Anxiety Flashcards
Prevalence of anxiety
o 10 – 20% of children diagnosed with anxiety
o Girls report more stress than boys
Name four methods of distinguishing normal from pathological
o Object: o Intensity: o Impairment: (Social functioning, Academic functioning, Family functioning) o Ability to Recover/Coping Skills
General fears of: Infants Toddlers School age Adolescents
o Infants; loud, strangers
o Toddlers; darkness, seperation
o School-age; injury, natural events, attribution bias
o Adolescents; school, social competence, health
Confidence of predictors at age 5
Being confident age 5 = less likely to develop anxiety disorders
Children who are passive, shy, fearful, and avoid new situations at 3 and 5 years = more likely to exhibit anxiety later in life
Three most common anxiety disorders?
The most common anxiety disorders
• Separation Anxiety
• Generalized Anxiety
• Specific Phobias
What are the clinical presentations of anxiety?
o Unable to recognize their fears as unreasonable o often cannot articulate their feelings o often see physical symptoms Headaches nausea increased heart rate diarrhoea or constipation sleep disturbance colds appetite change fatigue & exhaustion
What is separation anxiety?
What are the symptoms?
Age of development?
o Excessive fear when separated from home or attachment figures
o Gender ratios are generally equal
Symptoms
• difficulty sleeping alone, nightmares
• somatic complaints
• school refusal
o earliest age of onset among anxiety disorders
may develop after a stressor
o precursor to of adult psychiatric conditions like depression /anxiety
What are specific phobia?
Key criteria?
Age?
o Fear of a particular object or situation which is avoided or endured with great distress
o Avoidance is key: if it is a true phobia, will avoid at all costs
o Specific phobias often dissipate with age
phobias that persist into adulthood remit only infrequently (20%)
What is GAD?
What symptoms do children exhibit?
Lifetime?
o chronic, excessive worry in multiple areas with at least one associated somatic symptom (schoolwork, social interactions, family, health/safety, world events, natural disasters)
o Affected children:
perfectionistic
seek reassurance
struggle is evident to parents and teachers
o Worry is not limited to a specific situation or object
o GAD often report they’ve felt anxious their entire life
Over half presenting for treatment report onset in childhood or adolescence but after 20 is not uncommon
What is social anxiety?
What are presenting symptoms?
What could be a new type of social phobia?
o Feeling scared or uncomfortable in one or more social or performance situations (Fear of scrutiny, Fear of doing something embarrassing)
o Struggle to answer questions in class, reading aloud, initiate conversation, talking with unfamiliar people, and attend parties and social events
o The anxiety dissipates when away from a social situation (unlike GAD)
o 90% of children with Selective Mutism meet criteria for Social Phobia
Selective Mutism = specific type of Social Phobia?
o Social Phobia begins in childhood and is usually both lifelong and continuous
What is panic disorder?
What are the symptoms?
Age of onset?
o Recurrent episodes of intense fear that occur unexpectedly
o attacks become less severe if they occur more often
o Somatic symptoms: (Heart pounding and/or racing, Sweating, Cold hands/painful extremities,Can feel so extreme that one feels (s)he is dying)
o Uncommon before puberty period
What is OCD?
What do O and C stand for?
How do symptoms change over time?
o Most patients experience both obsessions and compulsions
Obsessions are intrusive, continuous, unmanageable thoughts/worries –
Compulsions are “ritualistic” actions performed in response to obsessive thoughts
• Performing compulsive actions relieves anxiety
o Symptoms worse with stress or trauma
o Changes in symptoms and in intensity over time
o Symptoms commonly exist for years before reaching clinical attention
o Usually improves with time
Three main features of anxiety disorders?
o Increased behavioural inhibition (the tendency to be unusually withdrawn/timid and to show fear/withdrawal in novel/ unfamiliar social and nonsocial situations)
o Increased attention to threat
o Increased response to any arousal
people with anxiety disorders can find anything exciting unpleasant, regardless of valence
Genetics of anxiety?
Heritability factors?
o No clear data support specific genes for specific anxiety disorders
o Anxiety is heritable
Panic Disorder (48%)
Generalized Anxiety Disorder (32%)
o Genes account for some but not all of risk increase
Environmental factors must play a major role
What is the Reticular Activating System?
network of ascending, arousal-related neural systems
Locus coeruleus mobilizes in response to real or perceived threat –
• Dorsal raphe mediates the locus coeruleus
Serotonin and anxiety
High levels of serotonin in the brain during development can lead to permanent changes in the response to stress
Serotonin is strongly implicated in emotion
• Serotonergic drugs are often prescribed for anxiety disorders
• SSRIs are effective against panic, anxiety and depression
When the Serotonin receptor and transporter is knocked out mice exhibit…
Carrying the short form is associated with…
increased fear and anxiety
• Transporter protein has Two Alleles – short and long
Higher levels of anxiety
Increased amgydala reactivitiy
Less habituation of amygdala response is associated with Trait Anxiety
Three Interactions between gene and environment
- People with short form are less resilient
- Gene dosage matters (two copies worse than one)
- Long form is “protective”?
Where does cortisol release occur and what does it do?
HIppocampus during stress
results in cell death
Where do Cognitive distortions (seeing threat where there isn’t real threat) occur?
o Hypothalamus and prefrontal cortex
ASD and anxiety
Prevalence?
Which two symptoms are associated with both?
o Prevalence 40 –84%
Impairments in social functioning
Impairments in Theory of Mind
heightened “Intolerance of uncertainty” (All ambiguous stimuli interpreted as negative )
Sensory atypicalities
Presence and severity of repetitive behaviours
Why does ASD symptom severity increase vulnerability to anxiety disorders?
- Less cognitive reserve/ability to cope
- Increased likelihood of negative response from others
- Increased likelihood of stress and negative life events
Anxiety and Williams Prevalence? Main type? What protects against anxiety in Williams? What does it present like?
o 50% o Mainly specific phobia (childhood) o IQ and anxiety are negatively correlated Higher intelligence may be protective o ASD
Fragile X and anxiety
Anxiety is high prevalence because?
In social situations, anxiety presents like?
There is an association between anxiety and…?
o Anxiety is part of the diagnosis
• “ASD-like” behaviours in social situations
Association between anxiety and repetitive behaviours
