Anxiety Flashcards
Describe the anxiety circuitry
(hint: 2 reaction types)
- Fast reaction: thalamus → amygdala → response
- Slow reaction: thalamus → prefrontal cortex determines level of threat → decide if you’re in danger
What is normal anxiety?
- fear resulting from the perception of danger
- May arise from internal impulses that threaten a person’s well-being (cramming for a test)
(anxiety is a learning problem→ you must unlearn the process to remove anxiety)
What is pathological anxiety?
- Ineffective adaptation to normally occurring threat
- Pathological when functioning is disrupted
What are the two types of symptoms that caused disruption in adaptation leading to pathological anxiety?
- Psychological: worried, demoralization
- Physical symptoms: cardiac, respiratory, GI or neurological
Patients w/ panic or phobias have greater cardiac and respiratory reactivity during _____. Sodium lactate infusions and breathing CO2 may induce ______, which elicit panic attacks.
- sleep
- respiratory alkalosis and exaggerated elevations of brain lactate
Anatomic relations to anxiety (3)
- Locus coeruleus: relay center for bodies alarm system
- Dopamine receptors in the prefrontal cortex: avoidance conditioning
-
Dysegulation of serotonin system (panic disorder)
4.
PET studies: look at which structures in anxiety?
- Amygdala
- Hypothalamus
- Prefrontal cortex
- Fear network
Describe the hypothalamic-pituitary-adrenal axis reaction to anxiety
Acute stress → CRF from the paraventricular nucleus (hypothalamus) ⇒ ACTH + cortisol levels → activation of the sympathetic and parasympathetic nervous systems
Endocrine disorders that can cause anxiety (4)
- Pheochromocytoma
- Thyroid dysfunction
- Pituitary dysfunction
- Adrenal disorder
Neurological causes of anxiety (4)
- Head trauma
- Neurosyphilis
- Seizure disorder
- CNS neoplasm
Toxic and metabolic causes of anxiety (8)
- Alcohol or sedative withdrawal
- Stimulant intoxication
- Sympathomimetic agents
- Cannabis
- B12 deficiency
- Hypoxia
- Ischemia
- Anemia
Autoimmune disorders that may cause anxiety (3)
- Systemic lupus erythematosis
- Temporal arteritis
- Polyarteritis nodosa
Men with panic disorder have twice the risk of _____
death (cardio & suicide)
Anxiety disorders increase the overall rate of _______
Alcoholism
Social phobias decrease educational attainment and increase the rate of _______ (2).
- Teenage pregnancy
- Marital violence
Define classical conditioning
Person learns to associate a neutral object or situation with something that naturally results in a fear response.
(Ex: Watson taught a child to be afraid of a rat by presenting it immediately before a loud and startling noise)
Define operant conditioning
Reward vs. punishment influences the response
Define negative reinforcement
Person is influenced to escape a situation→ tendency to avoid situation rainforest
(this is not the same thing as punishment!!)
Define positive reinforcement
Positive stimulus influences → increases desired behavior
(giving children at Goldstar)
Define repression
Unacceptable thoughts, impulses or desires kept out of conscious reach
(trauma: did or didn’t do something → reppress → can’t remember)
Interviewing guidelines for anxiety (5)
- Anxiety symptoms
- Associated symptoms
- Life history
- Medical history
- Cultural understanding
(and of course, be calm and reassuring, avoid irritation or impatience with them)
What is included in a history of anxiety symptoms (6)?
- Psych & Physical symptoms
- Onset
- Duration
- Distribution
- Quality
- Intensity
Which associated symptoms are particularly important with anxiety disorder?
- Depression
- Suicidal ideation
When taking a life history for a patient with anxiety what two things would you want to know?
- Psychosocial triggers
- Context of anxiety
Anxiety disorders have a tremendous overlap with _____ (disease).
MDD
(it is possible to have MDD, GAD & SAD simultaneously)
What is the first rule of panic attacks?
A single panic attack does not mean they have panic disorder
Criteria for panic attack: A discrete period of intense fear or discomfort, w/four (or more) of the following developed abruptly and reached a peak within 10 minutes:
- Palpitations
- Sweating
- Trembling
- Sensation of SOB
- Feeling of choking
- Chest pain
- Nausea
- Dizzy, unsteady, lightheaded, or faint
- Derealization or depersonalization
- Fear of losing control or going crazy
- Fear of dying
- Paresthesias
- Chills of hot flashes
Agoraphobia: anxiety about places (2 or more of the following) for at least 6 months:
- Use public transport
- Being in open spaces
- Being in closed spaces
- Standing in line or in a crowd
- Being outside of home alone
Agoraphobia anxiety last _____.
at least 6 months
(not better accounted for by another psychiatric disorder)
Agoraphobia: Situations are avoided or feared because ________ (2).
- Escape might be difficult
- Help might not be available in the event of a panic attack
(Fear or anxiety is out of proportion to the actual danger posed)
Criteria for panic disorder: Recurrent unexpected panic attacks that happen to be followed by at least one month of one of the following:
- Panic about having a panic attack
- Worry about the implications of another attack
- Maladaptive change in behavior-related to the attacks (can happen in your sleep)
Panic disorder occurrence is highly variable and may occur either _____ or _____ (time frames).
several per day or 2/xs a year
Panic disorder are often comorbid with ______ (5).
- MDD
- Social phobia
- GAD
- OCD
- PTSD
(in order from most to least common)
Physical findings of panic disorder (2).
- Transient tachycardia
- Moderate elevation of systolic blood pressure
General medical conditions comorbid with panic disorder (5)
- Arrhythmias
- Asthma
- Hyperthyroidism
- COPD
- IBS
Panic disorder: genetics
- Prevalence in first degree relatives 20%
- 45% concordance in identical twins; 15% in non-identical twins
Prevalence of panic disorder: lifetime? one-year? femal:male
- Lifetime 1-3.5%
- One-year: 0.5-1.5%
- Female:male 2:1
(Agoraphobia present 1/3 to ½ patients with PD)
Panic disorder age of onset & course
- Late adolescence - mid-thirties
- Chronic: waxing and waning
Panic disorder: primary treatment (4)
- Relaxation training
- CBT
- SSRI
- SNRI
Panic disorder secondary treatment (2)
- TCA
- Benzos
(tertiary: MAOI’s, anticonvulsant. Adjuncts: buspirone, beta blocker)
Relaxation exercises for panic disorder
- Visual Imagery
- Diaphragmatic Breathing
- Autogenic training
- Progressive Muscle Relaxation
- Yoga
- Meditation
(be familiar)
