Anxiety Flashcards
Fear vs Anxiety
Fear: emotional response to real or perceived threat
Anxiety: anticipation of future threat
anxiety disorders often have both
What causes anxiety to become pathological?
- Autonomy
- Intensity
- Duration
- Behavior-dysfunctional behaviors
Amygdala centered circuit:
fear, panic, phobia
Cortico-striatal-thalamic-cortical
worry, anxious misery, apprehension, expectation, obsessions
What are the neurotransmitters that are indicated in anxiety?
- Serotonin-raphe nuclei-low=aggression, impulsivity, depression, suicide attempts, self-injury, intrusive thoughts and repetitive behavior
- Ne-Locus ceruleus
associated with orienting, selective attention, hypervigilance, mood and autonomic arousal - GABA-increase gaba-alleviate anxiety
- glutamate-learning and memory
Male vs female anxiety
female
Panic Attack
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
Panic Disorder
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
Can panic attacks occur in any generalized anxiety disorder?
yes
What is the most common anxiety disorder comorbidity ?
agoraphobia: avoid places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed
2nd most common: GAD
What is the most common non-anxiety comorbidity to anxiety?
major depression
Others:
alcohol>other substances
personality disorders-especially cluster C
What is the median age of onset of an anxiety disorder?
20-24
What are the symptoms of anxiety?
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
When are panic attacks and disorders risk factors for suicide?
diagnosis in the prior 12 months
What is the neurocircuitry model theory of anxiety?
abnormally sensitive fear network, centered in amygdala
GABA, serotonin, norepinephrine, implicated
What is first line for treatment of anxiety?
SSRI, SNRI
2nd line: TCAs, MAOI
while waiting for antidepressant effect: also treat with Benzo
Cognitive behavior therapy
Agoraphobia
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
What is the treatment for agoraphobia?
systematic desensitization
What is GAD, Specific Phobia, Social anxiety? How long do you have to have symptoms?
Female to male?
Comparison in prevalence
Age of onset?
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
What are the courses like for GAD, specific phobia, social phobia?
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
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?
average 3
situational-not childhood onset
Males and females= in blood/injection/injury
What two anxiety disorders use CBT and systemic desensitization?
agoraphobia and specific phobia
What is separation anxiety?
concerning separation from home or attachment figure
M
fairly common
-majority of children-no anxiety disorders in lifetime
-can be seen adults
What is selective mutism?
failure to speak in specific social situations
What are 3 comorbidities with anxiety?
- depression-most common
- substance abuse
- personality traits/disorders-cluster c
Adjustment disorder
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
Acute stress disorder and PTSD are exposed to what?
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
Acute stress disorder
Intrusion symptoms Negative mood dissociative symptoms avoidance symptoms arousal symptoms Duration 3days to 1 month
PTSD
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
OCD
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:
- anxiety disorder (usually anxiety then COD)
- mood disorder (OCD then Mood)
- Tic disorder (especially if OCD child)
Treatment: high dose SSRI
exposure therapy
Body dysmorphic disorder?
preoccupied with minor or imagined defects in appearance leading to significant emotional distress
Hoarding disorder
persistent difficulty parting with possessions, hoarding causes clinically significant distress
trichotillomania
hair pulling
excoriation disorder
skin picking
Exposure therapy
phobias and OCD
