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Psychiatry > Anxiety > Flashcards

Anxiety Flashcards

1
Q

Anxiety Disorders in General

A
  • Common and lifelong. Early onset teens or early 20s; Female 2:1; Waxing/waning; Similar to MDD and DM in QoL
  • Must impair social/occ functioning
  • Anxiety is adaptive
  • If associated with substance, treat that first and reassess after 28 days off of substance
  • Must rule out medical conditions and consider life stressors
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2
Q

Neuroanatomy of Anxiety

A
  • Amygdala
  • Medial prefrontal cx (anterior cingulate, subcallosal, medial frontal)
  • Hippocampus
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3
Q

Genetics of Anxiety

A
  • PD, GAD, OCD, phobias have significant familiar agreggation
  • PD 43% in twin studies
  • GAD 32% in twin studies
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4
Q

Specific Phobia

A
  • > 6 months marked or persistent fear that is excessive or unreasonable cued by presence or anticipation of a specific object or situation. Anxiety must be out of proportion to actual danger and interfere significantly with routine or function
  • 15% general population, onset early, female 2:1
  • Tx with Systematic Desensitization
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5
Q

Social Anxiety Disorder

A
  • 7% population; onset teens; females; significant disability, increased depressive disorders
  • Must be more than 6 months and interfere with function
  • fMRI studies showed that while both had increased medical prefrontal cx activity in response to intentional versus unintentional transgression, SAD showed significant response to unintentional transgression and also significant amygdala and insula bilaterally
  • Tx with CBT or Citalopram (reduce amygdala and hippocampal activation); behavior or social skills training; SSRI/SNRI/MAOI/BZD/Gabapentin
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6
Q

Panic Disorder

A
  • Recurrent, unexpected attacks for at least one month; + persistent worry about having and implications of attach; + change in behavior
  • Need at least 4 of 13 symptoms peaking in 10 min
  • 2-3% population; 5-10% primary care pts; onset teens or early 20s; female 2-3:1
  • Generally waxing and waning course
  • 50-60% have lifetime MD, 1/3 have current
  • 20-25% history substance dependence
  • Tx with SSRI, 70% respond; eliminate caffeine; CBT; SSRI/venlafax/TCA/MAOI/BZD/VPA/Gabapentin
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7
Q
  • Agoraphobia
A
  • > 6 months of anxiety about at least 2 situations: public transportation, open spaces, enclosed spaces, standing in line or in a crowd, being outside of home alone. If only 1 is specific phobia.
  • 2% population, females 2:1, 17yo mean, 30% have panic attacks or disorder (most don’t); higher risk of other anxiety disorder, depression, or substance use
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8
Q

GAD

A

> 6 months excessive worry for more days than not, about a number of events, difficult to control the worry

  • Need at least 3 symptoms of restlessness/feeling on edge, easy fatigue, difficulty concentrating, muscle tension, sleep disturbance
  • 4-7% population, mean 30yo but range, female 2:1
  • 90% have other axis 1 disorder in lifetime; 66% current axis 1; worse 5yr prognosis than panic disorder
  • Tx with buspirone, BZD, SSRI/venlafax/imipramine, CBT
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9
Q

OCD

A

Recurrent impulses that are intrusive and unwanted and cause anxiety or distress. Person tries to suppress with some other thought or action (compulsion)

  • Take >1 hr/day or cause clinically significant distress or functional impairment
  • Specify insight, or whether tic-related
  • 2% population, mean 19.5yo, 25% by 14yo
  • Males earlier onset but F=M
  • Increased risk of anxiety, MDD, schizo disorders
  • Tx with serotonergic antidep, behavior, adjunctive antipsych or psychosurg. 40-60% response
  • PANDAS- tx with PCN, plasmapheresis, IVIG
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10
Q

Body Dysmorphic Disorder prevalence

A

2.4% (9-15% derm, 7% cosmetic surgery, 10% oral/maxillofacial surgery)

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11
Q

Hoarding Disorder prevalence

A

2-6% Male>Female

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12
Q

Trichotillomania

A

1-2% Female 10:1

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13
Q

Excoriation Disorder prevalence

A

1.4% F>M

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14
Q

OCD etiology

A
  • Genetic, serotonergic dysfx, cortico-striato-thalamo-corticol loop, autoimmune PANDAS
  • See increased Right Caudate activity. CBT (and pharmacotx) reduces resting state metabolism/blood flow here in responders.
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15
Q

PTSD

A

Exposure to event somehow

  • At least 1 intrusive sx afterward (memories, nightmares, dissociative rxn, distress, reactivity)
  • Persistent avoidance
  • At least 1 month with functional impairment
  • Need dissociative sx (derealization or depersonalization) with delayed expression (>6 months after event). <1 is ASD.
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16
Q

PTSD epidemiology

A

7-9% population. 60-80% trauma victims. 30% combat veterans. 50-80% sexual assault victims.

  • Women, younger people
  • Increased with trauma dose, lack of social support, pre-existing psych disorder
  • Comorbid depression, anxiety, substance use, somatization, dissociative disorders
17
Q

PTSD etiology

A
  • Conditioned fear, genetic vulnerability, stress-induced NE, CRF, Cortisole; Autonomic arousal immediately after trauma is predictive
  • Increased amygdalar activation, Decreased medial prefrontal cx (orbitofrontal, anterior cingulate)
18
Q

PTSD tx

A
  • Debriefing right after NOT effective
  • CBT, exposure, group tx
  • Antidep, mood stabilizers, B-blockers, clonidine, prazosin, gabapentin
  • Prazosin: 1mg qhs x3 -> increase by 1mg q3nights until nightmares improve OR postural hypotension
  • Paroxetine: increased anterior cingulate cx function
19
Q

Acute Stress Disorder

A
  • 3 days to 1 month after trauma, presence of at least 9 symptoms from categories of intrusion, negative mood, dissociation, aoidance, arousal
  • Tx: antidep, anxiolytics, antipsych, mood stabilizers, CBT
20
Q

Anxiety Tx

A
  • Cornerstone is to increase serotonin (SSRI or SNRIs)
  • Start at half dose e.g. citalopram 10mg, then go slow, warn that anxiety may get worse first, may need anxiolytic while titrating
  • Hydroxyzine: 50 PRN. Anticholinergic SE.
  • Buspirone: 60 daily for GAD
  • Propranolol: for discrete social phobia e.g. performance anxiety
  • Atypical antipsychotics at low doses for augmenting refractory OCD
  • Antconvulsants: VPA, carbamazepine, gabapentin
  • BZDs very effective but dependence. No Alprazolam d/t reinforcing! Not good for h/o addiction`
21
Q

Specific Phobia prevalence

A

15%, females 2:1, early onset

22
Q

Social Anxiety Disorder prevalence

A

7%, females, teen onset

23
Q

Panic Disorder prevalence

A

2-3% (5-10% PCP patients), onset teens/20s, F 2-3:1

24
Q

Agoraphobia prevalence

A

2%, F 2:1, 17yo

25
Q

Generalized Anxiety Disorder prevalence

A

4-7%; 30yo; F 2:1

26
Q

OCD prevalence

A

2%; 19.5yo; F=M

27
Q

Body Dysmorphic Disorder prevalence

A

2.4% (9-15% derm, 7% cosm, 10% OMFS)

28
Q

Hoarding Disorder prevalence

A

2-6%; M>F

29
Q

Trichotillomania prevalence

A

1-2%; F 10:1

30
Q

Excoriation Disorder prevalence

A

1.4%; F>M

31
Q

PTSD prevalence

A

7-9%; women, younger

Psychiatry (5 decks)

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