10/11 Anxiety Disorders - Tamburello

Question 1

anxiety

pathological anxiety

Answer 1

sense of uneasiness of distress about future uncertainties

UNIVERSAL EXPERIENCE

unpleasant, but might be essential for adaptive functioning

pathological when it is…

• excessive or illogical
• maladaptive
• causing inappropriate avoidance

Question 2

mind-body connection : anxiety

Answer 2

psychic anxiety (mental)

somatic anxiety (physical)

Question 3

parts of brain involved in fear response

Answer 3

fear circuit involves…

• sensory afferents
• hippocampus
• amygdala
• prefrontal cortex
• hypothalamus

Question 4

neurotransmitters assoc with anxiety

Answer 4

• GABA (inhibitory, dampens anx)
• NE (increases anx)
• DA (increases anx)
• serotonin (early on, can increase anxiety; both high and low levels associated with anxiety)

Question 5

substances associated with anxiety

Answer 5

stimulants/caffeine

decongestants

asthma medications (ex. albuterol)

SSRIs (ex. fluoxetine/Prozac)

marijuana

corticosteroids

sodium lactate (in panic disorder)

Question 6

substance use/withdrawal and anxiety

Answer 6

opiates

cocaine

alcohol

benzodiazepines

Question 7

behavioral theory of anxiety

Answer 7

anxiety can be learned

• classical conditioning
• operant conditioning

behavioral tx is aimed at extinguishing avoidance behaviors

Question 8

cognitive theory of anxiety

Answer 8

anxiety may be related to cognitive distortions

examples:

• jumping to conclusions
• overstimating severity of an event
• underestimating your coping ability

Question 9

generalized anxiety disorder

Answer 9

persistent, excessive anxiety over ‘everyday stressors’

aka “free-floating” anxiety

DSM5: excessive anx and worry occuring more days than not for at least 6 mos about number of events/activities

prevalence: 4-7%, more in women

• typical onset: early 20s, but can occur any time in life

may present with somatic sx

overlap with MDD (80% comorbid)

strongly tied to levels of stress

Question 10

panic attack

Answer 10

abrupt surge of intense fear/discomfort that peaks within minutes with 4 or more physical/mental symptoms:

• palpitations, pounding heart, accel HR
• sweating
• trembling, shaking
• SOB or smothering feeling
• feeling of choking
• chest pain/discomfort
• nausea, abd distress
• dizzy, unsteady, lightheaded, faint
• chills/hot flashes

potential mental sx

• derealization or depersonalization
• fear of losing control, going crazy
• fear of dying

Question 11

diff between generalized anxiety and panic attack

Answer 11

gen vs panic

• long timeframe vs shorter timeframe

Question 12

panic attacks vs panic disorder

Answer 12

panic attacks are COMMON (30% will have one in a given year)

• may be a specifier to any other mental disorder

panick attacks within a panic disorder? spontaneous! unprovoked

Question 13

panic disorder

Answer 13

recurrent unexpected panic attacks

• worry about addtl attacks or enact behavior changes to avoid future attacks
• NOT due to physiological effects of substance or another medical condition/mental disorder

prevalence: 2-5%, 2x common in women, typical onset in early 20s

comorbidities:

• MDD and other mood disorders
• other anx disorders
• substance abuse disorders

Question 14

agoraphobia

Answer 14

fear or avoidance of being helpless in a place where escape may be difficult or embarassing

ex. public transport, open/closed spaces (bridges/theaters), standing in line, being in a crowd, being outside the house alone

Question 15

phobia

types

Answer 15

specific, unreasonable fears of object/situations

types:

• animal type (spiders, dogs)
• natural environment (heights, water)
• blood-injection-injury (needles) → closely linked to vasovagal response! (often faint!)
• situational (airplanes, elevators, enclosed spaces)
• other

Question 16

phobia features

Answer 16

common (11% lifetime prevalence)

onset usually in childhood, F>M, genetic component (75% have relative with a phobia)

often see anxious/avoidant personality traits

often don’t seek tx unless affecting work/activities

Question 17

social anxiety disorder

(social phobia)

Answer 17

marked or persistent fear of social situations with risk of scrutiny by others

• not the same as “shy” → only 12% of shy meet criteria for SAD

prevalence: 13%, similar for men/women, usually starting in adolescence

Question 18

performance anxiety

Answer 18

specifier for social phobia!

limited to specific perfomance situations

• beta-blockers may be helpful!

Question 19

separation anxiety disorder

Answer 19

more common inchildren (4%) but can also occur as new-onset illness in adults (2%)

may present as…

• school phobia/refusal
• nightmares of separation
• somatic symptoms

over 4wk in kids, 6mo in adults

attachment figure is usually parent for kids, spouse/friend for adults

Question 20

obsessive-compulsive and related disorders

Answer 20

OCD

body dysmorphic disorder

hoarding disorder

trichotillomania (hair-pulling)

excoriation disorder (skin picking)

Question 21

obsessions

Answer 21

recurrent and persistent throughts, impulses, or images that are experienced as intrusive and unwanted

→ provoke anxiety

examples:

• contamination
• self-doubt
• aggressive/sexual thoughts
• order/symmetry

Question 22

compulsions

Answer 22

repetitive behaviors (or mental rituals) that are engaged in with the goal of reducing teh anxiety assoc with obsessions

• checking
• counting
• washing
• arranging

Question 23

OCD: obsessive-compulsive disorder

specifiers

Answer 23

chronic obsessions and compulsions that cause significant distress, interfere with fx, or are excessively time-consuming (> 1hr per day)

12 month prevalence: 1%, F a little higher than M, onset typicaly in adolescence/young adulthood (younger in males)

specifiers:

• tic-related (can be comorbid with Tourette’s)
• insight (good, fair, absent/delusional)

Question 24

OCD and neurosurgery

Answer 24

last resort tx: cigulotomy

Question 25

hoarding disorder

Answer 25

before DSM5, hoarding was listed as an OCD "compulsion" ex. animal hoarding onset is in childhood, but impairment is progressive

Question 26

body dysmorphic disorder

Answer 26

preoccupation with imagined/exaggerated body defect NOT EATING DISORDER onset usually in early teens

Question 27

PTSD dx risk factors comorbidities

Answer 27

traumatic stress: psych sx following severe traumA * 50% of people suffering acute trauma → acute stress sx * 50% of these have sx for 1mo+ ex. combat stress diagnosis: * severe trauma * re-experiencing of the trauma * avoidance of reminders * negative changes in thinking/mood * hyperarousal (easily startled) * chronicity (1month+) risk factors: * severity/nature of trauma * feeling of 'powerlessness' * genetic/personality factors * early traumatic exp * less supportive environment comorbidities: * MDD, other mood disorders * phobic, other anxiety disorders * substance use disorders

Question 28

what kinds of trauma lead to PTSD?

Answer 28

exposure to actual or threatened death, serious injury, or sexual violence: * directly experienced * witnessed * second-hand knowledge of trauma to close family member, close friend * repeated or extreme exposure to details of traumatic events

Question 29

PTSD treatment

Answer 29

psychotherapy * cognitive behavior therapy * group therapy (survivors group) * \*single-session "debriefing can be harmful! EMDR: eye movement desensitization and reprocessing

Question 30

acute stress disorder

Answer 30

like PTSD, but for less than a month * can develop into PTSD!

Question 31

adjustment disorder

Answer 31

clinically significant sx in response to an identifiable stressor * not another mental disorder * not "normal bereavement" once stressor is over, sx stop within 6mo specify: depressed mood, anxiety, disturbance of conduct, mixed