Download Week 8 Anxiety Disorders 10 16 12

OT 460A
Week 8
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10/16/12
Include a range of disorders that can be
episodic periods of intense anxiety and/or
chronic periods of lower levels of anxiety
It’s an internal sense of apprehension and
psychological distress. It may or may not have
a specific focus
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Panic Attacks and Agoraphobia
Specific Anxiety Disorders
Panic Disorder
 Specific Phobia
 Social Phobia
 Obsessive-Compulsive Disorder
 Post traumatic Stress Disorder (PTSD)
 Acute Stress Disorder
 Generalized Anxiety Disorder
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Onset, prevalence, and prognosis
Impact on Function
Medical Management
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Acute Inpatient- severe sx; unable to fx;
medication and stabilization is main focus
Outpatient- usually partial hospital; cannot yet
return to former occupations; need
considerable support and structure. Eventually
can fx well outside medical system
Home Care- may be concurrent with a physical
disability; Agorophobia; OCD may benefit
from one-on-one home care
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Anxiety- unpleasant emotional, cognitive, behavioral,
or physical experience of stress
Trait anxiety- enduring “anxious” personality
Acute anxiety- time-limited, situational
Anticipatory anxiety- predictive in rx to future (real or
imagined) situations
Chronic anxiety-developing around new stressors
despite resolution of immediate problems
Free-floating anxiety-generalized and vague in origin
Clinical anxiety- disruption in fx
May be side effect of medical condition or drugs
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Normal anxiety: worry that propels someone
to act
Almost always anticipatory
 Can be a force that propels people to act, cope or
perform more efficiently
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Clinical or Abnormal anxiety: disrupts
function
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Response is greater than expected
Feelings may continue even when stimulus is
removed
Can impact all occupations
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Emotional
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Physiological
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Cardiovascular; GI; Respiratory; Urinary; Genital; Autonomic;
Muscular
Cognitive
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Uneasy, off-balance; overwhelmed; impending doom; out of
control, helpless; depersonalization; derealization
Confusion; poor memory; distractibility; thought blocking;
cognitive distortion; obsessive thoughts; fears of loss of control;
poor problem solving
Behavioral
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Looks preoccupied; immobile; withdrawn; overactive, agitated;
excess or decreased consumption of substances or food; rituals to
alleviate anxiety
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Employment-  concentration, memory and problem
solving
Social isolation- alienation by rigidity and withdrawal;
 participation in social activities
ADL-  concentration and focus
Leisure- neglected;  ability to sustain attention
Stress in relationships
Depression
Increased chronic health problems
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limited period of fear and distress in which 4 or
more of the following symptoms progress
rapidly and peak in 10 minutes:
cardiac symptoms (palpitations, rapid heart beat);
trembling;
 shortness of breath;
 feelings of suffocation;
 chest pain sensation of choking;
 nausea or abdominal distress;
 dizziness or lightheadiness;
 fear of losing control, dying, or going crazy;
 numbness and tingling;
 chills or hot flashes
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Reaction to repeated panic attacks
Avoidance of, or suffering through, situations
where it might be difficult or embarrassing to
leave in the event of a panic attack
Feelings of terror
Leads to restrictions in travel
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Appear in teen or early adult years
May be related to transitions
Women are twice more likely to have disorder
than men
Individual has repeated and unexpected panic
attacks with at least one attack followed by
worrying about another attack
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Fear of losing control
Situational avoidance: Avoid circumstances where
fear of attacks is strong
Often accompanied by depression, alcohol abuse,
and/or multiple phobias
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Frequently begins in childhood or mid-20s
Illogical, recurrent, excessive fear and anxiety
evoked during either an actual or expected
encounter with a specific stimulus
Stimulus can be real or imagined
An object or situation is avoided although there
is typically some insight about the reaction being
irrational
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One type of phobia can lead to other similar ones
One strategy to continue functioning is to avoid the
stressor
Most typical stressors: animals, spiders, bats, and rats
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Also called Social Anxiety Disorder
Excessive fears of potential humiliating social
or performance situations in which there is
anticipation of examination or judgment by
others
Key factors: Extreme self-consciousness and
worry of being ridiculed
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Typical fears: mind going blank, having a panic
attack, losing bladder control
Can have influence on occupations, e.g., if job
requires public speaking
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Typically occurs in adolescence or young adulthood
Characterized by recurrent obsessions (unwanted
persistent thoughts and images) and compulsions
(behaviors developed to neutralize or reduce
unwanted thoughts) that cause great anxiety
Examples: hoarding, pulling on hair, persistent hand
washing
 Attempts to reduce behaviors lead to increased anxiety
even when a person wants to stop
 Often interfere with daily functioning because they are
time consuming
 Co-diagnoses of depression and eating disorders are
common
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More common in women than men
Occurs mostly in adults, but can occur in children
Occurs to people who have been exposed to
overwhelming traumatic event that continues to
impact daily functioning and causes severe
distress
Can experience trauma or witness it
Based on perceived or actual life threatening
situations in which terror or helplessness are
responses
Reexperience trauma in different ways, including
overwhelming anxiety, hypersensitivity, and
symptoms of intrusion, arousal, and avoidance
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Reoccurring nightmares or dreams
Intrusive images or thoughts
Flashbacks
Triggers can evoke memories
Common strategies:
Avoidance
 Emotionally numb and disconnected
 Hypervigilence
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Symptoms can continue for > 1 month; occur in
close proximity to actual event
Can become chronic
People may turn to substance abuse or violence
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Based upon exposure to a traumatic event with
response of horror, terror, and helplessness
Similar to PTSD
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Symptoms develop within 1 month of event
Symptoms last 2 days to 1 month
Experience at least one symptom of PTSD, but
also feel a sense of detachment
May be associated with dissociative symptoms,
e.g., numbing, depersonalization, amnesia
World seems “dreamlike”
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Persistent, uncontrollable, and excessive anxiety
and worry
Occurs twice as often in women than men
Develops gradually from childhood to middle age
Often have pessimistic outlook; continuously
anticipate problems
Focus of worry can change
Symptoms include sleep disturbance, fatigue,
muscle tension, sweating, GI distress, headaches,
lightheadiness, irritability
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Goal is to reduce level of arousal through
regulation of neurotransmitters and activating
hormones in brain
Several groups of medications:
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Anti-anxiety: Benzopdiazapines, e.g., Ativan,
Valium, Xanax
 Effective for acute anxiety, panic attacks, social anxiety,
etc.
 Used as short-term therapy
 Rapidly reduce distressing symptoms
 Beneficial in short-term, but can lead to drug
dependence and tolerance
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Antidepressant medications: best long-term
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Commonly prescribed for anxiety, especially when
depression is present
 Side effects: lethargy, GI symptoms, sexual dysfunction
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SSRIs: Prozac, Luvox (Good for OCD): Less side
effects
MAOIs: oldest class of antidepressants: Nardil; Can
have serious side effects with other meds and food
Cardiac medications, Beta-blockers, like Inderal
are sometimes used for social anxiety
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Behavioral approaches
Cognitive-behavioral approaches: 1st treatment:
studies indicate efficacy and cost-effectiveness
Systematic desensitization
Mindfulness meditation
Exposure and response prevention
Biofeedback
EMDR
Couples Therapy
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Relaxation Training
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Assertiveness
Community mobility/ re-entry
Expressive
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Breathing
Progressive Muscle Relaxation
Visualization
Autogenic Training
Journal writing
Crafts/ hobbies
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Functional behavior training
Educational/ Lifestyle training
Rational/ Cognitive Approaches
Time Management
Sensory Diet
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