Anxiety

Question 1

panic disorder

Answer 1

Sudden overwhelming episodes of anxiety that include both somatic and psychic elements - along with worry about either the implication of the attack or about having future attacks

Can occur with or without agoraphobia

Lifetime prevalence = 1.5% - 3.5%

Female:Male = 2:1

Age of Onset = typically early adulthood (

Question 2

generalized anxiety disorder

Answer 2

Excessive worry and more generalized somatic symptoms of anxiety (Worry, Anxiety, Tension)

Approximately 75-90% comorbid with other psychiatric disorders (most commonly depression)

Chronic condition with estimated lifetime prevalence = 5.1%

Female:Male = 2:1

Question 3

social phobia

Answer 3

Overwhelming anxiety in situations where one would have to interact with others, be
the center of attention, or perform in front of others

Not “shyness”

Lifetime prevalence = 13.5%

Only 1 - 2% of sufferers seek treatment

Fears:
Performing in front of others
Being the center of attention
Eating in public
Writing in public
Using public restroom (particularly in men)
Using telephone

Question 4

obsessive-compulsive disorder

Answer 4

-Obsessions or compulsions or both

-Obsessions: recurrent, persistent thoughts,
images, or impulses that are intrusive and cause
anxiety

-Compulsions: repetitive behaviors or mental acts that are performed in order to reduce anxiety

Lifetime prevalence = 2.5%
Age of onset late adolescence or early adulthood (earlier for males)

Long lagtime between onset of symptoms and diagnosis (up to 10 years)

~25% of Childhood onset is result of PANDAS
(Pediatric Autoimmune Neuropsychiatric Disorders Associated with Strep)

High comorbidity with Tourette’s Disorder
 35 -50% of Tourette’s patients have OCD
 Only 5-7% of OCD patients have Tourette’s, although 20-30% have history of tics
 Suggests basal ganglia disorder

Question 5

types of anxiety

Answer 5

panic anxiety
generalized anxiety
conditioned anxiety
anticipatory anxiety
social anxiety
situational anxiety

Question 6

Biological theories of anxiety

Answer 6

Sympathetic system
 Simple autonomic dysregulation unlikely
 Locus coeruleus
 Dysregulated noradrenergic function

GABA-benzodiazepine system
 Decreased BZD receptor binding in hippocampus in panic patients
 Decreased BZD receptor binding in prefrontal cortex during panic attack

Neurocircuitry of Fear
 Integrates neurochemical, imaging, and treatment findings
Fear Generation – Amygdalocortical interactions
Fear Extinction – Orbitofrontal Cortex & Prefrontal Cortex

Question 7

Sx of panic attack

Answer 7

• Palpitations, pounding heart, or tachycardia
• shortness of breath or sensation of smothering
• sweating
• trembling or shaking
• feeling of choking
• chest pain or discomfort
• nausea or abdominal distress
• dizziness, feeling faint
• paresthesias chills or hot flushes
• derealization or depersonalization
• fear of losing control or going crazy
• fear of dying

Question 8

Treatment of panic disorder

Answer 8

Pharmacologic:

• BDZ
• TCADs
• MAOIs
• Serotonin specific reuptake inhibitors
• Serotonin Norepinephrine reuptake inhibitors

Non-Pharm:
CBT (panic reduction therapy)

Question 9

GAD treatment

Answer 9

Pharm:
Benzodiazepines
Buspirone
TCAs
MAOIs
SNRIs
SSRIs

Non-Pharm:
CBT

Question 10

Treatment of Social phobia

Answer 10

Pharm:
Benzodiazepines
Beta blockers
MAOIs
SSRIs

Non-Pharm Treatment
-CBT (esp group therapy)

Question 11

Treatment of OCD

Answer 11

Pharm

• Clomipramine
• SSRIs
• Augmentation w/ atypical antipsychotics

Non-Pharm

• Behavioral therapy (exposure, response prevention)
• Neurosurgery