1 Anxiety, Trauma- and Stressor-Related, and Obsessive-Compulsive and Related Disorders Flashcards
_____ is a negative mood state characterized by bodily symptoms of physical tension and by apprehension about the future.
Anxiety
_____ is an immediate emotional reaction to current danger characterized by strong escapist action tendencies and, often, a surge in the sympathetic branch of the autonomic nervous system.
Fear
Intense fear or intense discomfort that reaches a peak within minutes:
1) Palpitations, pounding heart, or accelerated heart rate
2) Sweating
3) Trembling or shaking
4) Shortness of breath or smothering
5) Feeling of choking
6) Chest pain or discomfort
7) Nausea or abdominal distress
8) Dizzy, unsteady, lightheaded, or faint
9) Chills or heat sensations
10) Paresthesias (feelings of numbness or tingling sensations)
11) Derealization (feelings of unreality) or depersonalization (being detached from oneself)
12) Fear of losing control or going crazy
13) Fear of dying
Panic Attack (4+)
In psychopathology, a _____ is defined as an abrupt experience of intense fear or acute discomfort, accompanied by physical symptoms that usually include heart palpitations, chest pain, shortness of breath, and, possibly, dizziness.
panic attack
Two basic types of panic attacks are described in DSM-5:
- Unexpected attacks—panic disorder, no clue or when
2. Expected attacks—specific phobias or social phobia
Two basic types of panic attacks are described in DSM-5:
- Unexpected attacks—panic disorder, no clue or when
2. Expected attacks—specific phobias or social phobia
Biological Contributions of Panic Attack
No single _____ seems to cause anxiety or panic. Instead, contributions from collections of genes in several areas on chromosomes make us vulnerable when the right psychological and social factors are in place.
gene
Biological Contributions of Panic Attack
Depleted levels of _____, part of the _____–benzodiazepine system, are associated with increased anxiety, although the relationship is not quite so direct.
gammaaminobutyric acid (GABA)
Biological Contributions of Panic Attack
The _____system has also been implicated in anxiety, and evidence from basic animal studies, as well as studies of normal anxiety in humans, suggests the serotonergic neurotransmitter system is also involved.
noradrenergic
Biological Contributions of Panic Attack
_____ system as central to the expression of anxiety (and depression) and the groups of genes that increase the likelihood that this system will be turned on.
Corticotropin-releasing factor (CRF)
Biological Contributions of Panic Attack
The area of the brain most often associated with anxiety is the _____ system which acts as a mediator between the brain stem and the cortex.
limbic
Biological Contributions of Panic Attack
The late _____, a prominent British neuropsychologist, identified a brain circuit in the limbic system of animals that seems heavily involved in anxiety. The system that Gray calls the behavioral inhibition system (BIS).
Jeffrey Gray
Psychological Contributions of Panic Attack
_____ thought anxiety was a psychic reaction to danger surrounding the reactivation of an infantile fearful situation.
Freud
Psychological Contributions of Panic Attack
_____ theorists thought anxiety was the product of early classical conditioning, modeling, or other forms of learning
Behavioral
Psychological Contributions of Panic Attack
A general _____ may develop early as a function of upbringing and other disruptive or traumatic environmental factors.
“sense of uncontrollability”
Psychological Contributions of Panic Attack
Parents who provide a _____ but allow their children to explore their world and develop the necessary skills to cope with unexpected occurrences enable their children to develop a healthy sense of control.
“secure home base”
Social Contributions of Panic Attack
_____ life events trigger our biological and psychological vulnerabilities to anxiety. Most are social and interpersonal in nature—marriage, divorce, difficulties at work, death of a loved one, pressures to excel in school, and so on. Some might be physical, such as an injury or illness
Stressful
Social Contributions of Panic Attack
DSM-5 now makes it explicit that panic attacks often co-occur with certain medical conditions, particularly _____ disorders, even though the majority of these patients would not meet criteria for panic disorder
cardio, respiratory, gastrointestinal, and vestibular (inner ear)
Based on epidemiological data, Weissman and colleagues found that _____ of patients with panic disorder had attempted suicide
20%
A. Excessive anxiety and worry (apprehensive expectation) on more days than not on at least 6 months in work or school performance
B. Difficulty to control worry
C. Anxiety and worry with at least 3, more days than not at least 6 months (only 1 for children)
1) Restlessness or feeling keyed up or on edge
2) Easily fatigued
3) Difficulty concentrating or mind going blank
4) Irritability
5) Muscle tension
6) Sleep disturbance (difficulty falling or staying sleep or restless, unsatisfying sleep)
D. Anxiety, worry, physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
E. Disturbance is not due to physiological effects of substance or general medication
F. Disturbance is not better explained by another mental disorder (anxiety, worry about panic attacks in panic disorder, negative evaluation in SAD)
Generalized Anxiety Disorder
Whereas panic is associated with autonomic arousal, presumably as a result of a sympathetic nervous system surge (for instance, increased heart rate, palpitations, perspiration, and trembling), _____ is characterized by muscle tension, mental agitation, susceptibility to, fatigue (probably the result of chronic excessive muscle tension), some irritability, and difficulty sleeping.
Focusing one’s attention is difficult, as the mind quickly switches from crisis to crisis.
GAD
Statistics of GAD
About _____ of individuals with GAD are female in both clinical samples. But this sex ratio may be specific to developed countries. In the South African study mentioned here, GAD was more common in males.
median age of onset based on interviews is 31.
two-thirds
Statistics of GAD
GAD is prevalent among _____. In the large national comorbidity study and its replication, GAD was found to be most common in the group over 45 years of age and least common in the youngest group, ages 15 to 24.
older adults
Treatment for GAD
_____ are most often prescribed for generalized anxiety, and the evidence indicates that they give some relief, at least in the short term.
Risks: First, impair both cognitive and motor functioning. They don’t seem to be as alert on the job or at school when they are taking _____. May impair driving, and in older adults they seem to be associated with falls, resulting in hip fractures.
Produce both psychological and physical dependence, making it difficult for people to stop taking them.
Benzodiazepines
Treatment for GAD
There is stronger evidence for the usefulness of _____ in the treatment of GAD, such as paroxetine (also called Paxil) and venlafaxine (also called Effexor)
antidepressants
Treatment for GAD
_____ for GAD in which patients evoke the worry process during therapy sessions and confront anxiety-provoking images and thoughts head-on.
_____ and the antidepressant drug sertraline (Zoloft) were equally effective immediately following treatment compared with taking placebo pills for children with GAD and other related disorders.
cognitive-behavioral treatment (CBT)
A. Recurrent unexpected _____ attacks are present
B. At least 1 of the attacks followed by 1 month or more of 1 or both of the following:
- Persistent concern or worry about additional _____ attacks or their consequences (losing control, having a heart attack, going crazy))
- Significant maladaptive change in behavior related to the attacks (avoid panic attacks, avoidance of exercise or unfamiliar situations)
C. Disturbance is not attributable to the psychological effects of a substance (drug abuse, medication) or another medical condition (hyperthyroidism, cardiopulmonary disorders)
D. Disturbance is not better explained by another mental disorder (_____ attacks do not occur only in response to feared social situations as in social anxiety disorder)
Panic Disorder
A. Fear or anxiety about 2 or more: Public transportation, open spaces, enclosed places, standing in line, or being in a crowd, outside the home alone
B. Fears or avoid these situations due to escape is difficulty or help is not available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms (fear of falling in the elderly, fear of incontinence—mapaihi)
C. _____ situations almost always provoke fear or anxiety
D. _____ situations are actively avoided, requires companion, or endured with intense fear or anxiety
E. Fear or anxiety is out of proportion to the actual danger in situations or sociocultural context
F. Fear, anxiety, or avoidance is persistent. 6 months or more.
G. Fear, anxiety, avoidance causes distress or impairment in social, occupational or other important areas of functioning.
H. If a medical condition is present (inflammatory bowel disease, Parkinson’s) the fear, anxiety, avoidance is clearly excessive
I. Fear, anxiety, avoidance is not better explained by specific phobia, situation type, social situation (SAD) and not obsessions (ODC), perceived physical flaws (BDD), reminders of PTSD, or sepanx
Agoraphobia
_____, in which individuals experience severe, unexpected panic attacks; they may think they’re dying or otherwise losing control.
_____ is accompanied by a closely related disorder called agoraphobia, which is fear and avoidance of situations in which a person feels unsafe or unable to escape to get home or to a hospital in the event of a developing panic symptoms or other physical symptoms, such as loss of bladder control.
Panic Disorder
In DSM-_____, panic disorder and agoraphobia were integrated into one disorder.
IV
The term agoraphobia was coined in 1871 by Karl Westphal, a German physician, and, in the original Greek, refers to fear of the _____.
marketplace
Agoraphobic _____ seems to be determined for the most part by the extent to which you think or expect you might have another attack rather than by how many attacks you actually have or how severe they are. Thus, agoraphobic _____ is simply one way of coping with unexpected panic attacks
avoidance
Most patients with panic disorder and agoraphobic avoidance also display another cluster of avoidant behaviors that we call _____ avoidance, or avoidance of internal physical sensations.
Some patients might avoid exercise/sauna baths because it produces increased cardiovascular activity or faster respiration, which reminds them of panic attacks and makes them think one might be beginning.
interoceptive
Statistics for Panic Disorder and Agoraphobia
_____ two-thirds of them women. Onset is in early adult life. Median age is between 20 and 24.
60% of the people with _____ have experienced such nocturnal attacks
(75% or more) of those who suffer from agoraphobia are women.
Panic Disorder
Causes of Panic Disorder and Agoraphobia
Clark said, although we all typically experience rapid heartbeat after exercise, if you have a _____, you might interpret the response as dangerous and feel a surge of anxiety.
psychological or cognitive vulnerability
Causes of Panic Disorder and Agoraphobia
One hypothesis that panic disorder and agoraphobia evolve from psychodynamic causes suggested that early _____ and/or separation anxiety might predispose someone to develop the condition as an adult.
object loss
Causes of Panic Disorder and Agoraphobia
_____ personality tendencies often characterize a person with agoraphobia. These characteristics were hypothesized as a possible reaction to early separation.
Dependent
Treatment for Panic Disorder and Agoraphobia
A large number of drugs affecting the noradrenergic, serotonergic, or GABA–benzodiazepine neurotransmitter systems, or some combination, seem effective in treating panic disorder.
High-potency benzodiazepines, the newer selective-serotonin reuptake inhibitors (SSRIs) such as Prozac and Paxil.
_____ are currently the indicated drug for panic disorder
SSRIs
Treatment for Panic Disorder and Agoraphobia
The strategy of _____ treatments is to arrange conditions in which the patient can gradually face the feared situations and learn there is nothing to fear.
exposure-based