05a_Anxiety disorders Flashcards
“Pure” Anxiety Symptoms
ANS arousal
Apprehension
Tension
Trembling
Excessive worry
Nightmares
“Pure” Depression Symptoms
Depressed mood
Anhedonia
Loss of interest in usual activities
Suicidal ideation
Decreased libido
Separation Anxiety Disorder:
Three Developmentally inappropriate and Excessive fears
Separation from home or attachment figures
Fear of being alone
Physical Complaints
Separation Anxiety Disorder:
Duration criteria
4+ weeks = Children and adolescents
6+ months = Adults
Separation Anxiety Disorder:
Three Age Ranges associated with School Refusal
5-7yo
10-11yo
14-16yo
Separation Anxiety Disorder:
Frequent Precipitating Stressors
Death of a relative or pet
Parental divorce
Move to new neighborhood
Separation Anxiety Disorder:
Differential diagnosis
Developmentally appropriate separation anxiety
Agoraphobia
GAD
Conduct disorder
SAD
Separation Anxiety Disorder:
Treatment
Systematic desensitization and other behavioral interventions
Cognitive approaches for older children and adolescents
School refusal:
Primary goal of treatment
Immediate return to school
Limit academic failure, social isolation, and other secondary impairments
Specific phobia:
Duration criteria
6+ months
Specific phobia:
Subtypes
Animal
Natural environment
Blood-injection-injury
Situational
Specific phobia:
Etiology
Abnormal levels of 5HT, NE, GABA
Cognitive factors
Classical conditioning
Specific phobia:
Two-factor Theory
Phobia is developed through Classical Conditioning
Phobia is maintained through Operant Conditioning
Negative Reinforcement of Avoidance
Specific phobia:
Treatment
In vivo exposure
Cognitive self-control
Social Anxiety Disorder (social phobia):
Duration criteria and symptoms
6+ months
Fear of negative evaluation
Avoidance of situations
*Or endurance with intense anxiety
Social Anxiety Disorder:
Potential Etiology
Behavioral inhibition temperament
Selective attention
Social Anxiety Disorder:
Treatment
ERP
Social skills training or cognitive restructuring
Pharmacotherapy, including beta blockers
Panic Disorder:
Diagnostic Criteria
1+ panic attack
1+ month of persistent concern about additional attacks
4+ characteristic symptoms
Panic attack:
Characteristic symptoms
Palpitations or accelerated heart rate
Sweating
Trembling
Feelings of choking
Chest pain or discomfort
Paresthesias
Derealization or depersonalization
Fear of losing control
Panic Attack:
Definition
Abrupt surge of intense fear or intense discomfort
Reaches a peak within minutes
Panic Disorder:
Rule outs
Hyperthyroidism
Hypoglycemia
Cardiac arrhythmia
Other medical conditions
Panic Disorder:
Prevalence
2-3% for adolescents and adults
Females 2:1
Panic Disorder:
Primary reason children do not receive diagnosis
Cognitive limitations preclude catastrophic interpretations of bodily symptoms
Panic Disorder:
Treatment
Exposure
Panic control therapy (PCT)
Pharmacotherapy
*High risk for relapse when used alone
Agoraphobia:
Feared situations
Public transportation
Open or enclosed spaces
Lines / Crowds
Outside of home alone
Agoraphobia:
Diagnostic Criteria
2+ feared situations
6+ months
Agoraphobia:
Differential diagnosis: specific phobia
Phobia typically involves only a single situation
Phobia is not mainly focused on panic-like, incapacitating, or embarrassing symptoms
Agoraphobia:
Differential diagnosis: Social Anxiety Disorder
SAD = Fear of Negative Evaluation
*Anxiety increases in the presence of a family member or friend
Agoraphobia: friend/family reduces anxiety
(“safe person”)
Agoraphobia:
Treatment
In vivo exposure
Generalized Anxiety Disorder:
Diagnostic criteria
Excessive anxiety and worry about multiple domains
6+ months
3+ characteristic symptoms
Generalized Anxiety Disorder:
Characteristic Symptoms
Restlessness or feeling keyed up or on edge
Being easily fatigued
Difficulty concentrating
Irritability
Muscle tension
Sleep disturbance
Generalized Anxiety Disorder:
Comorbidity
*Highest comorbidity rate of all anxiety disorders**
50% have additional diagnoses
90% have 1 other lifetime psychiatric diagnosis
Generalized Anxiety Disorder:
Comorbidities, highest to lowest frequency
MDD or PDD
Substance use disorder
Simple phobia
Social anxiety disorder
Generalized Anxiety Disorder:
Age-related focus of Worry
Children and adolescents: performance in school, sports, and natural disasters
Young adults: work, family, finances, future
Older adults: personal health, minor/routine matters
Generalized Anxiety Disorder:
Treatment
CBT
Combination of CBT and pharmacotherapy
Generalized Anxiety Disorder:
Two pharmacotherapy choices when individual is nonresponsive to SSRI or SNRI
Benzodiazepine
Buspirone (BuSpar)
