICULTY FALLING ASLEEP
      • DEPRESSION
      • DEPRESSED MOOD
      • ANHEDONIA
      • WEIGHT LOSS OR GAIN
      • SUICIDAL THOUGHTS
      • EARLY MORNING AWAKENING
    • 82. MEDICATIONS THAT REDUCE ANXIETY
      • AZASPIRONES
      • BUSPRIONE BUSPAR
      • BETA BLOCKERS
      • PROPANOLOL INDERAL
      • ATENOLOL TENORMIN
    • 83. ANXIETY DISORDERS IN PRIMARY CARE: GUIDELINES
      • RECOGNIZE ANXIETY AS CAUSE OF PT’s PRESENTING SYMPTOMS:
      • LOOK FOR MULTIPLE SYMPTOMS
      • GREATER # OF PHYSICAL SYMPTOMS, MORE LIKELY ANXIETY D/O PRESENT
      • GREATER # OF SOMATOFORM SYMPTOMS, MORE LIKELY ANXIETY D/O PRESENT
    • 84. ANXIETY DISORDERS IN PRIMARY CARE: GUIDELINES
      • RECOGNIZE ONLY A SMALL NUMBER OF PT’S WITH ANXIETY SYMPTOMS ARE A RESULT OF GENERAL MEDICAL CONDITION.
      • LOOK FOR ANXIETY IN OTHER LIFE AREAS
      • LOOK FOR TRIGGERS OR AVOIDANCE
      • (TIME/PLACE/SETTING/CONTEXT)
      • LOOK FOR MULTIPLE SYMPTOMS
      • LOOK FOR SOMATOFORM SYMPTOMS
      • EPIDEMIOLOGY = APPEARS IN YOUNGER PT-->
      • LESS RISK FOR ILLNESS
    • 85. ANXIETY DISORDERS IN PRIMARY CARE: GUIDELINES
      • A SIGNIFICANT # OF PT’S WITH ANXIETY SYMPTOMS HAVE CO-MORBID PSYCHIATRIC DISORDERS.
      • 26% SUFFER FROM 2 OR MORE INDEPENDENT ANXIETY DISORDERS. 55% SUFFERED FROM MULTIPLE DISORDERS, ONE OF WHICH HELPED CAUSE THE OTHERS.
      • MAJOR DEPRESSION
      • SUBSTANCE DEPENDENCE/ ABUSE

    ×