117b - Anxiety Disorders Flashcards
What is required to diagnose OCD?
- Presence of either obsessions or compulsions (or both)
- Individual has realized that the obsessions and/or compulsions are unreasonable (has insight)
- Symptoms are time consuming
Which parts of the brain are important for regulating fear and anxiety states?
Amygdala
Also hippocampus, locus coeruleus, hypothalamic/pituitary/adrenocortical axis
When does specific phobia usually present?
Bimodal onset: Childhood or early adulthood
Early onset cases are more likely to remit
Which medications can be used to manage panic disorder?
- SSRIs
- Benzos (2nd line, should not be used long-term)
- May serve a a bridge since SSRIs take awhile to start working
Which parts of the DSM-5 criteria are similar for all anxiety disorders?
Symptoms must be:
- Persistent
- Out of proportion to the threat/danger
- Cause clinically significant distress or impariment
Which areas of the brain have increased activity in patients with OCD?
- Cingulate
- Caudate
- Prefrontal cortex
“Chronic daily worry” is a symptom of which anxiety disorder?
Generalized anxiety disorder
Which anxiety disorder is most likley to benefit from surgical intervention if medical management is unsuccessful?
OCD
We understand more about the neural circuitry: OCD results from overactive cingulate, caudate, and prefrontal cortex
Which neurotransmitters have a role in anxiety?
- GABA
- Too little GABA = anxiety
- Serotonin
- Too little serotonin = anxiety
- NE
- Poor regulation w/Bursts of NE = anxiety
What is the most common obsession found in OCD?
Uncleanliness obsessions
In general, what is the prognosis for anxiety disorders?
Chronic illness, but many improve with treatment
-
80% remit or improve
- 30% remit
- 50% improve
- 20% remain significantly ill
Varies with specific disorder, setting of treatment
When does panic disorder usually onset?
between Adolescence - 30’s
(later than other anxiety disorders)
What is necessary to diagnose a panic disorder?
- Recurrent or unexpected panic attacks
- At least 1 of the attacks has been followed by 1 month+ of either:
- Persistent concern about additional attacks
- Maladaptive change in behavior related to attacks
Not everyone who has had a panic attack has a panic disorder!
Which treatments are most helpful for OCD?
- Response prevention/flooding
- TCAs, SSRIs
- Atypical antipsychotics (as an ad-junct)
- Surgical
- May be helpful in refractory cases
What is the lifetime prevalance of anxiety disorder?
~30%
Definition of obsessions:
-
Obsessions = recurrent persistent thoughts experienced as intrusive and unwanted, usually causing marked distress
- patients try to ignore, suppress, or neutralize them (different than obsessive compulsive personality disorder)
Definition of compulsions
- Compulsions = repetitive behaviors where the person feels driven to perform them in response to obsession; the performance is aimed at preventing or reducing anxiety or preventing a dreaded outcome; but the actions are not realistically connected w/ what they are intended to prevent
What is OCD commonly associated with?
Tourette’s syndrome
Agoraphobia DSM5 Critieria:
-
Agoraphobia DSM5 Criteria:
- marked fear/anxiety about 2 of the following: using public transportation, being in open spaces, being in enclosed spaces, standing in line or being in a crowd, or being outside of the home alone
- fear these situations b/c escape is difficult, and help isn’t available if panic symptoms were to start
- the fear/anxiety is persistent (>6 months) and out of proportion
Specific Phobia DSM 5 Criteria:
-
Specific Phobia DSM5 Criteria:
- marked fear or anxiety about a specific object or situation
- the object/situation is actively avoided or is endured with intense anxiety
- the fear is persistent (> 6 months) and causes impairment/distress
Social Anxiety Disorder Criteria
-
Social Anxiety Disorder DSM5 Criteria:
- marked anxiety about one or more social situations where the individual is exposed to possible scrutiny of others
- individual fears how they will show anxiety symptoms and be negatively evaluated
- social situations are avoided or endured w/ intense fear
- anxiety is out of proportion, persistent (> 6 months), and distressing/causing impairment
Generalized Anxiety Disorder Criteria:
Generalized Anxiety Disorder DSM5 Criteria:
- excessive anxiety, more days than not, for at least 6 months about several events or activities
- difficult to control the worry
- 3 or more anxiety symptoms: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance
- symptoms cause distress and impairment and are not due to use of a substance or a medical condition
