Anxiety Flashcards
DD for anxiety?
- Think organic (med) causes: caffeine, substance abuse (stimulants), withdrawal, hyperthyroidism, arrythmia, vit B12 deficiency, hypoglycemia, pheochromocytoma
- usually seen in ED setting (acute MI, PE, COPD, asthma); take a HISTORY about med and psych components, do physical, and send labs to rule out med causes if needed
- Psych disorder associated with anxiety: depression, schizo, eating disorders, personality disorders, substance dependence
To diagnose anxiety, symptoms must
- be persistent (usually at least 6 months, but shorter for kids)
- Interfere with normal functioning (work, job, marriage, etc.)
- Cause significant distress
Etiology of anxiety: biopsychosocial associations
- Psychosocial factors: traumatic events or extreme stressors (PTSD, panic attack); maladaptive coping skills/personality traits can make people vulnerable to increased stress levels; learned?
- Biologic factors: greater prevalence in populations of family members with anxiety disorders (genetics possibly, less so than bipolar, ADHD, schizo); also gender bias with women>men except OCD
- Neurobiological factors (less serotonin, GABA; more NE and glutamate)
GAD:
- Excessive anxiety/worry, occurring more days than not for > or = 6 months, about > or = 1 event/activity
- Difficult to control worry
- Associated with at least 3 of these symptoms: restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance
- Causes significant impairment
- No other explanation for symptoms
Occurrence for GAD:
- 3-5% of general pop
- Women > men
- About 50% begin prior to adulthood
- May have had generally anxious parents
- Self-med (booze);
prgonosis: without treatment, tends to worsen over time!! Think especially STRESSFUL times
Treat GAD?
- Therapy (CBT or psychodynamic)
- Meds (antidepressants that increase SR or NE or both, downregulate or desens receptors; use 5HT1a receptor agonist like buspirone; benzos, but second line because of risk of addiction, falls, apnea; beta blockers, more for symp relief of performance anxiety, NOT GAD!!!!!!)
For panic disorder, look out for
panic attack: abrupt surge of intense fear or discomfort, peaking within minutes that is UNEXPECTED, with at least four of the symptoms in the slide
Panic disorder: how to diagnose
- Recurrent unexpected PANIC ATTACKS
- At least one attack followed by at least 1 month of at least one of the following: concern about additional panic attacks or consequences; significant maladaptive change in behavior related to attacks
- No other explanation for symptoms
For panic disorder with agoraphobia, what is needed to diagnose?
- Fear/anxiety about at least 2 of the in the slide
- Fear of not being able to escape situation
- Situation almost always causes fear/anxiety
- Avoids situations
- Fear/anxiety out of proportion to actual danger
- At least 6 months
- Causes significant impairment
- No other explanation for symptoms
Occurrence, prognosis, treatment of panic disorder
Occurrence: 1.5-3.5%, F>M;
Prognosis: chronic, recurring, increased risk of depression and suicide
Treatment: therapy is CBT with SYSTEMATIC DESENS preferred or flooding, or psychodynamic therapy; meds are fast-acting benzos like alprazolam, SSRI/SNRI (long term first-line), intermediate or long-acting benzos (2nd line because of addiction potential); COMBO treatments
For specific phobia, how to diagnose?
At least
- 6 months or more
- Cause significant impairment
- Marked fear/anxiety about a specific object/situation
- Object/situation almost always provokes fear/anxiety
- Actively avoid object/situation
- Fear/anxiety out of proportion to actual danger
- No other explanation for symptoms
For social anxiety phobia, how different than specific?
Change object/situation to social situation specifically; also fear of acting in ways that will be negatively scrutinized;
if PERFORMANCE only, then fear is restricted to public speaking or performing and won’t generalize to other social aspects of life
Occurrence, comorbidities, treatment of phobias?
O: 5% men, 10% women (usually women > men)
C: other anxiety disorders and depression
T: specific phobia: think therapy first with flooding, systematic desens (CBT!!!!); meds likes sedatives?
for social phobia: do therapy with CBT, assertiveness training, group therapy; meds include SSRI/SNRI (first-line), MAOI’s (after you’ve given SSRI’s and benzos), then beta blockers (best for PERFORMANCE ONLY variant)
Physical and Psychological manifestations of anxiety?
Physical: 1. symp NS (diaphoresis, mydriasis, tachy, and TREMOR) 2. GI/GU symptoms (diarrhea, increased urinary freq) 3. Hyperventilation (dizziness, syncope, PARESTHESIA) 4. Numbness and tingling in extremities and around mouth
Psychological: Restlessness, irritability, trouble concentrating, worry
Fear of clowns
coulrophobia
