Psychiatry: Anxiety, Somatic, and Sleep Disorders

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Psychiatry: Anxiety, Somatic, and Sleep Disorders
2013-01-30 16:18:38
Psychiatry Anxiety Somatic Sleep Disorders

Psychiatry: Anxiety, Somatic, and Sleep Disorders
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  1. A discrete period of intense fear or discomfort in the absence of real danger that is accombined by at least 4 of 13 somatic or cognitive symptoms
    Panic attack
  2. 3 Types of Panic Attacks
    • Uncued
    • Situationally Bound
    • Situationally Predisposed
  3. Anxiety about, or avoidance of places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having a Panic Attack or panic-like symptoms
  4. Neither panic attacks nor agoraphobia are
  5. Symptoms of a panic attack reach a peak within
    10 minutes
  6. Type of panic attack:
    Occurs spontaneously or "out of the blue"
    Uncued Panic Attack (Panic Disorder)
  7. Type of Panic Attack:  Invariably occurs immediately on exposure to, or in anticipation of, the situational cue or trigger
    Situationally bound (or cued)- (specific phobia)
  8. Type of Panic Attack:
    No invariably associated with the cue and do not necessarily occur immediately after the exposure
    Situationally predisposed (generalized panic attack)
  9. 2 Symptoms that Panic Disorder Without Agoraphobia must have
    • 1) Recurrent unexpected panic attacks
    • 2) At least one of the attacks has been followed by 1 month (or more) of:
    •      a)  persistent concern about having additional attacks
    •      b) worry about the implications of the other attack or its consequences
    •      c) a significant change in behavior related to the attacks

    *Note the person must have absence of agoraphobia
  10. If something is generating your panic attacks, it is NOT
    Panic disorder

    Panic disorder comes out of the blue.
  11. Name the 3 DSM-IV diagnoses with panic attacks and agoraphobia
    • 1) Panic disorder w/o agoraphobia
    • 2) Panic disorder w/ agoraphobia
    • 3) Agoraphobia w/o a history of panic disorder
  12. Clinically significant anxiety that is provoked by exposure to a specific feared object or situation.
    Specific Phobia

    • *The pt. recognizes the fear as excesseive and unreasonable
    • *Leads to avoidance behavior or is endured with dread
  13. Clinically significant anxiety that is provoked by exposure to certain types of social or performance situations, often leading to avoidance (Fear of embarrassment and negative assessment)
    Social Phobia
  14. The development of a characteristic set of symptoms after exposure to an extreme traumatic stressor which the pt. responded w/ intense fear, helplessness, or horror. 
    • PTSD:  Symptoms present > 1 month
    • Acute Stress Disorder:  Lasts > 2 days & < 4 wks
  15. Obsessions or compulsions that are severe enough to be time consuming or cause marked distress/ significant impairment.  Pt. recognizes that the obsessions or compulsions are excessive or unreasonable.
  16. Persistent ideas,thoughts impulses or images that are experience as intrusive and inappropriate and that cause marked anxiety or distress
  17. Repetitive behaviors (e.g. hand washing, ordering, checking) or mental acts (e.g. praying, counting, repeating words silently) the goal of which is to prevent or reduce anxiety or distress
  18. Excessive anxiety and worry occuring more days than not for a period of at least 6 months.
    Generalized Anxiety Disorder
  19. Clinically significant anxiety that is judged to be due to the direct physiological effects of a general medical condition
    Anxiety Disorder Duet o a General Medical Condition
  20. Somatoform Disorders
    • Somatization
    • Conversion
    • Hypochondriasis
    • Body Dysmorphic
    • Pain

    (Pts. are convinced they are ill, symptoms are not willfully controlled)
  21. Disorder         Control      Motivation
    Somatoform       U                 U
    Factitious           C                 C
    Malingering        C                 C   
  22. Multiplicity of complaints and multiple organ systems affected
    Somatization Disorder
  23. Preoccupation w/ fear of having a serious disease, no medical cause can be found
  24. Intentional production of signs and symptoms of illness; only apparent motivation is to assume the role of a patient
    Factitious Disorder
  25. Intentional production of false or grossly exaggerated symptoms motivated by external incentive
  26. One or more neurologic symptoms preceded by conflict or other stressors
    Conversion Disorder
  27. Preoccupation with an imaginary bodily defect or an exaggerated distortion of a minor defect
    Body Dysmorphic Disorder
  28. Pain that is not fully accounted for by a nonpsychiatric medical condition
    Pain Disorder
  29. Sleep Stages and waves
    • Awake= alpha
    • 1= theta
    • 2= theta
    • 3= delta
    • REM= mixed
  30. K complexes and sleep spindles are found in what stage of sleep
    Stage 2
  31. Normal Sleep Stage Percentages
    • Stage 1= 5%
    • Stage 2= 45%
    • Stages 3/4= 20-25%
    • Stage REM= 25%
  32. DSM-IV Sleep Disorders
    • Primary: Dyssomnias, Parsomnias
    • Secondary:  Caused by anothe rmental disorder, a general medical condition, or substance use
  33. Characterized by abnormal behavioral or physiological events occuring in association w/ sleep, specific sleep stage, or sleep-wake transitions.
  34. Disorders of initiating or maintaining sleep or of excessive sleepiness and are characterized by a disturbance in the amnt, quality, or timing of sleep
  35. Name 3 Parasomnias
    • Nightmare disorder
    • Sleep terror disorder
    • Sleepwalking disorder
  36. Name 5 Dyssomnias
    • Primary Insomnia
    • Primary Hypersomnia
    • Narcolepsy
    • Breathing-Related Sleep Disorder
    • Circadian Rhythm Sleep Disorder
  37. Reptitive episodes of upper airway obstruction that occur during sleep.  Present with:
    Observed pauses in breathing when sleeping
    Excessive daytime sleepiness
    Obstructive sleep apnea
  38. Narcolepsy is characterized by
    • 1) excessive sleepiness
    • 2) cataplexy
    • 3)  sleep paralysis
    • 4) hypnagogic hallucinations
  39. Narcolepsy is associated with deficits in
  40. Sleep-related Enuresis:
    • Bed-wetting
    • Usually in children
    • Might be a symptom of underlying sleep disorder like Obstructive Sleep Apnea
    • Can occur in any stage of sleep
  41. 4 Tx's for Sleep-related Enuresis
    • Scheduled awakenings
    • Desmopressin
    • Bell and pad
    • Tricyclic antidepressants
  42. Stage of Sleep:  Obstructive Sleep Apnea
    All stages
  43. Stage of Sleep:  Sleepwalking, sleep terrors
  44. Stage of Sleep:  Periodic Limb Movment
    Classically occurs in non-REM sleep, but can occur during REM.
  45. Stage of Sleep:  Nightmare disorder, REM behavior disorder
  46. Multiple sleep latency test
    • •Four opportunities to nap during the day
    • •Each nap opportunity separated by two hours
    • •Patient lies down in a dark room and told to
    • relax
    • •If the patient doesn’t fall asleep within 20
    • minutes the nap opportunity is terminated
    • •If the patient falls asleep any time during
    • the nap opportunity, he / she is allowed to sleep for 15 minutes then the nap is terminated
    • Mean Sleep Latency = average time to fall asleep
  47. Sleep changes with aging
    • Total sleep time decreases
    • % of REM decreases
    • % of slow wave sleep decreases