Week 11: Anxiety D/O's, OCD and Related D/O's, and Trauma & Stressor-Related D/O's

Anxiety Disorder d/t Another Medical Condition:

-Many medical disorders can produce anxiety symptoms which will usually resemble a panic disorder or GAD -Most anxiety symptoms will not be caused by a medical disorder, but essential to identify those that are

Obsessive-Compulsive and Related D/O:

-Obsessive Compulsive D/O -Body Dysmorphic D/O -Substance/medication-Induced Obsessive Compulsive and Related D/O -Obsessive-Compulsive and Related D/O due to another medical condition -new to DSM 5 and brings together D/O's previously classified in DSM IV-TR w/anxiety disorders, somatoform disorders, and impulse control disorders -similarity is... relatedness to OCD

Agoraphobia:

-fear of any situation/place where escape seems difficult or embarrassing or where help might be unavailable if anxiety symptoms should occur -open or public spaces such as theaters and crowded supermarkets, travel from home -individuals avoid fear place/situation entirely; if situation is confronted, individuals suffers intense anxiety or requires companion

Social Anxiety D/O (previously Social Phobia):

-fear of appearing clumsy, silly, or shameful -may be noticeable physical symptoms associated w/ SAD such as blushing, hoarseness, tremor, and sweating -may have actual panic attacks -children may express anxiety by clinging, crying, freezing, refusing to speak as examples

Adjustment D/O's:

*don't underestimate; assess for suicidal/homicidal ideations -people develop symptoms of emotional distress or behavioral symptoms in response to stressful event or feel overwhelmed by their circumstances -typically does not meet criterion for Acute Stress or PTSD -people can experience varied symptoms ranging from depression to anxiety to impaired work ability -3 month time frame -may be responding to one stress or to multiple -response exceeds what you'd expect for most people in similar circumstances -course is relatively brief - not lasting longer than 6 months after the end of the stressor -individual feels overwhelmed by the demands of something in the environment resulting in: Low mood Crying, Complaints of feeling nervous or panicky, or Other depressive or anxiety symptoms

Generalized Anxiety D/O:

-Disorder can be hard to DX, excessive worry (about everything) that is hard to control -GAD worry is typically about issues than facts can justify -Symptoms can also manifest as low-level nervousness and chronic, not usually include panic attacks

PTSD, Essential Features:

-Repeatedly relive their event in nightmares or upsetting dreams or intrusive images or dissociative flashbacks -Take steps to avoid the event: refusal to read or watch film, tv, social media or pushing away thoughts or memories -Thinking becomes "downbeat"; gloomy thoughts, negative mood, loss of interest, feeling detached -Experience hyper arousal: irritability, excessive vigilance, trouble concentrating, insomnia, startle response -the more horrific/enduring the trauma, greater likelihood of developing PTSD. Children can develop PTSD.

Anxiety D/O's-DSM 5:

-Separation Anxiety D/O -Selective Mutism (moved from age related d/t common symptoms) -Specific Phobia -Social Anxiety D/O -Panic D/O -Agoraphobia -Generalized Anxiety D/O -Substance/Medication induced anxiety D/O -Anxiety disorder due to another medical condition -Other specified anxiety D/O -Unspecified anxiety D/O

Key points for OCD (DSM 5):

-chapter is new and is intended to reflect understanding that a spectrum of disorders related to OCD is sufficiently distinct from anxiety disorders and should stand alone -OCD criterion have been revised to emphasize that obsessions are often urges, not impulses, and that they are intrusive and unwanted rather than merely inappropriate. -Obsessive-Compulsive and Related Disorders differ from developmentally normative preoccupations and rituals by being excessive or persisting beyond developmentally appropriate periods

PTSD:

-common in general population and can occur at any age, even in young children -generally begins soon after event is experienced, but onset can be delayed -chronic, but symptoms can fluctuate and may become worse in stressful times -major etiological factor involves exposure to actual or threatened death, serious injury, or sexual violence and is considered outside of the range of normal experience -mood, Anxiety, and Substance Use Disorders are frequently comorbid

Obsessive Compulsive D/O:

-hallmark of OCD is presence of Obsessions and compulsions -individuals are bothered by repeated thoughts or behaviors that appear senseless, even to them -Obsessions: recurrent and persistent ideas, thoughts, urges, or images that are experienced as intrusive and unwanted and that in most individuals causes marked anxiety and distress -Compulsions: recurrent and intentional behaviors or mental acts performed in response to obsessions or according to certain rules that must be applied rigidly; they are meant to neutralize or reduce person's discomfort or prevent a dreaded event or situation -individuals become trapped by rigidity

Panic D/O:

-individual experiences unexpected panic attacks and worries about having another -efforts to avoid further attacks include abandoning favorite activities or avoiding places where panic attacks have occurred -unexpected

Specific Phobia:

-individuals fear specific objects or situations. ie. animals, storms, heights... -anxiety produced by exposure of such stimuli may take form of a panic attack or of a more generalized sensation of anxiety, but it is directed at something specific -individuals can have more than one specific phobia -consider developmental stage -limits functioning

OCD 4 major symptom patterns:

-most common is a fear of contamination that leads to excessive hand washing -doubts lead to excessive checking -obsessions w/out compulsions constitute a less common pattern -obsessions and compulsions slow some individuals down to point that it can take them hours to finish breakfast or other daily routines -obsessions about symmetry and forbidden thoughts also commonly occur

Body Dysmorphic D/O:

-physically normal individuals believe that parts of their bodies are misshapen or ugly -worry there is something wrong w/shape or appearance of a body part -ideas are not delusional, they can be perceived as overvalued ideas -can be devastating avoiding social situations, become housebound, onset of depression, entertain suicidal ideas, request for medical procedures then not pleased w/ results -may begin in teen years, peak in menopause

Acute Stress D/O:

-symptoms have been collapsed into a list of 14 possible symptoms of which at least 9 must be present to indicate a diagnosis, non mandatory -dissociative symptoms are included but are not required as they were in the DSM IV-TR (this is because people's reactions to stress are variable and do not always include dissociation) -clinical presentation of disorder involves an anxiety response w/some form of re-experience or reactivity to traumatic event -based on observation that some people develop symptoms immediately after a traumatic stress Criteria embodies the same elements required for PTSD: -Exposure to an event that threatens body integrity -Re-experiencing the event -Avoidance of stimuli associated w/event -Negative changes in mood and thought -Increased arousal and reactivity -Distress or impairment

Substance/medication-induced Anxiety D/O:

-symptoms of anxiety can be attributed to use of chemical substance -can occur during intoxication or during withdrawal but symptoms must be severe enough to warrant clinical attention -many substances can produce anxiety symptoms: ie. Marijuana, Amphetamines, Caffeine, Alcohol

OC and related D/O due to another medical condition:

A physical condition appears to have caused -obsessions -compulsions -hair pulling, etc...

_______________ is involved in triggering panic attacks.

Amygdala

__________ d/o's are the most prevalent psychiatric conditions worldwide.

Anxiety

Acute stress d/o, criteria, features...

Criteria: (P 281) Diagnostic Features: -development of symptoms lasting from 3 days to 1 mo following exposure to traumatic event -anxiety response w/some form of reexperiencing or reactivity to event -recurrent and intrusive recollections -distressing dreams -altered awareness (depersonalization/derealizatoin) Development and Course: -DX'd 3 days after event -PTSD may be DX'd after 1 month -children may have dreams and relive through play directly relating to trauma (draw fire...) Differential DX: -adjustment d/o -panic d/o -dissociative d/o -PTSD -OC d/o -psychotic d/o's -TBI

OC and related D/O due to another medical condition, criteria, features...

Diagnostic Criteria: A. Obsessions, compulsions, preoccupations w/appearance, hoarding, skin picking, hair pulling, other body-focused repetitive behaviors, or other symptoms characteristic of obsessive-compulsive and related disorder predominate in the clinical picture. B. evidence from history, physical examination, or laboratory findings that disturbance is direct pathophysiological consequence of another medical condition . C . disturbance is not better explained by another mental disorder. D. disturbance does not occur exclusively during course of a delirium . E . disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Diagnostic Features: -d/o judged to be result of medical condition -based on evidence from hx, physical... -no better explained by another mental d/o -not in course of delirium -impaired functioning Differential DX -delirium -mixed presentation of symptoms -susbtance/medication-induced OC and related d/o -OC and related d/o (primary) -illness anxiety d/o -associated feature of another mental d/o -other specified OC and related d/o or unspecified OC and related d/o

Generalized Anxiety D/O, criteria, features..

Diagnostic Criteria: A. excessive anxiety and worry, occurring more days than not for @ least 6 months B. individual finds it difficult to control worry C. anxiety and worry are associated w/3 or more of following: 1) restlessness; 2) easily fatigued; 3) difficulty concentrating, mind blank; 4) irritability; 5) muscle tension; 6) sleep disturbance D. anxiety, worry, or physical symptoms cause impaired functioning in various areas E. not attributable to physiological effects of substance abuse/medication; or medical condition F. not better explained by another mental D/O Diagnostic Features: -excessive anxiety/worry -worry out of proportion to actual threat -interfere w/psychosocial functioning and impaired function -pervasive, pronounced, and distressing worries -long duration and can occur w/out precipitants -subjective distress due to worry -accompanied by restlessness, on edge, easily fatigued, difficulty concentrating, irritability, muscle tension, disturbed sleep Development and Course: -median age of onset age 30 -rarely occurs before adolescence -occur chronically across lifetime -worry appropriate to age (school, sports, work) -over DX'd in children, consider OCD, separation, ... Differential DX: -anxiety d/o due to medical condition -substance/medication-induced anxiety d/o -social anxiety d/o -obsessive compulsive d/o -PTSD and adjustment d/o -depressive, bipolar and psychotic Comorbidity: -likely to meet critter for GAD + other anxiety and unipolar depressive d/o

OCD, criteria, features...

Diagnostic Criteria: A . Presence of obsessions, compulsions, or both: Obsessions are defined by: 1 . Recurrent and persistent thoughts, urges, or images experienced, at some time during the disturbance, as intrusive and unwanted and that in most individuals cause marked anxiety or distress. 2. individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them w/ some other thought or action (by performing a compulsion). Compulsions are defined by (1) and (2): 1 . Repetitive behaviors (hand washing, ordering, checking) or mental acts (praying, counting, repeating words silently) that individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly. 2. behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation ; however, behaviors or mental acts are not connected in a realistic way w/what they are designed to neutralize or prevent, or are clearly excessive. Note: Young children may not be able to articulate the aims of these behaviors or mental acts. B. obsessions or compulsions are time-consuming (take more than 1 hour/day) or cause clinically significant distress or impairment in social , occupational, or other important areas of functioning. C. obsessive-compulsive symptoms are not attributable to physiological effects of a substance (a drug of abuse, a medication) or another medical condition. D . The disturbance is not better explained by symptoms of another mental disorder (excessive worries, as in generalized anxiety disorder; preoccupation w/appearance, as in body dysmorphic disorder; difficulty discarding or parting w/possessions, as in hoarding disorder; hair pulling, as in trichotillomania [hair-pulling disorder]; skin picking, as in excoriation [skin-picking] disorder; stereotypies, as in stereotypic movement disorder; ritualized eating behavior, as in eating disorders; preoccupation with substances or gambling, as in substance-related and addictive disorders; preoccupation w/ having an illness, as in illness anxiety disorder; sexual urges or fantasies, as in paraphilic disorders; impulses, as in disruptive, impulse-control, and conduct disorders; guilty ruminations, as in major depressive disorder; thought insertion or delusional preoccupations, as in schizophrenia spectrum and other psychotic disorders; or repetitive patterns of behavior, as in autism spectrum disorder) Diagnostic Features: -presence of obsession and compulsions -compulsions performed in response to obsession -obsessions/compulsions are time consuming, 1 + hour/day Development and Course: -mean age 19.5 years -males earlier onset -untreated usually results in chronic symptoms -onset in childhood can lead to lifetime of OCD Suicide Risk: -suicidal thoughts in 1/2 of individuals w/OCD -attempts reported in 1/4 of individuals w/OCD -presence of MDD increases risks Differential DX: -anxiety d/o's -MDD -other obsessive compulsive and related d/o's -eating d/o -tics and stereotyped movements -psychotic d/o's -other compulsive behaviors -OC personality d/o Comorbidity: -anxiety d/o's -depressive/bipolar d/o -tic disorder -OC personality d/o

PTSD, criteria, features...

Diagnostic Criteria: A. Exposure to actual or threatened death , serious injury, or sexual violence B. Presence of one (or more) of following intrusion symptoms associated w/traumatic event(s), beginning after traumatic event(s) occurred: 1 . Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children older than 6 years, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed. 2. Recurrent distressing dreams in which the content and/or affect of the dream are related to traumatic event(s) . Note: In children, there may be frightening dreams without recognizable content. 3. Dissociative reactions (flashbacks) in which individual feels or acts as if traumatic event(s) were recurring. (Such reactions may occur on a continuum, w/most extreme expression being a complete loss of awareness of present surroundings.) Note: In children, trauma-specific reenactment may occur in play. 4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). 5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of traumatic event(s) . C. Persistent avoidance of stimuli associated w/traumatic event(s) , beginning after traumatic event(s) occurred , as evidenced by one or both of following: 1 . Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s) . 2. Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated w/traumatic event(s) . D. Negative alterations in cognitions and mood associated w/traumatic event(s), beginning or worsening after traumatic event(s) occurred , as evidenced by two (or more) of following: 1 . Inability to remember an important aspect of the traumatic event(s). 2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or world ("I am bad" "No one can be trusted ," ''The world is completely dangerous," "My whole nervous system is permanently ruined") . 3. Persistent, distorted cognitions about cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others. 4. Persistent negative emotional state (fear, horror, anger, guilt, or shame) . 5. Markedly diminished interest or participation in significant activities. 6. Feelings of detachment or estrangement from others. 7. Persistent inability to experience positive emotions (inability to experience happiness, satisfaction , or loving feelings) . E . Marked alterations in arousal and reactivity associated w/ traumatic event(s) , beginning or worsening after traumatic event(s) occurred , as evidenced by two (or more) of following: 1 . Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects. 2. Reckless or self-destructive behavior. 3. Hypervigilance. 4. Exaggerated startle response. 5. Problems w/concentration . 6. Sleep disturbance (difficulty falling or staying asleep or restless sleep) . F. Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month . G . The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of function ing. H . The disturbance is not attributable to physiological effects of a substance (medication, alcohol) or another medical condition . Development and Course: -can occur at any age following 1st year of life. -symptoms begin w/in 3 months or can be delayed -initially can be considered acute stress d/o -PTSD symptoms can be exaggerated in OA -children may not be able to identify onset Suicide Risk: -increased suicide risk -associated w/SI and attempts Differential DX: -other post traumatic d/o's and conditions -acute stress d/o -anxiety d/o and OC d/o -personality d/o's -dissociative d/o's -conversion d/o -psychotic d/o's -TBI Comorbidity: -more likely to meet criteria for another d/o -substance use and conduct d/o common in males -comorbidity between PTSD and major neurocognitive d/o

Agoraphobia, criteria, features...

Diagnostic Criteria: A. Marked fear or anxiety about two + of following five situations: 1 . Using public transportation (automobiles, buses, trains, ships, planes); 2. Being in open spaces (parking lots, marketplaces, bridges); 3. Being in enclosed places (shops, theaters, cinemas); 4. Standing in line or being in a crowd; 5. Being outside of home alone. B. Individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms (fear of falling in the elderly; fear of incontinence) C. Agoraphobic situations almost always provoke fear or anxiety. D. Agoraphobic situations are actively avoided , require presence of a companion, or are endured with intense fear or anxiety. E. Fear or anxiety is out of proportion to actual danger posed by the agoraphobic situations and to sociocultural context. F. Fear, anxiety, or avoidance is persistent, typically lasting for 6 months + G . Fear, anxiety, or avoidance causes clinically significant distress or impairment in social , occupational , or other important areas of functioning. H . If another medical condition (inflammatory bowel disease, Parkinson's disease) is present, fear, anxiety, or avoidance is clearly excessive. I . Fear, anxiety, or avoidance is not better explained by symptoms of another mental disorder-for example, symptoms are not confined to specific phobia, situational type; do not involve only social situations (as in social anxiety disorder) ; and are not related exclusively to obsessions (as in obsessive-compulsive disorder) , perceived defects or flaws in physical appearance (as in body dysmorphic disorder) , reminders of traumatic events (as in posttraumatic stress disorder) , or fear of separation (as in separation anxiety disorder) . Note: Agoraphobia is DX'd irrespective of presence of panic disorder. If an individual's presentation meets criteria for panic disorder and agoraphobia, both diagnoses should be assigned. Diagnostic Features: -marked fear/anxiety triggered by real or anticipated exposure to situations -thoughts something terrible may happen -fear occurs nearly every time exposed to feared situation -actively avoids situation or situation invokes fear/anxiety -fear out of proportion to actual danger -only DX'd if avoidance persists -only DX'd if causes impairment in functioning -duration 6 months + Development and Course: -usually initial onset before age 35 -childhood onset rare -typically persistent and chronic -other d/o may accompany (anxiety, depressive, substance-use and personality d/o's) Differential DX: -specific phobia, situational type -separation anxiety d/o -social anxiety d/o -panic d/o -acute stress d/o and PTSD -MDD -other medical conditions Comorbidity: -anxiety d/o's -depressive d/o's -PTSD -alcohol use

Substance/medication-induced OC and related D/O's, criteria, features...

Diagnostic Criteria: A. Obsessions, compulsions, skin picking, hair pulling, other body-focused repetitive behaviors, or other symptoms characteristic of obsessive-compulsive and related disorders predominate in clinical picture. B. evidence from history, physical examination, or laboratory findings of both ( 1 ) and (2) : 1 . symptoms in Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication . 2. involved substance/medication is capable of producing the symptoms in Criterion A. C. disturbance is not better explained by an obsessive-compulsive and related disorder that is not substance/medication-induced. Such evidence of an independent obsessive-compulsive and related disorder could include the following: symptoms precede the onset of the substance/medication use; the symptoms persist for a substantial period of time (e.g., about 1 month) after the cessation of acute withdrawal or severe intoxication; or there is other evidence suggesting the existence of an independent non-substance/medication-induced obsessive-compulsive and related disorder (a history of recurrent non-substance/medication related episodes) . D. disturbance does not occur exclusively during course of a delirium . E . disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Diagnostic Features: -prominent symptoms of OC and related d/o attributable to effects of substance -d/o must have developed during or soon after intoxication, withdrawal, or exposer to medication or toxin, and substance must be capable of producing symptoms Differential DX: -substance intoxication -OC and related d/o (not induced by substance) -OC and related d/o due to another medical condition -delirium

Anxiety Disorder d/t Another Medical Condition, criteria, features...

Diagnostic Criteria: A. Panic attacks or anxiety is predominant B. evidence from history, physical examination, or laboratory findings that disturbance is direct pathophysiological consequence of another medical condition. C. disturbance is not better explained by another mental disorder. D . disturbance does not occur exclusively during course of a delirium. E . disturbance causes clinically significant distress or impairment in social , occupational, or other important areas of functioning. Diagnostic Features: -anxiety judged to be explained as physiological effect of medical condition -based on history, labs, exam... -not DX'd if occurring w/delirium -must cause clinically significant distress or impairment in functioning Development and Course: -follows course of underlying illness -in OA's consider chronic medical illness and development of secondary independent anxiety d/o's Differential DX: -delirium -mixed presentation of symptoms -substance/medication induced anxiety d/o -anxiety d/o's (not due to medical condition) -illness anxiety d/o -adjustment d/o's -associated feature of another mental d/o -other specified/unspecified anxiety d/o

Social Anxiety D/O, criteria, features...

Diagnostic Criteria: a. marked fear about one or more social situations in which individual is exposed to scrutiny by others b. individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated c. social situations almost always provoke fear or anxiety. d. social situations are avoided or endured w/intense fear or anxiety. e. fear or anxiety is out of proportion to actual threat posed by social situation and to the sociocultural context. f. fear, anxiety, or avoidance is persistent, typically lasting 6 months + g. fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. h. fear, anxiety, or avoidance is not attributable to physiological effects of a substance (drug of abuse , a medication) or another medical condition. i. fear, anxiety, or avoidance is not better explained by symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder. j. if another medical condition (Parkinson's disease, obesity, disfigurement from burns or injury) is present, fear, anxiety, or avoidance is clearly unrelated or is excessive. Diagnostic Features: -marked intents fear or anxiety of social situation in which individual will be scrutinized -concerned about being judged by others -situations almost always provoke fear/anxiety -situations may be endured w/intense fear/anxiety -fear/anxiety is out of proportion to actual risk -duration at least 6 months -impaired functioning in multiple areas Development and Course: -median age onset 13 -can occur in early childhood -adolescents endorse pattern of fear and avoidance (dating) -OA may fear decline in functioning or medical conditions Differential DX: -normative shyness -agoraphobia -panic d/o -GAD -separation anxiety d/o -specific phobias -selective mutism -major depressive d/o -body dysmorphic d/o -delusional d/o -autism spectrum d/o -personality d/o's -other mental d/o's -other medical conditions -ODD Comorbidity: -often comorbid w/other anxiety d/o's, MDD, and substance used d/o's -isolation may lead to depression -self-medication w/substance -in children, comorbidities include autism and selective mutism

Body Dysmorphic D/O, criteria, features...

Diagnostic Criteria: A. Preoccupation w/one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others. B. At some point during the course of disorder, individual has performed repetitive behaviors (mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (comparing his or her appearance with that of others) in response to appearance concerns. C . preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. D . appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder. Diagnostic Features: -preoccupied w/flaws and/or defects in physical appearance -repetitive behaviors formed in response to preoccupation -impairment in functioning -muscle dysmorhia, mostly in males, idea that body is too small or lean Development and Course: -average age onset 12-13 years -onset before 18 increases suicide attempts Suicide Risk: -SI and attempts high in both adults and children/adolescents -Risk X suicide high in adolescents Differential DX: -normal appearance concerns and clearly noticeable defects -eating d/o's -OC related d/o's -illness anxiety d/o -MDD -anxiety d/o's -psychotic d/o's -other d/o's and symptoms Comorbidity: -MDD most common, w/onset after Body Dysmorphic D/O -social anxiety d/o, OCD, and substance-related d/o's common

Substance/medication-induced Anxiety D/O, criteria, features...

Diagnostic Criteria: A. Panic attacks/anxiety is predominant B. evidence from history, physical examination , or laboratory findings of both... 1 . symptoms in Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication. 2. involved substance/medication is capable of producing the symptoms in Criterion A. C. disturbance is not better explained by an anxiety disorder that is not substance/medication-induced . Such evidence of an independent anxiety disorder could include following: symptoms precede onset of substance/medication use; symptoms persist for a substantial period of time (about 1 month) after the cessation of acute withdrawal or severe intoxication; or there is other evidence suggesting existence of an independent non-substance/medication-induced anxiety disorder (a history of recurrent non-substance/medication-related episodes). D . disturbance does not occur exclusively during course of a delirium . E . disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Note: diagnosis made instead of a diagnosis of substance intoxication or substance withdrawal only when the symptoms in Criterion A predominate in clinical picture and they are sufficiently severe to warrant clinical attention . Diagnostic Features: -prominent symptoms of anxiety/panic d/t effects of substance -developed soon after intoxication/withdrawal Differential DX: -substance intoxication/withdrawal -anxiety d/o -delirium -anxiety d/o due to another medical condition

Panic d/o, criteria, features...

Diagnostic Criteria: A. Recurrent unexpected panic attacks; an abrupt surge of intense fear or intense discomfort, reaches a peak wi/in minutes, and during which time four + of following symptoms occur: (abrupt surge can occur from a calm state or an anxious state) 1 . Palpitations, pounding heart, or accelerated heart rate; 2. Sweating; 3 . Trembling or shaking; 4. Sensations of shortness of breath or smothering; 5. Feelings of choking; 6. Chest pain/discomfort; 7. Nausea/ abdominal distress; 8. Feeling dizzy, unsteady, light-headed, or faint; 9. Chills or heat sensations; 10. Paresthesias (numbness/tingling sensations); 11. Derealization (feelings of unreality) or depersonalization (being detached from oneself); 12. Fear of losing control or "going crazy"; 13. Fear of dying, culture-specific symptoms (tinnitus, neck soreness, headache, uncontrollable screaming or crying) may be seen and should not count as one of four required symptoms. B. At least one of the attacks has been followed by 1 month (or more) of one or both of following: 1. Persistent concern/worry about additional panic attacks or their consequences (losing control, having a heart attack, "going crazy'') . 2. significant maladaptive change in behavior related to the attacks (behaviors designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations) C. disturbance is not attributable to physiological effects of substance (drug of abuse, a medication) or another medical condition (hyperthyroidism, cardiopulmonary d/o's). D. disturbance not better explained by another mental disorder (panic attacks do not occur only in response to feared social situations, as in social anxiety disorder: in response to circumscribed phobic objects or situations, as in specific phobia; in response to obsessions, as in obsessive-compulsive d/o; in response to reminders of traumatic events, as in posttraumatic stress disorder: or in response to separation from attachment figures, as in separation anxiety disorder). Diagnostic Features: -recurrent unexpected panic attacks -worries about visible symptoms of attack, "going crazy" -avoidance of panic attacks or consequences (restricting activities) Development and Course: -median age 20-24 years -can be continuous or episodic -can be traced back to childhood in some -possibly underdiagnosed in OA's -adolescents may be less willing to discuss Suicide Risk: -panic d/o DX'd in past 12 months related to higher rate of suicide attempts and ideation Differential DX: -other specified anxiety d/o -anxiety d/o due to another medical condition -substance/medication induced anxiety d/o -other mental d/o's w/panic attacks as an associated feature Comorbidity: -prevalence elevated w/other anxiety d/o's, MDD, bipolar, mild alcohol use d/o -comorbid w/medical symptoms (hypothyroid, COPD, dizziness...)

Specific Phobia, criteria, features...

Diagnostic Criteria: a. marked fear/anxiety about specific object situation b. object/situation almost always provokes fear/anxiety c. object/situation actively avoided or endured w/intense fear/anxiety d. fear/anxiety out of proportion to actual danger posed by object/situation and to sociocultural context e. fear, anxiety, avoidance, is persistent, 6 + mo f. fear, anxiety, avoidance, causes significant distress/impairment in social, occupational or other areas of functioning g. disturbance not better explained by another mental d/o (ie. agoraphobia); objects related to obsessions (OCD); reminders of traumatic events (PTSD); sedation form home/attachment figures (separation anxiety d/o); or social situations (social anxiety d/o) Diagnostic Features: -presence of specific situation/object (phobic stimulus) -response must be intense or severe Development and Course: -can occur following experiencing/observing traumatic event -specific phobias usually develop in early childhood, majority before age 10 -in child, consider developmental stage, impact on impairment, duration... -can be experienced late in life, may be related to medical conditions, manifests atypical can included both depression/anxiety in OA Suicide Risk: 60% more likely to make an suicidal attempt; may be related to d/t comborbidity w/personality d/o and other anxiety d/o Differential DX: -agoraphobia -social anxiety d/o -separation anxiety d/o -panic d/o -OCD -trauma and stressor-related d/o's -eating d/o's -schizophrenia spectrum and other psychotic d/o's Comorbidity: -frequently associated w/depression in OA's -usually early onset, typically temporarily primary d/o -individuals are at risk of redevelopment of other d/o, including anxiety d/o, depressive and bipolar d/o, substance related d/o, somatic symptoms and related d/o, and personality d/o's (dependent)

Adjustment D/O's, criteria, features...

Diagnostic Features: A. development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring w/in 3 months of onset of stressor(s). B. These symptoms or behaviors are clinically significant, as evidenced by one or both of the following: 1 . Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation . 2. Significant impairment in social, occupational, or other important areas of functioning. C. The stress-related disturbance does not meet criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder. D. symptoms do not represent normal bereavement. E. Once the stressor or its consequences have terminated, symptoms do not persist for more than an additional 6 months. Development and Course: -begins w/in 3 months of onset of stress and lasts no longer than 6 months after stressor ceased Differential DX: -MDD -PTSD and acute stress d/o -personality d/o -psychological factors affection other medical conditions -normative stress reaction Comorbidity: -can accompany most mental d/o's -commonly can accompany any medical illness and may be psychological response to medical d/o

New in DSM 5 is the addition of ____________ ____________ and ___________ and ___________ related D/O's.

Obsessive compulsive; trauma and stressor related d/o's

Trauma and Stressor-realted D/O's:

Posttraumatic stress disorder Acute stress disorder Adjustment disorder -new diagnostic chapter brings together many conditions previously listed in anxiety disorders, disorders of infancy/childhood/adolescence, and adjustment disorders -all disorders in this chapter result from exposure to traumatic or stressful situations or events recognized in the criterion set -chapter developed because of research showing variations in clinical expression of psychological distress following exposure to traumatic or stressful events

DSM 5 reclassified anxiety d/os' and pairs by _____ of onset of shared features.

age

The ______________ system warns us when a danger is present in our environment and triggers fear reaction and then fight/flight reaction.

limbic

Anxiety D/O's include:

specific phobia social anxiety d/o panic d/o agoraphobia generalized anxiety d/o substance/medication-induced anxiety d/o anxiety d/o due to another medical condition

Substance/medication-induced OC and related D/O's:

use of some substance appears to have caused -obsessions -compulsions -hair pulling, etc...