12A Anxiety disorders Flashcards
Panic Attack
is a fear response involving a sudden onset of intense anxiety which may be triggered or occur
spontaneously.
Panic attacks peak within minutes and usually resolve within half an hour.
Patients may continue to feel anxious for hours afterwards and believe they are experiencing a prolonged panic attack.
in Panic Disorder patient develops
debilitating anticipatory anxiety about having future attacks (‘fear of the fear’).
DSM5 panic disorder
When a patient presents with an acute panic attack, must rule-out
potentially life-threatening medical conditions
(heart attack, thyrotoxicosis, thromboembolism, asthma).
Panic disorder has a chronic course
with waxing and waning symptoms; relapses are common with
discontinuation of medication. Only a minority of patients achieve full remission of symptoms.
Up to 65% of patients also have major depression
treatment of panic disorder
Combination
CBT + pharmacotherapy (SSRI, SNRI) is the most effective treatment approach.
Start SSRI or SNRI at low dose and slowly increase as side effects may initially worsen anxiety and suicidality,
especially in panic disorders.
Agoraphobia is a
is an intense fear of being in public places where escape or obtaining help may be difficult.
It often develops with panic disorder.
Agoraphobia dsm5
Etiology OF AGRAPHOBIA
- strong genetic component (heritability about 60%);
- psychosocial component (onset frequently follows a
traumatic event).
ETIOLOGY OF panic disorder
Etiology associated with
* genetic,
* biological,
* environmental, and
* psychosocial factors
Psychosocial factors: ↑ incidence of stressors (especially loss) prior to onset of disorder; history of childhood
physical or sexual abuse
More than 50% of patients experience a panic attack prior to developing
agoraphobia.
course of agoraphobia
Course is persistent and chronic, with rare full remission; avoidance may become as extreme as complete
confinement to the home.
treatment of agoraphobia
Treatment: similar approach as to panic disorder
Combination CBT + pharmacotherapy (SSRI, SNRI
Specific Phobias defined as
phobia is defined as an irrational fear that leads to persistence of the anxiety and/or avoidance of the feared
object or situation.
specific phobia DSM5
Phobias are the most common psychiatric disorder in which gender?
women and
second most common in men (substance-related
disorders are first).
treatment of specific phobias
behavior (exposure) therapy with 2 main approaches
* Flooding: The patient is exposed immediately to the most anxiety provoking
stimulus (ex. the top of a tall building if the fear is from heights)
*implosion: if imagination used
-
Systematic
desensitization
The patient overcomes maladaptive anxiety by approaching
the feared situation/object gradually and in a psychophysiologic
state that inhibits anxiety
Social Anxiety Disorder (Social Phobia) DSM5
Generalized Anxiety Disorder (GAD) PREVELANCE
Lifetime prevalence 5-9%; rates are higher in women compared to men (2:1 ratio).
Generalized Anxiety Disorder (GAD) SYMPTOMS begins at what age
Symptoms of worry usually begin in childhood; median age of GAD onset 30 years.
Generalized Anxiety Disorder (GAD) dsm5
course of generalized anxiety disorder
Course is chronic, with waxing and waning symptoms; rates of full remission are low.
GAD is highly comorbid with other anxiety and depressive disorders
generalised anxiety disorder treatment
- psychotherapy (CBT) and pharmacotherapy.
SSRI (sertraline, citalopram) and SNRI (venlafaxine) are 1st-line;
can also consider a short-term course of benzodiazepines or augmentation with
* buspirone(a partial agonist at 5HT1A receptor, thereby decreasing serotonergic activity)
*non-BDZ sedative-hypnotics
*slower onset of action than BDZ (takes several weeks
buspirone
(a partial agonist at 5HT1A receptor, thereby decreasing serotonergic activity)
*non-BDZ anxiolytic
*slower onset of action than BDZ (takes several weeks
*For patients with anxiety, evaluate their —– intake
for caffeine use and recommend significant reduction or elimination
**Exercise can significantly reduce anxiety.
SSRI
(sertraline, citalopram)
SNRI
venlafaxine
