Anxiety Flashcards
Anxiety guidelines
Chronological age - development of anxiety disorders?
Separation Anxiety (age 3-6 years)
Selective Mutism (< age 5)
Specific phobia (age of onset age 7)
Social anxiety disorder (age of onset 13)
Panic disorder (age of onset 20)
Agoraphobia (age of onset 25)
Generalized anxiety disorder (age of onset 30)
Risk factors for anxiety disorders
F> M (2:1 ratio)
Family history
ACE
Chronic medical illness: CVD, asthma, obesity
Anxiety guidelines meds - Social Anxiety Disorder?
VPS PEF Venlafaxine Paroxetine Sertraline Pregabalin Escitalopram Fluoxetine
Meds - Panic Disorder?
VPS CEFF Venlafaxine Paroxetine Sertraline Citalopram Escitalopram Fluoxetine Fluvoxamine
Meds - GAD ?
VESPPA D Venlafaxine Escitalopram Sertraline Paroxetine Pregabalin Agomelatine Duloxetine
Adjunctive therapy - Panic Disorder?
Second line: Alprazolam, Clonazepam
Third line: Aripiprazole, Divaloproex, Olanzapine, Pindolol, Risperidone
Which phobias does virtual reality exposure work for ?
Specific phobias
heights, spiders, claustrophobia
Adjunctive therapy - Social Anxiety Disorder?
Third line: Aripiprazole, Buspirone, Paroxetine, Risperidone
Adjunctive therapy - GAD ?
Second line: Pregabalin
Third line: Aripiprazole, Olanzapine, Quetiapine, Risperidone
GAD - prevalance/epi ?
Bimodal distribution (early 20s and 30/40 year olds)
OCD - Meds ?
F2EPS Fluxoetine Fluvoxamine Escitalopram Paroxetine Sertraline
OCD - Adjunctive therapy ?
First line - aripiprazole, risperidone
Second line - memantine , quetiapine, topiramate
What is not recommended in OCD ?
Clonazepam
Clonidine
Desimpramine
PTSD - meds ?
VFPS Venlafaxine Fluxoetine Paroxetine Sertraline
PTSD - Adjunctive therapy?
Second line - eszopiclone, Olanzapine, risperidone
Third line - aripiprazole, clonidine, gabapentin
What is not recommended in PTSD ?
alprazolam, citalopram, clonazepam, desimpramine, divaloproex, olanzapine, tiagabine
Most common- specific phobia
animal - adults
In kids < age 10, most common phobia
natural env’t (hts, water, storms)
Acute stress disorder ?
9 symptoms in 5 domains - any 9 timeline - between 3 days and 1 month after trauma Exposure symptoms - experiencing trauma Intrusion symptoms - flashbacks, etc Negative Mood Dissociative symptoms Avoidance symptoms Arousal symptoms
Good prognosis for PTSD ?
rapid onset of symptoms
short duration (< 6 months)
good premorbid functioning
strong social supports
Are all anxiety disorders more common in males or females?
females
Lifetime prevalence of anxiety disorders?
All anxiety disorders - 28% Social anxiety disorder - 12.1% PTSD - 6.8% GAD - 5.7% Panic Disorders - 4.7%
Recurrence rates over 12 year follow up - anxiety disorders?
60% panic
40% for SAD and GAD
33% convert to another anxiety disorder
Risk factors for childhood anxiety disorder?
Age of onset (early = worse) Divorced parents (no partner) History of childhood trauma Residual symptoms Parental substance abuse antidepressant discontinuation comorbid mood disorder
Psychological risk factors for developing anxiety disorders?
Neuroticism Introversion Behavioral Inhibition Anxiety sensitivity Harm avoidance Perfectionism Intolerance of Uncertainty
Anterior Cingulate Cortext
role of integration of attention such as decision making, reward anticipation, decision making
TOP DOWN INHIBITION
Hippocampus
Important for forming storage - episodic memories
BOTTOM UP INHIBITION –> inhibit amygdala
What is the lag time between the urge and reaction?
0.25 secs
Anxiety Disorders in DSM5
Panic Disorder Generalized Anxiety Disorder Separation Anxiety Disorder Agoraphobia Specific Phobia Selective Mutism
Obsessive Compulsive Related Disorders?
Obsessive Compulsive Disorder Body Dysmoprhic Disorder Hoarding Disorder Tricholitllomania Excoriation (skin picking)
Trauma/Stressor Related Disorders
PTSD Acute Stress Disorder Adjustment Disorders Reactive Attachment Disorder Disinhibited Social Engagement Disorder
Agoraphobia - DSM 5
Marked fear or anxiety about 2 or more of the following situations: Using public transportation Being in open spaces Being in enclosed spaces Standing in line or being in a crowd Being outside of the home alone
The fear, anxiety or avoidance:
Is persistent, typically lasting 6 months or longer
Causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning
Is clearly excessive, if another medical condition is present ( eg. IBD,
Parkinsons)
Neuroanatomical basis of worry?
Excitation of the cortico-striatal-thalamic-cortical loop
Top risk factors for developing an anxiety disorder?
family history of anxiety being female childhood stressful life events/trauma chronic medical issues behavioral inhibition
Social Anxiety Disorder - RF
lifetime prevalance 8-12%
more common in women
onset after 25 years is rare
lower SES, unmarried
Generalized Anxiety Disorder - RF
another anxiety disorder
substance abuse
MDD
MOA - Gabapentin and Pregabalin
Alpha-2 delta ligands ( pregabalin and gabapentin) bind to voltage sensitive calcium channels which in turns blocks the release of excitatory neurotransmitters ( like
glutamate). When this occurs in the amygdala or in the CSTC , then an anxiolytic effect may result.
Childhood onset OCD - RF
associated with higher symptom severity
higher rates of clinical obsessions and compulsions
higher rates of co occurring tic disorders
less chance of SRI response as adult
How many more x likely is someone with first degree relative of OCD likely to have OCD ?
4x
Obsessions and Compulsions in non clinical samples
80% obsessions
55% compulsions
What is the treatment for treatment resistant OCD?
cingulotomy or anterior capsulotomy
What percentage of patients with OCD are treatment refractory?
At least 10% of patients with OCD are treatment refractory
Prognostic indicators for poor prognosis in OCD?
early age of onset yielding to compulsions bizarre compulsions hospitalization comorbid depression lack of insight -delusions - overvalued ideas -schizotypal personality disorder
