This is a brief video on psych disorders related to nervousness, rumination, and related somatic complaints.
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ADDITIONAL TAGS:
Generalized anxiety disorder
5-10 percent lifetime prevalence; 2:1 W:M
Definition: Excessive worrying and anxiety for 6 months
Worry about school/grades, job, money, relationships, events, life
Pathophys: “disrupted functional connectivity of the amygdala and its processing of fear and anxiety”
At least 3 of symptoms: Restlessness, Tires easily, Problems concentrating, Irritability, Muscle tension, Problems with sleep
Specific phobias
10 percent lifetime prevalence; W M, approx 2:1
Definition: Irrational fear of a specific object, place, situation, or concept for 6+ months
Fear out or proportion to imminent threat
Fear interferes with functioning in society
Exposure induces immediate fear; removal reduces anxiety
Fear might have developed from related trauma
Social phobia: fear of embarrassment in public situation
Agoraphobia: fear of public places due to lack of ability to escape; fear of unsafe environment
Treatment:
Separation anxiety disorder
Definition: “excessive anxiety regarding separation from home or from people to whom the individual has a strong emotional attachment” for 4w in children or 6mo in adults
May include anxiety/fear/distress when separated; reluctance to be alone/leave home/school/work; worry about harm to attachment figures
Symptoms cause dysfunction in society
Treat with CBT, family therapy, and possibly adjunct SSRIs
Similar anxiety during normal child development:
Stranger anxiety at 6 months
Separation anxiety at 1 year
Panic attacks
4% lifetime prevalence; W:M 2:1
Definition: “sudden periods of intense fear that may include palpitations, sweating, shaking, shortness of breath, numbness, or a feeling that something bad is going to happen”
Occurrence of at least one attack
Constant worry about recurrence
Other symptoms … trembling, unsteadiness, depersonalization, palpitations, abdominal pain, chest pain
Must rule out medical etiologies: hyperthyroidism, afib, pheochromocytoma, drugs (amphetamines, sympathomimetics)
Obsessive compulsive disorder
2 to 3 percent lifetime prevalence; M=F
Obsessions: recurrent thoughts that persist despite trying to ignore them
Compulsions: explicit rituals that either reduce anxiety or that patients feel they have to perform
OCD is associated/comorbid with other psychiatric disorders: other anxieties, depression/bipolar, OCPD
Treatment:
Psychotherapy: CBT
Pharmacotherapy: SSRI clomipramine (TCA) ECT
Generalized anxiety d/o
Specific phobias
Separation anxiety d/o
Panic attacks
OCD
OCD-related d/o
PTSD
Acute stress d/o
Adjustment d/o
OCD-related disorders
Body dysmorphic disorder
WM, higher in derm and cosmetic sx pts
Perceived flaws in physical appearance
Excoriation disorder - compulsive skin picking
Hoarding disorder
Cannot discard possessions, regardless of value
Typically accumulate trash
Treat with specialized CBT
Trichotillomania - hair pulling disorder
Treat with specialized CBT: habit reversal training; SSRIs, atypical antipsychotics
Post traumatic stress disorder
Mental disorder occurring after exposure to trauma, such as sexual assault, warfare, violence, traffic collisions
Symptoms of increased reactivity, irritability, difficulty concentrating, hypervigilance, exaggerated startle, sleep difficulties
Avoidance of triggers of symptoms
Symptoms lasting 1 month
Acute stress disorder: PTSD-like condition with trauma occurring 1 mo ago symptoms lasting 1 mo
Treatment:
Psychotherapy: CBT (exposure therapy, cognitive processing therapy)
Adjustment disorder
Very common; up to 20 percent in outpatient clinics
Patient unable to cope with stress or major life event
Symptoms include loss of interest, crying, feeling of hopelessness
Symptoms occur within 3 mo of stressor and should resolve by 6 mo
Symptoms resolve when pt adapts to new situation
“Situational depression”
Treat with supportive therapy
Can consider temporary medications for some symptoms (insomnia, anxiety, or depression)