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Download Week 8 Anxiety Disorders 10 16 12
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OT 460A Week 8 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 OT 460A 2 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 10/16/12 OT 460A 3 10/16/12 Onset, prevalence, and prognosis Impact on Function Medical Management OT 460A 4 10/16/12 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 OT 460A 5 10/16/12 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 OT 460A 6 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 Clinical or Abnormal anxiety: disrupts function 10/16/12 Response is greater than expected Feelings may continue even when stimulus is removed Can impact all occupations OT 460A 7 Emotional Physiological Cardiovascular; GI; Respiratory; Urinary; Genital; Autonomic; Muscular Cognitive 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obsessive thoughts; fears of loss of control; poor problem solving Behavioral 10/16/12 Looks preoccupied; immobile; withdrawn; overactive, agitated; excess or decreased consumption of substances or food; rituals to alleviate anxiety OT 460A 8 10/16/12 Employment- concentration, memory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 OT 460A 9 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 10/16/12 OT 460A 10 10/16/12 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 OT 460A 11 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 10/16/12 Fear of losing control Situational avoidance: Avoid circumstances where fear of attacks is strong Often accompanied by depression, alcohol abuse, and/or multiple phobias OT 460A 12 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 10/16/12 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 OT 460A 13 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 Typical fears: mind going blank, having a panic attack, losing bladder control Can have influence on occupations, e.g., if job requires public speaking 10/16/12 OT 460A 14 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 10/16/12 OT 460A 15 10/16/12 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 OT 460A 16 Reoccurring nightmares or dreams Intrusive images or thoughts Flashbacks Triggers can evoke memories Common strategies: Avoidance Emotionally numb and disconnected Hypervigilence Symptoms can continue for > 1 month; occur in close proximity to actual event Can become chronic People may turn to substance abuse or violence 10/16/12 OT 460A 17 Based upon exposure to a traumatic event with response of horror, terror, and helplessness Similar to PTSD 10/16/12 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” OT 460A 18 10/16/12 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 OT 460A 19 Goal is to reduce level of arousal through regulation of neurotransmitters and activating hormones in brain Several groups of medications: 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 10/16/12 OT 460A 20 Antidepressant medications: best long-term Commonly prescribed for anxiety, especially when depression is present Side effects: lethargy, GI symptoms, sexual dysfunction 10/16/12 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 OT 460A 21 10/16/12 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 OT 460A 22 Relaxation Training Assertiveness Community mobility/ re-entry Expressive 10/16/12 Breathing Progressive Muscle Relaxation Visualization Autogenic Training Journal writing Crafts/ hobbies OT 460A 23 10/16/12 Functional behavior training Educational/ Lifestyle training Rational/ Cognitive Approaches Time Management Sensory Diet OT 460A 24