7.1 Panic Disorder and Generalized Anxiety Disorder

Question 1

Anxiety

Answer 1

• Feeling discomfort, apprehension, or dread related to anticipated danger often due to an unknown source.
• Anxiety is necessary for survival
• Only considered a disorder when it interferes with social/occupational functioning
• Most common psychiatric illness
• MORE COMMON IN WOMEN THEN MEN (2:1)

Question 2

Stress/Anxiety/Fear

Answer 2

Stress (Stressor)
- External pressure brought to bear on an individual

Anxiety
- Subjective emotional response to pressure

Anxiety is an emotional process where as fear is a cognitive one.
- Fear is intellectual appraisal of a threatened stimulus
- Anxiety is an emotional response to the appraisal.

Question 3

Etiology of Anxiety

Answer 3

Includes
- Genetics
- Developmental
- Environmental
- Psychological

Question 4

Common Co-morbidities of Anxiety

Answer 4

• Depression
• Substance abuse
• May be due to family pre-disposition

Question 5

How much is too much

Answer 5

• “Normal” is determined by societal standards.
• It is abnormal if anxiety is out of proportion to the situation creating it or interferes with social/occupational functioning

Question 6

Panic Disorder

Answer 6

• Sudden overwhelming feeling of terror or impending doom
• MOST SEVERE FORM OF ANXIETY
• Accompanied by behavioral, cognitive, and psychological signs and symptoms
• Can last 10-15 minutes

Question 7

Characteristics of Panic Disorders

Answer 7

• Recurrent, unpredictable onset
• Intense apprehension, fear, or terror
• Impending doom
• Usually lasts minutes or (rarely) hours
• Frequency/severity varies widely
• May experience multiple attacks for weeks, months, or years
• Periods of remission/exacerbation
• Onset is late 20s

Question 8

General Anxiety Disorder (GAD)

Answer 8

• More persistent than panic anxiety
• Lasts 6+ months where patient experiences more days of anxiety than not over the 6 months.
• Should not be attributed to physical impairment or medications
• Causes social/occupational impairment, muscle tension and restlessness

MANIFESTATIONS
- Chronic
- Increased time/effort to prepare for stressful activities
- Depressive symptoms are common
- Stress related exacerbations and somatic complaints are common

Question 9

Biological Theory of Panic Disorders

Answer 9

• Elevated levels of blood lactate
• Elevated norepinephrine, decreased GABA and serotonin

Question 10

Medical Conditions that Cause Anxiety

Answer 10

Cardiac
- MI, Congestive HF, Mitral Valve Prolapse

Endocrine
- Hypoglycemia, hypo/hyperthyroidism, pheochromocytoma

Respiratory
- COPD, Hyperventilation

Neurological
- Complex partial seizures, Neoplasms, encephalitis

Question 11

Substance Abuse that Cause Anxiety

Answer 11

• Either intoxication or Withdrawal

Examples
- Alcohol
- Amphetamines
- Cocaine
- Hallucinogens
- Sedatives/Hypnotics
- Anxiolytics
- Caffeine
- Cannabis