1: Anxiety Disorders Flashcards
features of anxiety disorders
- characteristic clinical course
- familial pattern
- disrupted brain circuits
- selective drug responses
describe the disrupted brain circuits of anxiety disorders
- mediated by prefrontal cortex
- in high levels of anxiety, prefrontal cortex not as good at modulating the limbic system
- major site of action for anti-anxiety drugs
3 general ways to decrease limbic activity
- strengthen prefrontal cortex -> CBT
- increase serotonin levels in circuits -> SSRI’s
- increase GABA inhibition in the amygdala and hippocampus -> benzodiazepines
specific treatment responses - psychological
- cognitive behavioral therapy (CBT)
- mindfulness - acceptance - based therapies (MABT)
specific treatment responses - pharmacological
- SSRI’s
- SNRI’s
- other antidepressants
- benzodiazepines
4 examples of SSRI’s
- prozac (fluoxetine)
- zoloft (sertraline)
- celexa (citalopram)
- lexapro (escitalopram)
2 examples of SNRI’s
- effexor (venlafaxine - higher dose)
- cymbalta (duloxetine)
which drug increases levels of both dopamine and norepi?
wellbutrin (bupropion)
panic attack qualifications
- development of sudden, intense fear/discomfort
- peaks within 10 minutes
- at least 4 Sx for full panic attack
- less than for ‘limited Sx attack’
potential panic attack Sx
- tachycardia
- SOB
- chest pain
- nausea
- sweating
- shaking
- dizziness
- numbness/tingling
- fear of dying
- fear of losing control
- depersonalization
- choking
- chills or hot flashes
panic disorder qualifications
- recurrent, unexpected panic attacks
- attack followed by at least 1 month of:
- concern about further attacks
- worry about consequences
- significant behavioral change
- panic attacks are not due to organic causes
- panic attacks are not better accounted for by another psychiatric disorder
what percent of the population is affected by panic disorder? what about panic attacks?
panic disorder 1-2%
panic attacks 5-8%
usual onset of panic disorder?
during teenage/early adult period
describe a panic disorder diagnosis
- typical Hx
- usually present with a physical focus
- convinced they have a ‘medical’ illness
- elicit classic pattern of Sx
- lack of physical signs and risk factors for other medical causes
Tx for panic disorder
Psychological:
-CBT
Pharmacological:
- SSRI’s
- tricyclic antidepressants
- benzodiazepines
- MAOi’s
describe dosing of SSRI’s in panic disorder
- all currently available SSRI’s are effective - sertraline and paroxetine
- start at very low dose (5 mg fluoxetine, 25 mg sertraline, 25 mg fluvoxamine or 5 mg paroxetine)
- many respond to lower doses than depression
5 comorbidities with panic disorder
- depression
- agoraphobia
- alcohol abuse
- other anxiety disorders
- personality disorders
7 criteria for social anxiety disorder (phobia)
- marked and persistent fear of one or more social situations (possible scrutiny by others)
- exposure invariably provokes anxiety or fear
- recognize that the fear is excessive
- feared situations are avoided or endured
- persistent for at least 6 months
- significantly interferes with normal life
- not due to another condition
4 most common fears
- speaking in groups (57%)
- meeting strangers (42%)
- eating in public (25%)
- writing in public (12%)
which gender do most anxiety disorders affect more?
females
mean age of onset of social anxiety disorder
11-15 years
environmental/socioeconomic factors associated with social phobia
- on welfare
- did not complete high school
- lowest 2 socioeconomic quartiles
- single or divorced
4 criteria for generalized anxiety disorder (GAD)
- excessive anxiety or worry about a number of events or activities for 6 months (more days than not)
- person finds it difficult to control the worry
- three of the following: restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance
- Sx cause clinically significant impairment in important areas of functioning
GAD onset: early vs. late
early onset:
- before 20
- female > male
- always been anxious
- childhood fears
late onset:
- adult onset
- female = male
- usually precipitated by a stressful event
GAD treatments
pharmacotherapy:
- benzodiazepines
- azospirones (buspirone) - but takes 4-6 weeks to start working
- antidepressants (SSRI’s)
psychotherapies to strengthen prefrontal cortex
OCD: diagnosis
- obsessions and/or compulsions
- cause significant disability/discomfort
- usually occupy 1 hour or more per day
psychiatric obsessions
- intrusive/irrational thoughts, ideas, or images
- usually distressing to the subject
most common obsessions:
- contamination
- fears of harm to self or others
psychiatric compulsions
- repetitive behaviors
- usually done to neutralize the anxiety induced by the obsession
- most patients acknowledge the futility
common compulsions:
- cleaning
- checking
- counting
OCD epidemiology
- 2-3% of population
- earlier onset and severe course in males
- one of the most disabling anxiety disorders
how is OCD pathophysiology different from other anxiety disorders?
affects different brain circuits - here the extrapyramidal pathway - basal ganglia pathway is affected (fronto-striato-thalamo-frontal circuit)
OCD treatment
- SSRI’s most effective first line Tx
- requires higher doses and longer duration
- always combine with behavior therapy
definition of trauma
- life-threatening or potentially life-threatening
- inherent subjective nature to severity
- most critical elements appear to be sense of horror and helplessness
PTSD criteria (6)
- severe trauma
- followed by at least 1 month of Sx
- re-experiening of the trauma (1 or more) flashbacks
- avoidance of situations/memories (1 or more)
- negative alterations in cognition and mood (2 or more)
- Sx of disturbed arousal (2 or more)
specify: with dissociative Sx or with delayed expression
4 risk factors for developing PTSD
- type of trauma
- gender
- age
- genetic vulnerability
PTSD pharmacological Tx
- SSRI’s improve about 50% of PTSD pts
- some anticonvulsants
- combination of medication + therapy = most effective
