Anxiety Disorders PDF

Anxiety Disorders Anxiety is a negative mood state characterized by bodily symptoms of physical tension and by apprehension about future. Panic Attack Panic attacks are a type of fear response. They're an exaggeration of your body's normal response to danger, stress or excitement. Reach...

Anxiety Disorders Anxiety is a negative mood state characterized by bodily symptoms of physical tension and by apprehension about future. Panic Attack Panic attacks are a type of fear response. They're an exaggeration of your body's normal response to danger, stress or excitement. Reaches peak within a minute Unexpected, no triggers/cue Generalized Anxiety Disorders (GAD) Complicated by panic attacks Generalized to the event of everyday life Agoraphobia fearing and avoiding places or situations that might cause panic and feelings of being trapped, helpless or embarrassed. Agoraphobia coined by Karl Westphal (1871) Specific Phobia Directly having stress directly to one object Has specific trigger Lasting for 6 months and more Blood Injury-Injection phobia Irrational fear to blood and injection Situational Phobia Fear of public transportation or enclosed place such as flying, riding in a car or on public transportation, driving Natural Environment Phobia Phobia with environment or weather Example: Astraphobia: Fear of thunder and lightning and Aquaphobia: Fear of water Separation Anxiety Disorder ( SEPAX) Separation anxiety disorder is an anxiety disorder in which an individual experiences excessive anxiety regarding separation from home and/or from people to whom the individual has a strong emotional attachment. Mostly occur with children and part of developmental Social Anxiety Disorder Worry that they will make themself like a fool Scared they might show anxiety symptoms If under 18- lasting for 6 months and more Richard Heimberg- Developed the Cognitive Behavioral Group Therapy (CBGT) the neurotransmitter most commonly associated with anxiety when levels are either too low or too high is serotonin. Other neurotransmitters that can contribute to anxiety if imbalanced include norepinephrine (noradrenaline) and GABA (gamma-aminobutyric acid). Somatic Disorders Somatoform Disorder Unexplained physical symptoms Old name is: Hysterical Neurosis Illness Anxiety Disorder (hypochondriasis) Fear of illness Focuses on long term illness like cancer, aids, and etc. Specification: care seeking type and care avoidant type Present for 6 months Somatization Disorders (Somatic symptoms disorder) occurs when a person feels extreme, exaggerated anxiety about physical symptoms. The person has such intense thoughts, feelings, and behaviors related to the symptoms, that they feel they cannot do some of the activities of daily life. Numerous physical complaints More than 6 months Conversion Disorder (Functional Neurological Symptoms Disorder) Anxiety turned into physical symptoms psychiatric condition that causes physical symptoms that can't be explained by a medical or neurological condition Malingering (faking) Faking to gain something Includes manipulation Factitious Disorder Sick role for attention Mood Disorders Persistent Depression Major Mild but persistent depression for 2 years and more Major Depressive Episodes Loss of pleasure or interest in activities Most of the day nearly everyday, at least 2 weeks Anhedonia Manic Episode High energy, excitement, or euphoria Hypomania Episode Abnormally manic but below manic Only for 4 days Do not caused impairment Bipolar Disorder I Depressive episode alternate with full manic Bipolar Disorder II Depressive episode alternate with hypomanic Cyclothymic disorder Rare mood disorder Cyclothymia causes emotional ups and downs, but they're not as extreme as those in bipolar I or II disorder. Dysphoric Manic/mixed Feels sad, anxious, or depressed all the same time Sexual Dysfunction Male hypoactive sexual desire disorder: Apparent lack of interest in sexual activity or fantasy Erectile disorder Recuning inability to achieve or maintain adequate erection Female sexual interest/arousal disorder: Recurring inability to achieve or maintain adequate lubrication Female orgasmic disorder Inability to achieve orgasm despite adequate desire and arousal Premature ejaculation: Ejaculation before it is desired, with minimal stimulation Genito-pelvic pain/penetration disorder Marked pain, anxiety, and tension associated with intercourse for which there is no medical cause; vaginismus (e. involuntary muscle spasms in the front of the vagina that prevent or interfere with intercourse); occurs in females Control Disorders Intermittent explosive disorder Intermittent explosive disorder (IED) involves frequent episodes of impulsive anger that’s out of proportion to the event that triggered it. Not committed to get a tangible object (ex. money) Conduct Disorder involves a consistent pattern of aggressive and disobedient behaviors. when a child has antisocial behavior. He or she may disregard basic social standards and rules. Oppositional Defiant Disorder (ODD) show a pattern of uncooperative, defiant, and hostile behavior toward peers, parents, teachers, and other authority figures. Kleptomania feels an uncontrollable urge to steal things. Pyromania can’t resist the urge to start fires. You know the fires are harmful, but you can’t control the impulse to start one. People with pyromania feel tension before setting fires and a release after. They don’t start fires for any other reason than the release. Personality Disorders Cluster A: unusual and eccentric thinking or behaviors. 1. Paranoid Personality Disorder – Marked by pervasive distrust and suspicion of others, leading individuals to interpret others’ actions as malevolent, even when unfounded. 2. Schizoid Personality Disorder – Characterized by a lack of interest in social relationships, limited emotional expression, and a preference for solitude. 3. Schizotypal Personality Disorder – Includes odd beliefs, eccentric behavior, and discomfort with close relationships, alongside cognitive or perceptual distortions. Cluster B: Dramatic, Emotional, or Erratic Disorders 1. Antisocial Personality Disorder – Involves a disregard for the rights of others, impulsivity, and often engaging in deceitful or aggressive behaviors. Commonly associated with criminal behavior, but also includes a lack of remorse for actions. 2. Borderline Personality Disorder– Characterized by unstable moods, self-image, and interpersonal relationships, along with impulsive behavior and fears of abandonment. 3. Histrionic Personality Disorder– Entails a strong need for attention, dramatic behavior, and exaggerated emotional expression, often to gain approval. 4. Narcissistic Personality Disorder – Features an inflated sense of self-importance, a deep need for admiration, and a lack of empathy for others, often masking underlying insecurity. Cluster C: Anxious or Fearful Disorders 1. Avoidant Personality Disorder – Marked by extreme sensitivity to rejection and a strong desire for social relationships, but inhibited by intense fear of embarrassment or criticism. 2. Dependent Personality Disorder – Involves excessive need for care, leading to submissive and clingy behavior and fears of separation. 3. Obsessive-Compulsive Personality Disorder (OCPD)– Characterized by preoccupation with orderliness, perfectionism, and control, to the detriment of flexibility and efficiency (distinct from obsessive-compulsive dIsorder). Schizophrenia Positive Symptoms- Obvious sign of psychosis Delusion- basic characteristic of madness Delusion of Grandeur- mistakenly belief that the person is a famous or powerful Delusion of Persecution- believe that someone is mistreating, spying on, or attempting to harm them Capgras syndrome- Belief that someone they know has been replaced by a double Cotard’s Syndrome- belief that they are dead Main criteria For Schizophrenia 1. Delusion 2. Hallucination 3. Disorganized Speech 4. Grossly Disorganized/catatonic 5. Negative Symptoms Hallucination- sensing something that does not exist. Auditory Hallucination is the most common hallucination Meta Cognition- examining your own thoughts Negative Symptoms- Indicate the absence or insufficiency of normal behavior Avolition- Lack of interest in activities Alogia- lack/limited of speech Anhedonia- lack of motivation Asociality- lack of interest in social interaction Affective flattening- Masking; no emotion and toneless Disorganized speech- Jump topic to topic ○ Tangentiality- changing the topic of conversation to unrelated topic. Inappropriate Affect and disorganized behavior- Laughing or crying at improper times Criteria for Catatonia associated with another mental disorder (catatonia specifier) 1. Stupor -responsive and only reacts to intense stimuli, like pain 2. Cataplexy 3. Waxy flexibility 4. Mutism 5. Negatism 6. Posturing  7. Mannerism 8. Stereotypy 9. Agitation 10.Grimacing 11.Echolalia- mimicking another’s speech 12.Echopraxia- mimicking another’s movement Schizophreniform DIsorder Experience the symptoms for a few months only; no flat affect Episode of the disorder last at 1 month but less than 6 months Schizoaffective Disorder With mood disorder (depression/bipolar) Delusion Disorder Belief is contrary from reality Specifier: ○ Erotomatic ○ Grandiose ○ Jealous ○ Persecutory Somatic ○ Mixed ○ Unspecified Substance/Medication Psychotic Disorder Withdrawal from certain substance w delusion or Hallucination Psychotic disorder associated with another medical disorder Due to another medical condition (Parkinson’s Disorder)\ Attenuated Psychosis Syndrome High risk to schizophrenia In Premodal stage Not severe enough Shared Psychotic Disorder (Folie a deux) Individual developed a delusion because of other delusion individual Brief Psychotic Disorder Duration 1 day or less than 1 month Stages: Premorbid Prodromal Onset/deterioration Chronic/Residual Neurodevelopmental Disorders Attention-deficit/hyperactivity disorder (ADHD) an ongoing pattern of inattention and hyperactive-impulsive behavior. Autism spectrum disorder (ASD) persistent challenges with social interactions, repetitive behaviors, and limited interests. Intellectual disabilities include problems with cognitive functioning and skills and adaptive behavior. include difficulties with communication, personal care, and social skills. Specific Learning Disorder difficulty in learning/ academics persisted for 6 months Tourette syndrome causes sudden, repetitive, and involuntary vocalizations and movements called tics. Fluency Disorder (Stuttering) disturbance in speech fluency(repeating words; prolonging sounds, extended pause) Language Disorder Limited speech in all situations Social (Pragmatic) Communication Disorder Problems with the social aspects of verbal and nonverbal communication Neurocognitive Disorders disorders that affect cognitive abilities, such as memory, learning, and problem-solving. They are caused by medical diseases, such as infections, injuries, or metabolic problems, that damage the brain's nerves and nerve connections. Delirium impaired consciousness and cognition during several hours or days. Delirium is one of the earliest-recognized mental disorders. Alois Alzheimer - German psychiatrist Dementia is the cognitive disorder that makes these fears real: a gradual deterioration of brain functioning that affects judgment, memory, language, and other advanced cognitive processes. Five classes of dementia based on etiology have been identified: Dementia of the Alzheimer’s type Vascular dementia Dementia due to other general medical conditions Substance-induced persisting dementia Dementia due to multiple etiologies Dementia not otherwise specified Vascular Dementia characterized by memory impairment and disturbances in cognitive functions such as planning, organizing, and abstracting. Head Trauma Marked by repetitive head impacts causing physical injuries like skull fractures, neurological impairments such as memory loss and slowed cognition, and progressive conditions like chronic traumatic encephalopathy (CTE), leading to long-term cognitive and behavioral decline Human Immunodeficiency Virus a virus that attacks the immune system, leading to severe immunosuppression. This compromises the body’s ability to fight infections and other diseases, eventually progressing to AIDS (Acquired Immune Deficiency Syndrome) if untreated​ Aphasia a language impairment caused by brain injury, affecting speech, comprehension, reading, and writing. It is often seen in individuals who have suffered strokes or brain trauma. Pick's Disease specific type of frontotemporal dementia, a degenerative brain disease that usually affects people under 65. affects a person’s behavior, but sometimes disrupts the ability to speak or understand others. CREUTZFELDT-JAKOB DISEASE a rare and fatal condition that affects the brain. It causes brain damage that worsens rapidly over time. caused by an abnormal infectious protein called a prion. These prions accumulate at high levels in the brain and cause irreversible damage to nerve cells. Amnestic disorders group of disorders that involve loss of memories, loss of the ability to create new memories, or loss of the ability to learn new information. Mental Health Services- Legal and Ethical Issues Perspectives on Mental Health Law Admission to a mental health facility requires that individuals pose a threat to themselves or others. Individuals often must seek help voluntarily, which can be unlikely. Treatment of psychological disorders is influenced by societal views. Confidentiality is always required. Civil Commitment The legal system significantly influences the mental health system. Laws may prioritize societal safety over individual rights. Civil Commitment Law: Defines when a person can be legally declared mentally ill and committed for treatment. Individuals cannot be committed against their will unless they are a direct threat to themselves or others. Criteria for Civil Commitment 1. The person has a “mental illness” and needs treatment. 2. The person is dangerous to themselves or others. 3. The person is unable to care for themselves (grave disability). Assisted Outpatient Treatment (AOT): Individuals with severe mental illness agree to treatment while living at home. Defining Mental Illness Mental Illness: A legal concept indicating severe emotional or thought disturbances that negatively affect health and safety. Dangerousness Dangerousness: A controversial concept suggesting that those with mental illness are perceived as more dangerous than those without. Research shows a slight increase in violence among individuals with mental illness. Public perceptions may be influenced by biases against minorities. Many people with mental illness have a damaged prefrontal cortex, affecting empathy Procedural Changes Affecting Civil Commitment Subjective judgment is used to identify mental illness and assess dangerousness. Legal language varies by state, affecting commitment procedures. The Supreme Court and Civil Commitment The Supreme Court ruled that a state cannot confine a non-dangerous individual capable of living safely with support.  Addington v. Texas (1979): Established that more than just a promise of improved quality of life is needed for involuntary commitment, limiting the government's ability to commit non-dangerous individuals. Criminalization In the 1960s and 1970s, individuals unable to be placed in mental facilities were funneled into the criminal justice system, leading to inadequate treatment and family distress. Deinstitutionalization and Homelessness Deinstitutionalization: The movement of individuals with severe mental illness out of institutions, often seen as a failure due to lack of care. Transinstitutionalization: Movement from psychiatric hospitals to nursing homes, group residences, or jails. Reactions to Strict Commitment Procedures Concerns arose over the risks posed to individuals not receiving treatment. Debate exists between individual freedom for those with mental illness and society’s responsibility to provide treatment. New criteria emphasize the need for treatment and addressing grave disabilities. Sex offenders can also be civilly committed. An Overview of Civil Commitment Establishing criteria for hospitalization is challenging; balancing safety concerns against individual rights is complex. The legal system may prioritize political considerations over addressing these issues. Changes in laws may reflect attempts to correct systemic problems while considering individual and societal needs. Criminal Commitment Debate continues regarding the responsibility of mentally ill individuals for their actions (e.g., Not Guilty by Reason of Insanity - NGRI). Criminal Commitment: Involves detaining individuals accused of crimes in mental health facilities until assessed as fit or unfit for legal proceedings, or found not guilty by reason of insanity. The Insanity Defense Legal Recognition: The law acknowledges that individuals may not be responsible for their behavior under certain conditions and should not be punished. M’Naghten Rule: In England, this rule states that individuals are not criminally responsible if they did not know what they were doing or did not understand that it was wrong. This established the foundation for the insanity defense.  Durham Rule: Proposed that an individual is not criminally responsible if their unlawful act was a product of a mental disease or defect. This broader criterion is no longer widely used due to difficulties in determining causation between mental illness and criminal acts. American Law Institute (ALI) Standard: States that individuals are not responsible for their criminal behavior if their mental illness prevents them from recognizing the inappropriateness of their actions or controlling their behavior. Diminished Capacity: Refers to a reduced ability to understand the nature of one’s behavior, affecting criminal intent due to mental illness. Mens Rea and Actus Rea: Mens Rea: Refers to the "guilty mind" or mental state of the defendant. Actus Rea: Refers to the physical act of committing a crime. Reactions to the Insanity Defense Public Outrage: Some segments of the public express anger over the use of the insanity defense. Legislative Changes: Approximately 75% of states have made it more difficult to successfully use the insanity defense. Challenges for Judges and Juries: Determining whether a defendant is legally insane can be complex and challenging. Frequency of Use: The insanity plea is invoked much less often than public perception suggests. Guilty but Mentally Ill Verdict: This verdict allows for a recognition of mental illness while still holding the individual accountable for their actions. Therapeutic Jurisprudence Definition: Therapeutic jurisprudence involves using behavioral change principles to assist individuals in legal trouble. Competence to Stand Trial: Defendants must understand their charges and be able to assist in their defense. Many individuals with severe impairments who commit crimes are not tried, raising concerns about dangerous individuals being released.  Duty to Warn: Professionals have a responsibility to warn potential victims based on information disclosed during therapy. Clinicians can consult colleagues when uncertain about the duty to warn. Mental Health as Expert Witness: Expert witnesses, such as mental health professionals, provide specialized knowledge to aid legal decisions. Patients’ Rights and Clinical Practice Guidelines Historically, individuals in mental health facilities had limited rights regarding treatment choices and communication with the outside world. The Right to Treatment: Poor conditions in facilities previously hindered treatment access. Individuals with mental illnesses and developmental disabilities have gained more rights over time. Mentally Ill Individuals Act: Establishes protection and advocacy agencies in each state to investigate abuse and neglect allegations. The Right to Refuse Treatment: While some may lack the capacity to make decisions, everyone deserves the right to choose regarding their treatment. The Right of Research Participants: Rights include being informed about research purposes, privacy, respect, protection from harm, voluntary participation, anonymity in results reporting, and safeguarding records. Informed Consent: A formal agreement by participants after being fully informed of study aspects and potential risks. Evidence-Based Practice and Clinical Practice Guidelines Evidence-Based Practice: Health-care practices supported by research demonstrating effectiveness.  Clinical Efficacy Axis: Involves thorough consideration of scientific evidence to determine intervention effectiveness. Conclusions Progress in therapy and scientific understanding takes time. Substance Related Addictive Disorder Substance Use Disorders Substance Use Disorder: A condition characterized by a problematic pattern of substance use leading to significant impairment or distress. Substance Induced Disorder: Immediate health problems caused by the substance, occurring during intoxication or withdrawal. Alcohol Use Disorders Alcohol Use Disorder: Inability to control alcohol use, resulting in significant life problems. Alcohol Intoxication: Temporary condition from recent alcohol consumption causing behavioral or psychological changes. Alcohol Withdrawal: Symptoms that occur when a heavy drinker suddenly reduces or stops alcohol consumption, including anxiety, tremors, gastrointestinal issues, and social/work disruptions. Caffeine Disorders Caffeine Intoxication: Clinically significant distress or impairment from excessive caffeine consumption. Caffeine Withdrawal: Symptoms following abrupt cessation of prolonged caffeine use. Cannabis Disorders Cannabis Use Disorder: Problematic patterns of cannabis use that interfere with daily life, often requiring increased amounts for the same effects. Cannabis Intoxication: Clinically significant behavioral or psychological changes during or shortly after cannabis use, including euphoria, anxiety, memory impairment, and impaired judgment. Effects last 3–4 hours. Cannabis Withdrawal: Symptoms develop after reducing or stopping heavy cannabis use, peaking within the first week and lasting 1–2 weeks. Sleep difficulties may persist for over 30 days. Hallucinogens  LSD (Lysergic Acid Diethylamide): A common hallucinogenic drug that can cause severe effects such as convulsions and hallucinations. Psilocybin: Found in magic mushrooms; ingestion leads to visual hallucinations and mood changes. Symptoms of Hallucinogen Use: Strong desire to use hallucinogens. Increased tolerance. Neglect of responsibilities. Engagement in dangerous activities while under the influence. Legal issues related to drug use. Inhalant Use Disorder Inhalant Use Disorder: Characterized by the inhalation of chemical substances that produce euphoric feelings. Inhalant Intoxication: Develops during or after inhaling volatile hydrocarbon substances. Opioid-Related Disorders Opioid Family: Includes natural opiates (e.g., morphine), synthetic variations (e.g., heroin, oxycodone), and naturally occurring brain substances (e.g., endorphins). Withdrawal from Opioids: Symptoms after stopping opioid intake include excessive yawning, nausea, vomiting, chills, muscle aches, diarrhea, and insomnia. Symptoms can last 1–3 days with full recovery typically within a week. GABA GABA is the primary inhibitory neurotransmitter in the brain. Sedative, hypnotic, and anxiolytic drugs, like alcohol, affect the GABA system. Combining alcohol with benzodiazepines or barbiturates can lead to dangerous synergistic effects. Amphetamine At low doses, amphetamines induce feelings of elation and reduce fatigue.  Overuse can lead to hallucinations and delusions. Cocaine Derived from coca leaves; historically used for its stimulating effects. Small amounts increase alertness, euphoria, blood pressure, and cause insomnia. Can lead to paranoia and rapid heart rate. Tobacco-Related Disorders Tobacco Use Disorder: Addiction to tobacco due to nicotine. Nicotine Effects: Small Doses: Stimulates the brain, reduces stress. High Doses: Can cause severe health issues, including seizures and death. Tobacco-Induced Sleep Disorder Characterized by sleep disturbances caused by nicotine, including difficulty falling asleep and insomnia. Non-Substance-Related Disorder Gambling Disorder: An addictive behavior with significant negative consequences similar to substance use disorders. Pathological gamblers face severe consequences such as job loss and legal issues. Brain imaging shows decreased activity in impulse-regulating areas.