What is the dx criteria for Generalized Anxiety Disorder? - anxiety on most days (six or more months) and w/ three or more somatic sx (restlessness, fatigue, difficulty concentrating, irritability, muscle tension, disturbed sleep) How is GAD tx? - Lifestyle changes psychotherapy medication - SSRIs - Venlafaxine - buspirone - Benzos for immediate sx relief How does OCD present? - Obsessions: persistent, unwanted, and intrusive ideas, thoughts, impulses, or images that lead to marked anxiety or distress and occur despite the patient's attempts to prevent them Compulsions: repeated mental acts or behaviors that neutralize anxiety from obsessions (e.g. handwashing, elaborate rituals for ordinary tasks, counting, excessive checking) Pts recognize these behaviors as excessive and irrational products of their own minds. Wish to get rid of the obsessions and/or compulsions How is OCD tx? - Pharmacotherapy - SSRIs (first line) CBT - exposure and desensitization relaxation techniques Pt education How do panic attacks present? - Discrete periods of intense fear or discomfort in which at least 4 of the following sx develop abruptly and peak w/in 10 min: - tachypnea - chest pain - palpitations - diaphoresis - nausea - trembling - dizziness - fear of dying or "going crazy" - depersonalization - hot flashes - perioral and/or acral paresthesias-->hyperventilation and low O2 sats one or more months of concern about having additional attacks or significant behavior change as a result of the attacks--avoiding situations that may precipitate attacks What other conditions should be considered when a pt presents w/ panic attack? - Angina MI arrhythmias hyperthyroidism Vita B12 deficiency pheochromocytoma substance-induced anxiety generalized anxiety disorder PTSD How are panic disorders treated? - CBT pharmacotherapy - SSRIs - TCAs Benzos - for immediate relief, but avoid long-term use - taper as soon as long term tx is on board What is the difference between OCD and OCPD? - OCD is ego-dystonic: recognize the obsessions/compulsions and want to be rid of them OCPD is ego-syntonic: do not recognize their behavior as problematic What is a social phobia? - characterized by marked fear provoked by social or performance situations in which embarrassment may occur. It may be specific (e.g. public speaking, urinating in public) or general (e.g. social interaction) and often begins in adolescence What is a specific phobia? - anxiety is provoked by exposure to a feared object or situation (e.g. animals, heights, airplanes). Most cases begin in childhood. How are specific phobias tx? - CBT involving desensitization through incremental exposure to the feared object or situation and relaxation techniques. Supportive, family and insight-oriented psychotherapy How are social phobias tx? - CBT SSRIs Low dose benzos B-blockers (for performance anxiety) What is PTSD? - reexperiencing of the event (e.g. nightmares), avoidance of stimuli associated w/ the trauma, numbed responsiveness (e.g. detachment, anhedonia), and increased arousal (e.g. hypervigilence, exaggerated startle) that lead to significant distress or impairment in fxning Sx last for >1 mo Other Sx - survivor guilt, irritability, poor concentration, amnesia, personality change, sleep disturbance, substance abuse, depression, and suicidality may present What other conditions need to be considered in presentation of PTSD? - major depressive disorder personality disorder adjustment disorder How is PTSD tx? - SSRIs (first line) TCAs MAOIs Short term agents - B- blockers - alpha2-agonists - Benzos (but avoided) Psychotherapy and support groups What are some of the causes of PTSD? - men - rape - combat women - childhood abuse - rape What are some of the causes of dementia? - Degenerative diseases - PD, HD Endocrine - thyroid, parathyroid, pituitary, adrena Metabolic - alcohol, electrolytes, vitamin B12 deficiency, glucose, hepatic, renal, Wilson's disease Exogenous - heavy metals, CO, drugs Neoplasia Trauma - subdural hematoma Infxn - meningitis, encephalitis, endocarditis, syphilis, HIV, prion, diseases, Lyme disease Affective disorders - pseudodementia Stroke/Structure - vascular dementia, ischemia, vasculitis, NPH What is agnosia? - inability to recognize previously known objects What is apraxia? - inability to perform motor activities