Anxiety and Anxiety-related disorders

Question 1

when is fear “pathologic”?

Answer 1

○ 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

Question 2

what are the “true” anxiety disorders?

Answer 2

• Panic disorder
• Agoraphobia
• Specific phobia
• Generalized anxiety disorder

Question 3

what are “anxiety-like” disorders

Answer 3

• Obsessive-compulsive disorder
• Post-traumatic stress disorder

Question 4

what is panic disorder characterized by?

Answer 4

recurrent panic attacks

Question 5

To be diagnosed with panic disorder, what does the person need to have?

Answer 5

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

Question 6

what is generalized anxiety disorder?

Answer 6

generalized worry that occurs more days than not that is disproportionate to the severity of the event that is feared

Question 7

T or F: Often anxiety reduces with age

Answer 7

true

Question 8

what is agoraphobia?

Answer 8

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

Question 9

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

Answer 9

true

Question 10

what is specific phobias

Answer 10

• fears of specific objects or situations that go beyond the true threat of the stimulus and cause avoidance and functional impairment

Question 11

what is social anxiety disorder?

Answer 11

• 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

Question 12

when does post-traumatic stress disorder happen?

Answer 12

○ Exposure to actual death, threatened death, physical or sexual violence, serious injury

Question 13

what are the 4 general categories of symptoms in post-traumatic stress disorder?

Answer 13

• intrusion symptoms
• avoidance behavior
• cognitive and mood symptoms
• arousal and reactivity symptoms

Question 14

what is obsession?

Answer 14

intrusive and unwanted repetitive thoughts, urges, or impulses that lead to a marked increase in anxiety or distress

Question 15

what is compulsion?

Answer 15

repeated behaviors or mental acts that are done in response to obsessions, or in a rigid rule-bound way (i.e. ritual)

Question 16

OCD Patients are usually aware that obsessions and compulsions are illogical and not based in fact, what is this called?

Answer 16

insight

Question 17

what’s a disorder that share a similar neurobiology with OCD?

Answer 17

hoarding disorder

Question 18

explain the fear response

Answer 18

activation of the locus coeruleus (LC), a midbrain nucleus that contains neurons that release norepinephrine (NE) at the presynaptic terminal

Question 19

what happens when there is release of norepinephrine?

Answer 19

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

Question 20

what are the 3 pathways that are affected in anxiety-type disorders?

Answer 20

Noradrenergic, Dopaminergic, Serotonergic Pathways

Question 21

what is “normal” anxiety

Answer 21

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

Question 22

what is “abnormal” anxiety

Answer 22

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

Question 23

OCD likely involves circuits that involve ?

Answer 23

the basal ganglia

Question 24

what is the ration of F:M for eating disorders?

Answer 24

10:1

Question 25

what are the anorexia diagnostic criteria

Answer 25

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

Question 26

what are the bulimia diagnostic criteria

Answer 26

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

Question 27

what is the mechanism for benzodiazepines?

Answer 27

facilitate binding of GABA to GABA receptors

Question 28

what are the adverse effects of benzodiazepine?

Answer 28

• hangover effects
• early morning rebound insomnia
• tolerance
• dependence
• withdrawal symptoms

Question 29

Severe symptoms usually occur on abrupt discontinuation after long-term use and/or high doses, and include:

Answer 29

• Increased blood pressure, temperature and pulse
• Rage
• Hallucinations and paranoia
• Seizures

Question 30

what is a BDZ antagonist

Answer 30

flumazenil, competitive inhibitor of BDZ