Anxiety Flashcards
panic disorder
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 (
generalized anxiety disorder
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
social phobia
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
obsessive-compulsive disorder
-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
types of anxiety
panic anxiety generalized anxiety conditioned anxiety anticipatory anxiety social anxiety situational anxiety
Biological theories of anxiety
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
Sx of panic attack
- 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
Treatment of panic disorder
Pharmacologic:
- BDZ
- TCADs
- MAOIs
- Serotonin specific reuptake inhibitors
- Serotonin Norepinephrine reuptake inhibitors
Non-Pharm:
CBT (panic reduction therapy)
GAD treatment
Pharm: Benzodiazepines Buspirone TCAs MAOIs SNRIs SSRIs
Non-Pharm:
CBT
Treatment of Social phobia
Pharm: Benzodiazepines Beta blockers MAOIs SSRIs
Non-Pharm Treatment
-CBT (esp group therapy)
Treatment of OCD
Pharm
- Clomipramine
- SSRIs
- Augmentation w/ atypical antipsychotics
Non-Pharm
- Behavioral therapy (exposure, response prevention)
- Neurosurgery