Anxiety

Question 1

What percentage of Americans have an anxiety disorder?

Answer 1

25%

Question 2

What is most common mental disorder in women? Men?

Answer 2

Specific phobia is most common mental disorder in women (2nd in men).
Substance abuse is most common mental disorder in men.

Question 3

More common in men / women:

Panic, GAD, OCD

Answer 3

Panic and GAD more common in women.

OCD is equal.

Question 4

2 components of anxiety

Answer 4

1) awareness of physiological sensations (palpitations / sweating)
2) awareness of feeling nervous / frightened

Question 5

Prognosis of panic disorder, GAD, and OCD

Answer 5

1/4 do well, 1/2 do OK, 1/4 do poorly

Question 6

What 2 parts of brain have receptors for cortisol?

Answer 6

Hypothalamus and hippocampus

Question 7

Regulation of amygdala

Answer 7

Amygdala is modulated / regulated via PFC, especially orbitofrontal cortex. PFC involved in extinction or “unlearning” of fear associations. PFC also learns from scary experiences. PFC can activate the amygdala and produce fear as well, such as occurs w/ ruminating.

Question 8

Systemic effects of chronic stress

Answer 8

Excessive stress / cortisol may lead to HTN, obesity, diabetes, osteoporosis, suppressed immune system, memory problems, changes in brain structure, and depression.

Question 9

What decreases neurogenesis?

What increases neurogenesis?

Answer 9

Chronic stress such as PTSD may lead to neuronal atrophy in hippocampus. Decreased neurogenesis in subgranular zone. Antidepressants, learning, and exercise help promote neurogenesis.

Question 10

Anxious temperament

Answer 10

Extreme behavioral inhibition to novel situations or strangers. May involve freezing. Identified early in life. Parents may pass this down via genes and behaviors. Predicts development of anxiety disorders, depression, and drug use later in life.

Question 11

Biological disturbances seen in panic disorder

Answer 11

Increased catecholamines, increased activity of locus ceruleus, CO2 hypersensitivity, disturbance in lactate metabolism, and abnormality in GABA

Question 12

Brain abnormalities seen in panic disorder

Answer 12

May have abnormalities in temporal lobe, specifically hypothalamus

Question 13

DSM criteria for panic disorder (2 main things)

Answer 13

A) recurrent unexpected panic attacks
B) attack is followed by 1+ month of persistent concerns about future panic attacks or maladaptive change in behavior related to attacks (avoidance)

Question 14

Agoraphobia

Answer 14

May be comorbid w/ panic disorder.
Involves anxiety about 2+ of the following: using public transportation, being in open spaces, being in enclosed spaces, standing in line or in a crowd, or being outside the home alone.

Question 15

Tx for panic disorder

Answer 15

• Tx w/ meds and psychotherapy.
• SSRI’s are 1st line. SNRI’s are also good.
• Benzos are good during panic attacks but should be limited to short periods of use. Benzos are also good for as needed until the SSRI kicks in.
• CBT used to education pxs to make more appropriate attributions for distressing somatic sxs (not actually having a heart attack or dying). Involves distraction and deep breathing. Exposure therapy may also be helpful.

Question 16

Biological changes seen w/ GAD.

What parts of brain?

Answer 16

NE, GABA, and 5HT disturbances in frontal lobe and limbic system

Question 17

Does environment or genetics play a stronger role for GAD?

Answer 17

Environment

Question 18

DSM criteria for GAD (3 main things)

Answer 18

A) Excessive anxiety and worry (apprehensive expectation) about multiple events or activities for at least 6 months.
B) Difficult to control the worry
C) Anxiety causes significant distress or impairment in social, occupational, or other functioning.

Question 19

Tx for GAD

Answer 19

• Tx w/ meds and psychotherapy.
• SSRI’s are 1st line. SNRI’s are also good.
• Benzos may be used but are not great due to risk of addiction.
• CBT involves restructuring distortions about anxiety-provoking aspects of their environment. Utilizes deep breathing, muscle relaxation, and imagery.

Question 20

DSM criteria for OCD (2 main things)

Answer 20

A) Obsessions, compulsions, or both (most pxs have both). Person tries to ignore or suppress thoughts, urges, or images, or relieves them via their compulsion.
B) Obsessions / compulsions are time consuming (takes >1 hr / day) or cause significant distress / impairment.

Question 21

Pathogenesis of OCD

Answer 21

Caused by serotonin dysfunction. Often have increased activity in PFC (obsessions) and in caudate (compulsions). Strong genetic component. In a different category than anxiety disorders in DSM.

Question 22

Common co-morbidities in OCD

Answer 22

Pxs w/ OCD also have depression 75% of the time. 20% of having a tic.

Question 23

PANDAS

Answer 23

Pediatric Autoimmune Neuropsychiatric Disorders Associated w/ Streptococcal Infections. Occurs in pxs following GAS.
May cause OCD.

Question 24

OCD associated w/ which neurologic disorders?

Answer 24

TBI, epilepsy, or Huntington’s.

Genetically linked to Tourette’s.

Question 25

Most common obsessions

Answer 25

Contamination, pathological doubt, somatic (fear of having an illness, concern w/ appearance, or preoccupation w/ body parts), need for symmetry / orderliness, aggressive impulses, and sexual impulses

Question 26

Most common compulsions

Answer 26

Checking, washing, counting, need to ask / confess, symmetry / precision, hoarding.

Question 27

Indicators of poor prognosis for OCD

Answer 27

Yielding to compulsions, childhood onset, bizarre compulsions, need for hospitalization, and coexisting depression or personality disorder.

Question 28

Indicators of good prognosis for OCD

Answer 28

Good social / occupational adjustment, presence of a precipitating event (such as pregnancy), and an episodic symptom course.

Question 29

Treatment for OCD

Answer 29

• Tx w/ meds and psychotherapy.
• SSRI’s are first line, but require higher dose and longer duration than what is needed for depression or anxiety.
• May augment w/ antipsychotic meds and psychosurgery (cingulotomy).
• CBT in this case involves exposure / response prevention. Family therapy is helpful to prevent family members from helping px fulfill their compulsions.

Question 30

OC personality disorder

Answer 30

Not distressing to the person. Lack insight into obsessions. Inflexible. Anal-retentive. Don’t realize your thoughts / actions are abnormal.

Question 31

Somatic symptom disorder
Description
Population
Co-morbidities

Answer 31

• Distressing / impairing somatic sxs that cannot be explained by physical / lab exam. May include pain (most common), GI sxs, sexual sxs, and neurological sxs. May cause high levels of anxiety about health and excessive time / energy is related to these matters.
• More common in women.
• Co-morbid anxiety / depression are common.
• Diagnosis of exclusion.

Question 32

Conversion disorder

Answer 32

Px presents w/ one or more neurological sxs such as blindness, seizures, or paralysis, w/o an identifiable neurological cause. Psychological factors may be causative. Pxs do not intentionally fake these sxs and may not be conscious of any link b/w psychological stress and their sxs.

Question 33

Anxiety disorder due to a medical condition

Answer 33

Hyperthyroidism, hyperparathyroidism, pheochromocytoma, hypoglycemia, cardiac arrhythmia, mitral vavle prolapse, pulmonary embolus, and MI.

Question 34

Anxiety disorder due to a substance / medication

Answer 34

Caffeine intoxication, stimulants (such as methylphenidate), alcohol / sedative / hypnotic withdrawal, albuterol, prednisone, thyroid medication, bupropion (antidepressant), pseudoephedrine (decongestant).