Anxiety and Anxiety-related disorders Flashcards
when is fear “pathologic”?
○ Fear is out of proportion to risk/severity of threat
○ Response lasts beyond the duration of the threat
○ Response becomes generalized to other situations (similar or dis-similar)
○ Social or occupational functioning is impaired
what are the “true” anxiety disorders?
- Panic disorder
- Agoraphobia
- Specific phobia
- Generalized anxiety disorder
what are “anxiety-like” disorders
- Obsessive-compulsive disorder
- Post-traumatic stress disorder
what is panic disorder characterized by?
recurrent panic attacks
To be diagnosed with panic disorder, what does the person need to have?
need to have periods in between attacks where patient a) fears another attack or b) does maladaptive things to avoid another attack
- Need at least 1 month history of avoidance or fear of another panic attack
what is generalized anxiety disorder?
generalized worry that occurs more days than not that is disproportionate to the severity of the event that is feared
T or F: Often anxiety reduces with age
true
what is agoraphobia?
unreasonable fear of being out-of-doors or being in a crowd or being in a place where they can’t escape from or may suffer embarrassment
T or F: people with agoraphobia has anxiety and its symptoms are typically present almost all of the time… even -when the patient is somewhere comfortable to them
true
what is specific phobias
- fears of specific objects or situations that go beyond the true threat of the stimulus and cause avoidance and functional impairment
what is social anxiety disorder?
- marked and persistent (>6 mo) fear of social or performance situations in which:
○ One is exposed to unfamiliar people or to possible scrutiny by others
○ One is afraid that fearing he/she will act in a way that maybe humiliating or embarrassing
○ Out-of-proportion fear that they will be harshly judged by their interpersonal interactions
when does post-traumatic stress disorder happen?
○ Exposure to actual death, threatened death, physical or sexual violence, serious injury
what are the 4 general categories of symptoms in post-traumatic stress disorder?
- intrusion symptoms
- avoidance behavior
- cognitive and mood symptoms
- arousal and reactivity symptoms
what is obsession?
intrusive and unwanted repetitive thoughts, urges, or impulses that lead to a marked increase in anxiety or distress
what is compulsion?
repeated behaviors or mental acts that are done in response to obsessions, or in a rigid rule-bound way (i.e. ritual)
OCD Patients are usually aware that obsessions and compulsions are illogical and not based in fact, what is this called?
insight
what’s a disorder that share a similar neurobiology with OCD?
hoarding disorder
explain the fear response
activation of the locus coeruleus (LC), a midbrain nucleus that contains neurons that release norepinephrine (NE) at the presynaptic terminal
what happens when there is release of norepinephrine?
Activation of the LC release of norepinephrine (NE)
- Activation of the amygdala – emotional “fear” responses
§ The amygdala is a prominent area that attaches an emotional weight to situations – this “weighting” can help prioritize and enhance learning
- Activation of the hypothalamus – activation of the sympathetic nervous system and cortisol release
- Activation of the reticular activating system in the brainstem – increased arousal
what are the 3 pathways that are affected in anxiety-type disorders?
Noradrenergic, Dopaminergic, Serotonergic Pathways
what is “normal” anxiety
areas activated include the locus coeruleus, amygdala activation of the sympathetic nervous system and temporary increased release of cortisol
§ Helps us deal with threats – the prefrontal cortex is able to regulate mood, negative cognition, and general worry
what is “abnormal” anxiety
areas activated OR inactivated include an area close to the amygdala (stria terminalis) and other midbrain nuclei like the dorsal raphe nucleus as well as the locus coeruleus
§ Poorer regulation of mood, fear/worry by the prefrontal cortex
§ Excessive long-term activation of cortisol release by activation of the hypothalamic pituitary axis as well as excessive chronic activation of the sympathetic nervous system
OCD likely involves circuits that involve ?
the basal ganglia
what is the ration of F:M for eating disorders?
10:1
what are the anorexia diagnostic criteria
A. intake and weight: restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
○ Significantly low weight a weight that is less than minimally normal
B. fear or behaviour: intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain, even though at a significantly low weight
C. perception: disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight
what are the bulimia diagnostic criteria
A. recurrent episodes of binge-eating; an episode of binge-eating is characterized by both of the following:
○ eating, in a single period of time, an amount of food that is larger than what most individuals would eat during a similar period of time and under similar circumstances
○ a sense of lack of control over eating during the episode
B. recurrent inappropriate compensatory behaviour in order to prevent weight gain such as:
○ self-induced vomiting
○ misuse of laxatives, diuretics, enemas, or other medications
○ Fasting
○ excessive exercise
C. the binge-eating and inappropriate compensatory behaviours both occur, on average, at least once a week for 3 months
D. self-evaluation is unduly influenced by body shape and weight
E. the disturbance does not occur exclusively during episodes of AN
what is the mechanism for benzodiazepines?
facilitate binding of GABA to GABA receptors
what are the adverse effects of benzodiazepine?
- hangover effects
- early morning rebound insomnia
- tolerance
- dependence
- withdrawal symptoms
Severe symptoms usually occur on abrupt discontinuation after long-term use and/or high doses, and include:
- Increased blood pressure, temperature and pulse
- Rage
- Hallucinations and paranoia
- Seizures
what is a BDZ antagonist
flumazenil, competitive inhibitor of BDZ
