10/11 Anxiety Disorders - Tamburello Flashcards
anxiety
pathological anxiety
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
mind-body connection : anxiety
psychic anxiety (mental)
somatic anxiety (physical)
parts of brain involved in fear response
fear circuit involves…
- sensory afferents
- hippocampus
- amygdala
- prefrontal cortex
- hypothalamus
neurotransmitters assoc with anxiety
- GABA (inhibitory, dampens anx)
- NE (increases anx)
- DA (increases anx)
- serotonin (early on, can increase anxiety; both high and low levels associated with anxiety)
substances associated with anxiety
stimulants/caffeine
decongestants
asthma medications (ex. albuterol)
SSRIs (ex. fluoxetine/Prozac)
marijuana
corticosteroids
sodium lactate (in panic disorder)
substance use/withdrawal and anxiety
opiates
cocaine
alcohol
benzodiazepines
behavioral theory of anxiety
anxiety can be learned
- classical conditioning
- operant conditioning
behavioral tx is aimed at extinguishing avoidance behaviors
cognitive theory of anxiety
anxiety may be related to cognitive distortions
examples:
- jumping to conclusions
- overstimating severity of an event
- underestimating your coping ability
generalized anxiety disorder
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
panic attack
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
diff between generalized anxiety and panic attack
gen vs panic
- long timeframe vs shorter timeframe
panic attacks vs panic disorder
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
panic disorder
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
agoraphobia
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
phobia
types
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
phobia features
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
social anxiety disorder
(social phobia)
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
performance anxiety
specifier for social phobia!
limited to specific perfomance situations
- beta-blockers may be helpful!
separation anxiety disorder
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
obsessive-compulsive and related disorders
OCD
body dysmorphic disorder
hoarding disorder
trichotillomania (hair-pulling)
excoriation disorder (skin picking)
obsessions
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
compulsions
repetitive behaviors (or mental rituals) that are engaged in with the goal of reducing teh anxiety assoc with obsessions
- checking
- counting
- washing
- arranging
OCD: obsessive-compulsive disorder
specifiers
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)
OCD and neurosurgery
last resort tx: cigulotomy
hoarding disorder
before DSM5, hoarding was listed as an OCD “compulsion”
ex. animal hoarding
onset is in childhood, but impairment is progressive
body dysmorphic disorder
preoccupation with imagined/exaggerated body defect
NOT EATING DISORDER
onset usually in early teens
PTSD
dx
risk factors
comorbidities
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
what kinds of trauma lead to PTSD?
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
PTSD treatment
psychotherapy
- cognitive behavior therapy
- group therapy (survivors group)
- *single-session “debriefing can be harmful!
EMDR: eye movement desensitization and reprocessing
acute stress disorder
like PTSD, but for less than a month
- can develop into PTSD!
adjustment disorder
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
