03 Fear & Anxiety Disorders Flashcards
1
Q
components of anxiety
A
- affective: fear, panic, shame
- cognitive: “I am in danger”, “I could die”
- physiological: increased heart rate, sweating, dizziness
- behavioral: fight, flight, freeze
2
Q
pathological anxiety when …
A
- the arousal system is hypersensitive and responds to only minor stimuli
- there is extreme anxiety in absence of actual danger
- intensity, duration, and/or frequency of anxiety become distressful and chronic
leading to severe interference in a person’s well-being and everyday functioning
3
Q
“classical” anxiety disorders
A
- agoraphobia
- panic disorder
- social phobia
- specific phobia
- generalized anxiety disorder
4
Q
agoraphobia
A
- anxiety in situations or places where it is difficult to escape and/or to get help
avoidance and/or safety behavior, dependence on accompanying persons - without or with panic disorder
5
Q
panic disorder
A
- recurrent and unpredictable panic attacks
- sudden onset and rapid increase of anxiety
- symptoms related to autonomic nervous system (palpitations, chest pain, shortness of breath, sweating, tremor, dizziness, feelings of unreality)
- secondary fear of dying, losing control, or going mad
- anticipatory anxiety (fear of one’s own fear) with impairment of functioning and behavior change for at least 1 month
6
Q
panic attack - prevalence
A
- more than 30% of population experience at least one panic attack in their life
7
Q
social phobia
A
- fear of scrutiny by other people in social situations
- fear to embarrass themselves, being criticized or humiliated, particularly by the presence of anxiety symptoms (e.g. blushing, sweating, tremor)
- avoidance and/or safety behavior
- special symptoms
8
Q
generalized anxiety disorder
A
- exaggerated anxiety and worries that are generalized to many different topics of everyday life (free-floating) for at least 6 months and more than 50% of time per day
- difficulty to control or stop worrying
- multiple physiological complaints, e.g. muscular tensions, trembling, sweating, palpitations, dizziness, epigastric discomfort
- concentration problems, nervousness, insomnia, irritability
9
Q
anxiety disorders - prevalences [%]
A
- any: 14,5
- specific phobia: 7,6
- panic disorder: 2,3
- agoraphobia and social phobia: both 2,0
- GAD: 1,5
- OCD: 0,7
- 2/3 of patients are female
10
Q
heritability of anxiety disorders
A
30 - 67%
11
Q
3 basic treatment strategies
A
- psychotherapy: cognitive behavioral therapy (CBT)
- psychopharmacotherapy: antidepressants
- psychoeducation, relaxation, exercise/sport
12
Q
decision parameters in treatment selection
A
- patient’s expectations
- diagnosis/symptomatology
- severity
- pre-treatment
- concomitant illness and medication
- availability of therapists
- competencies/resources of patient
13
Q
Psychopharmacotherapy
A
- alteration of monoaminergic neurotransmission by antidepressants
- Selective Serotonin Reuptake Inhibitors (SSRI)
- Selective Serotonin Norepinephrine Reuptake Inhibitors (SSNRI)
- Tricyclic Antidepressants (TCA) (involve more systems and cause more side effects)
- these 3 make more neurotransmitters available and work on Serotonin and Norepinephrine
- Calcium channel modulators (e.g. Pregabaline) work on glutamate
- targeting GABA not recommended in Germany
14
Q
cognitive behavioral therapy in anxiety
A
- reduction of avoidance and safety behavior to allow for a corrective experience (emotional learning, habituation, extinction)
- repeatedly confronting the anxiety provoking stimulus without the feared catastrophe actually happening
- stepwise integration of this new and functional experience in the patient’s everyday life
- exposure therapy as effective as exposure therapy + cognitive strategies
- patient has to be sufficiently informed and motivated
- stronger learning effect for exposures with higher anxiety
