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Anxiety & Obsessive Behaviors in people with I/DD

Anxiety & Obsessive Behaviors in people with I/DD. Alya Reeve, MD, MPH DDMI-TUG 3-12-12. Overview. Definitions Anxiety Obsession Behavior Prevalence of anxiety disorders Effective analysis of anxiety Treatment options. Definitions. ANXIETY Increased worry & concern

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Anxiety & Obsessive Behaviors in people with I/DD

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  1. Anxiety & Obsessive Behaviors in people with I/DD Alya Reeve, MD, MPH DDMI-TUG 3-12-12

  2. Overview • Definitions • Anxiety • Obsession • Behavior • Prevalence of anxiety disorders • Effective analysis of anxiety • Treatment options

  3. Definitions • ANXIETY • Increased worry & concern • Perceived lack of safety • Autonomic arousal • OBSESSION • Repetitive thoughts • Ego-dystonic; unwanted • Not enhancing function • BEHAVIOR • Observable actions that an animal/person makes

  4. Prevalence • Most common disorder • Reports from 17-95% of individuals with I/DD • Rate increased with history of untreated, unrecognized trauma • Spectrum • Normal  Psychopathological • Generalized Anxiety; phobias; panic disorder • PTSD • OCD • Specific habits: trichotillomania, pica…

  5. Detecting Anxiety • Is there something new (or scary) going on? • Does the person show physiologic signs and symptoms? • What is their state of arousal? • Evidenced in what is spoken about and what is specifically not said. • Excess worry may preoccupy all attention. • Not everyone shares the same worries.

  6. Perceiving obsessive behavior • Decoding compulsions • Number of repetitions; feel right • Repetition reflecting mental cues • Preoccupied • +/- vocalizations • Mannerisms • Behavior may not be fixed; can be interrupted • Increase with increasing stress or emotional pressure • May not respond to reassurance

  7. Therapeutic Strategies • Reassurance • Listen; take concerns for real • Environmental change • Assure safety; verify threat • Engage in participation • Medications • SSRI, SNRI, TCA • BZD, alpha-blocker, beta-blocker • AED, mood stabilizer, antipsychotic… • Psychotherapy

  8. Therapeutic Strategies • Relaxation • Direct touch: massage, hot-tub • Self-directed: auto-hypnosis, meditation • Exercise • Movement: • Increase aerobic expenditure • Kinesthetic feedback • Outdoor activity; solo or group • Sleep restoration • Improve sleep quality, duration • Assure regular hours (circadian rhythm)

  9. Case discussions… • A woman like her mother • IMI • A man who wouldn’t go out • Luvox • …

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