Anxiety Disorders, PTSD, and Related Disorders
Week 6: Anxiety Disorders, PTSD, and Related Disorders
Oh no! It is happening again. I am having a heart attack… I know it. My heart is racing, I can’t breathe, and I am shaking all over. I can’t go to the ER again. They will say what they always say… I am not having a heart attack. It is all in my head.
Barbara, age 68
The anxiety disorders provide us a good opportunity to take a close look at the nature/nurture debate as well as the gene/environment interactions that influence the nervous system and neurochemistry. A significant part of most of Sigmund Freud’s theories, the concept of anxiety has been debated and discussed over many years in the psychiatric literature. While Freud’s theories focused on the “mind” and the unconscious, another way to look at anxiety is with Hans Selye’s concept of “fight or flight” in which the sympathetic nervous system is activated as a response to stress. As you explore the concept of anxiety, you will notice that no two cases of anxiety are the same.
This week, you will explore evidence-based treatment methods for clients with anxiety disorders. You also will complete a midterm exam.
Learning Resources
Required Readings
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
“Anxiety Disorders”
“Trauma- and Stressor-Related Disorders”
Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Publications.
Chapter 16, “Panic Disorder”
Chapter 18, “Social Anxiety Disorder (Social Phobia)”
Chapter 19, “Generalized Anxiety Disorder”
Chapter 20, “Specific Phobia”
Hayes, J. P., Logue, M. W., Reagan, A., Salat, D., Wolf, E. J., Sadeh, N., & … Miller, M. W. (2017). COMT Val158Met polymorphism moderates the association between PTSD symptom severity and hippocampal volume. Journal of Psychiatry & Neuroscience: JPN, 42(2), 95–102. doi:10.1503/jpn.150339
Maples-Keller, J. L., Price, M., Rauch, S., Gerardi, M., & Rothbaum, B. O. (2017). Investigating relationships between PTSD symptom clusters within virtual reality exposure therapy for OEF/OIF veterans. Behavior Therapy, 48(2), 147–155. doi:10.1016/j.beth.2016.02.011
Quinn, B. L., & Peters, A. (2017). Strategies to reduce nursing student test anxiety: A literature review. Journal of Nursing Education, 56(3), 145–151. doi:10.3928/01484834-20170222-05
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
Chapter 9, “Anxiety Disorders” (pp. 387–417)
Chapter 11, “Trauma- and Stressor-Related Disorders” (pp. 437–451)
Stahl, S. M. (2017). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (6th ed.). New York, NY: Cambridge University Press.
To access information on specific medications, click on The Prescriber’s Guide, 6th Ed. tab on the Stahl Online website and select the appropriate medication.
Anxiety Generalized anxiety disorder Panic disorder
alprazolam
amitriptyline
amoxapine
buspirone
chlordiazepoxide
citalopram
clomipramine
clonazepam
clonidine
clorazepate
cyamemazine
desipramine
diazepam
dothiepin
doxepin
duloxetine
escitalopram
fluoxetine
fluvoxamine
gabapentin (adjunct)
hydroxyzine
imipramine
isocarboxazid
lofepramine
loflazepate
lorazepam
maprotiline
mianserin
mirtazapine
moclobemide
nefazodone
nortriptyline
oxazepam
paroxetine
phenelzine
pregabalin
reboxetine
sertraline
tiagabine
tianeptine
tranylcypromine
trazodone
trifluoperazine
trimipramine
venlafaxine
vilazodone
alprazolam
citalopram
desvenlafaxine
duloxetine
escitalopram
fluoxetine
fluvoxamine
mirtazapine
paroxetine
pregabalin
sertraline
tiagabine (adjunct)
venlafaxine
alprazolam
citalopram
clonazepam
desvenlafaxine
escitalopram
fluoxetine
fluvoxamine
isocarboxazid
lorazepam
mirtazapine
nefazodone
paroxetine
phenelzine
pregabalin
reboxetine
sertraline
tranylcypromine
venlafaxine
Posttraumatic stress disorder Reversal of benzodiazepine effects Social anxiety disorder
citalopram
clonidine
desvenlafaxine
escitalopram
fluoxetine
fluvoxamine
mirtazapine
nefazodone
paroxetine
prazosin (nightmares)
propranolol (prophylactic)
sertraline
venlafaxine
flumazenil citalopram
clonidine
desvenlafaxine
escitalopram
fluoxetine
fluvoxamine
isocarboxazid
moclobemide
paroxetine
phenelzine
pregabalin
sertraline
tranylcypromine
venlafaxine
Document: Reimbursement Rate Template (Word document)
Required Media
Wolpe, J. (Producer). (n.d.). Joseph Wolpe on systematic desensitization [Video file]. Mill Valley, CA: Psychotherapy.net.
Note: The approximate length of this media piece is 59 minutes.
Optional Resources
Acosta, M. C., Possemato, K., Maisto, S. A., Marsch, L. A., Barrie, K., Lantinga, L., . . . Rosenblum, A. (2017). Web-delivered CBT reduces heavy drinking in OEF-OIF veterans in primary care with symptomatic substance use and PTSD. Behavior Therapy, 48(2), 262-–276. doi:10.1016/j.beth.2016.09.001
Substance Abuse and Mental Health Services Association (SAMHSA). (2014). TIP 57: Trauma-informed care in behavioral health services. Retrieved from: http://store.samhsa.gov/product/TIP-57-Trauma-Informed-Care-in-Behavioral-Health-Services/SMA14-4816
Note: This document is available as a free download.
Discussion: Treatment of Anxiety Disorders
Anxiety disorders are common in both primary care and psychiatric practice. Clients with anxiety disorders including generalized anxiety disorders, agoraphobia, and other specific phobias will present to the PMHNP’s office with a significant level of distress. Successful recognition and treatment of anxiety disorders includes an accurate diagnostic assessment with a treatment plan that includes a combination of psychopharmacology and psychotherapy. Although psychoanalytic theories are based on the concept of anxiety, the more recent standard of care is with the cognitive-behavioral therapies.
In this Discussion, you will analyze evidence-based treatment plans for clients with anxiety disorders.
Learning Objectives
Students will:
Analyze differences between adjustments disorders and anxiety disorders
Analyze diagnostic criteria for anxiety disorders
Analyze evidence-based psychotherapy and psychopharmacologic treatment for anxiety disorders
Compare differential diagnostic features of anxiety disordersPost:
Explain the difference between an adjustment disorder and anxiety disorder. Provide examples to illustrate your rationale.
Explain the diagnostic criteria for your assigned anxiety disorder.
Explain the evidenced-based psychotherapy and psychopharmacologic treatment for your assigned anxiety disorder.
Support your rationale with references to the Learning Resources or other academic resource.
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