Anxiety

Question 1

Fear vs Anxiety

Answer 1

Fear: emotional response to real or perceived threat
Anxiety: anticipation of future threat
anxiety disorders often have both

Question 2

What causes anxiety to become pathological?

Answer 2

1. Autonomy
2. Intensity
3. Duration
4. Behavior-dysfunctional behaviors

Question 3

Amygdala centered circuit:

Answer 3

fear, panic, phobia

Question 4

Cortico-striatal-thalamic-cortical

Answer 4

worry, anxious misery, apprehension, expectation, obsessions

Question 5

What are the neurotransmitters that are indicated in anxiety?

Answer 5

1. Serotonin-raphe nuclei-low=aggression, impulsivity, depression, suicide attempts, self-injury, intrusive thoughts and repetitive behavior
2. Ne-Locus ceruleus
   associated with orienting, selective attention, hypervigilance, mood and autonomic arousal
3. GABA-increase gaba-alleviate anxiety
4. glutamate-learning and memory

Question 6

Male vs female anxiety

Answer 6

female

Question 7

Panic Attack

Answer 7

abrupt surge of intense fear that reaches a peak within 10 minutes and 4 or more occur
Palpitations
Paresthesias 
Abdominal Distress
Nausea
Intense fear of dying
I-lIghtheadedness
Chest pain
Chills
Chocking
C disConnectedness
Sweating
Shaking
SOB

4 or more four panic attack within 10 minutes

Question 8

Panic Disorder

Answer 8

unexpected panic attacks with no identifiable trigger. at least one attack is followed for 1 month by anticipatory anxiety

• worry about an additional attack or the consequences of an attack
• significant maladaptive change in behavior related to the attack

Question 9

Can panic attacks occur in any generalized anxiety disorder?

Answer 9

yes

Question 10

What is the most common anxiety disorder comorbidity ?

Answer 10

agoraphobia: avoid places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed

2nd most common: GAD

Question 11

What is the most common non-anxiety comorbidity to anxiety?

Answer 11

major depression

Others:
alcohol>other substances
personality disorders-especially cluster C

Question 12

What is the median age of onset of an anxiety disorder?

Answer 12

20-24

Question 13

What are the symptoms of anxiety?

Answer 13

Physical symptoms:..
Affective: edginess to terror and panic; often viewed as irritability or restlessness
Cognitive: worry apprehension, poor concentration, mind blank, tense/jumpy, anticipate the worst
Behavioral: made an effort to diminish or avoid the stress; response can be checking behaviors, rituals, avoidance

–Without treatment: WAXING AND WANING

Question 14

When are panic attacks and disorders risk factors for suicide?

Answer 14

diagnosis in the prior 12 months

Question 15

What is the neurocircuitry model theory of anxiety?

Answer 15

abnormally sensitive fear network, centered in amygdala

GABA, serotonin, norepinephrine, implicated

Question 16

What is first line for treatment of anxiety?

Answer 16

SSRI, SNRI
2nd line: TCAs, MAOI
while waiting for antidepressant effect: also treat with Benzo
Cognitive behavior therapy

Question 17

Agoraphobia

Answer 17

fear or anxiety in at least 2 of the following situations for more than 6 months 
1. pubic transport
2. enclosed spaces
3. open spaces
4 standing in line
5. outside of the home alone 

-onset late teens; late 20’s if no panic attacks/disorder
remission rare unless treated

Question 18

What is the treatment for agoraphobia?

Answer 18

systematic desensitization

Question 19

What is GAD, Specific Phobia, Social anxiety? How long do you have to have symptoms?
Female to male?
Comparison in prevalence
Age of onset?

Answer 19

GAD-excessive anxiety/ worry about many things-adults

Specific phobia-fear/anxiety about a specific situation or object-children

social anxiety-fear/anxiety from social situations where one is exposed to scrutiny/judgement by others; blushing-teens

> 6 months
F>M
Comorbidities: other anxiety disorders, depression, substance abuse disorders

Prevalence: specific> social> GAD

Question 20

What are the courses like for GAD, specific phobia, social phobia?

Answer 20

GAD-wax and wanted, tends to persist, full remission low

Specific- wax and wane; if persistent into adulthood, then full remission low

social-60% for years in adulthood=30% lasts

Question 21

How many phobias to specific phobias tend to have? What specific phobia does not have a childhood onset? What phobia is equal in males and females?

Answer 21

average 3
situational-not childhood onset
Males and females= in blood/injection/injury

Question 22

What two anxiety disorders use CBT and systemic desensitization?

Answer 22

agoraphobia and specific phobia

Question 23

What is separation anxiety?

Answer 23

concerning separation from home or attachment figure
M
fairly common
-majority of children-no anxiety disorders in lifetime
-can be seen adults

Question 24

What is selective mutism?

Answer 24

failure to speak in specific social situations

Question 25

What are 3 comorbidities with anxiety?

Answer 25

1. depression-most common 2. substance abuse 3. personality traits/disorders-cluster c

Question 26

Adjustment disorder

Answer 26

emotional or behavior symptoms in response to an identifiable stressor occurring within 3 MONTHS - out of proportion distress - significant impairment -once stressor is terminated symptoms do not persist for more than 6 months

Question 27

Acute stress disorder and PTSD are exposed to what?

Answer 27

exposure to actual or threatened death, injury, or sexual violence -direct experience, witnessing, learning trauma occurred to close family member or friend, or repeated exposure to aversive details

Question 28

Acute stress disorder

Answer 28

``` Intrusion symptoms Negative mood dissociative symptoms avoidance symptoms arousal symptoms Duration 3days to 1 month ```

Question 29

PTSD

Answer 29

``` Intrusion symptoms Negative alteration in mood and cognition avoidance symptoms arousal symtpoms duration>1 month -50% recover in 3 months ``` F>M Cocomrbi-mood disorders, anxiety disorder, substance abuse disorder (M>F) Treatment: antidep, no benzos

Question 30

OCD

Answer 30

Obsessions - recurrent and persistent thoughts, images or urges - intrusive and unwanted cuasing anxiety/stress COmpulsions - repetitive behavior or mental acts - usually in response to obsession to reduce distress or prevent feared event at least > 1 hour/day F>M Mean age 19 (males younger) chronic waxing and waning over lifetime Comorbid: 1. anxiety disorder (usually anxiety then COD) 2. mood disorder (OCD then Mood) 3. Tic disorder (especially if OCD child) Treatment: high dose SSRI exposure therapy

Question 31

Body dysmorphic disorder?

Answer 31

preoccupied with minor or imagined defects in appearance leading to significant emotional distress

Question 32

Hoarding disorder

Answer 32

persistent difficulty parting with possessions, hoarding causes clinically significant distress

Question 33

trichotillomania

Answer 33

hair pulling

Question 34

excoriation disorder

Answer 34

skin picking

Question 35

Exposure therapy

Answer 35

phobias and OCD