Anxiety ch 10 Flashcards
Phobic disorder
Three components:
a. anticipatory anxiety,
b. fear of the outcome from coming in contact with object or situation,
c. and avoidance behaviors.
Prevalence - 10%
Etiology - run in families, maladaptive cognitive functioning,head injury.
Bio - dysfunction of neural circuitry, amygdala.
s/s - related to sympathetic NS activation - unsteadiness, SOB, pounding heart, sweating , nausea, choking, smothered, cp, faintness, trembling, fear of dying, fear of going crazy, perception of impending doom; avoidance behaviors,
TX - REduce stress and functional impairment via psychotherapy, pharmacotherapy, psychosocial. Ist line of tx - is EXPOSURE therapy.
paroxetine, escitalopram.
GAD
- excessive anxiety and pervasive worry for at least 6 months.
- restlessnes, fatigue, poor concentraiom, irritability, muscle tension, poor sleep.
- Hypervigilance and somatic symptoms.
Impaired cognitive functioning, interpersonal, social, and vocational.
Worry about everything and everyday things. Wrory is out of proportion.
Greater intensity of emotions, inability to self soothe, poorer understanding of feelings.
Prevalence - 6-8%
Onset - After age 20 in adults, 8-9 yrs in kids, Many adults had anxiety issues as kids, late onset after 50.
Gender - twice in women than men.
Risk - increase in stressors, SMI, losses, trauma, separation, divorce,behavioral inhibition.
etiology - genetic predisposition, attachment theory, avoidance theory, intolerance of uncertainty theory, psychoanalytical theory (unresolved unconscious conflicts).
Bio basis - NT involved in fear/anxiety circuit include GABA, NE, serotonin, glutamate, cortisol. Decreased GABA.
Prsentation - excessive anxiety, uncontrolled worry, serious distress, interferes with daily living, physical symptoms. Hx early anxiety, social isolation, academic difficulties, disturbed family situation.
Comorbid - mdd, axis ll.
Tx - improvement of symptoms, psychotherapy, SSRIs, SNRIs, benzos, busprione, anticonvulsants, antidepressants, SGA. Paroxetine, escitalopram, venlafaxien, duloxetine.
SAD
fear of being evaluated by others, judged to be inadequate or rejected, fear of social or performance situations.
Nongeneralized - only one situation, limited social fear.
Generalized - overal distress, anxiety, more impairment
Onset - Begins in midadolescence, mean age 15. females, single, unemployed, less education, lower incomes.
Risk factors - inhibited temperament, insecure attachment, fear of social evaluation.
S/s - anxiety, palpitations, trembling, sweating, shaking of hand, diarrhea, blushing, confusion.
comorbid with mood, anxiety, substance related, and eating d/o, and avoidant personality d/o.
TX - paroxetine, sertraline, fluxvoxamine, citalopram.
Nongeneralized SAD - betablokers or benzos. BB reduces autonomic arousal such as tacky, palpitations, tremors, sweating, dry mouth.
Panic DO
Occur repeatedly, great concern about further attacks, avoidance of situations. Origins lied in brain dysfunction.
Prodromal signs - anxiety, hypochondriacal fears, dependence on others, avoidance behaviors
Most attacks last 5-20 minutes. . May develop agoraphobia.
Prevalence - women twice the rate, never married.
Onsert - early 20 and 30s, hx of childhood anxiety.
Risk - female, native america, middle ages, widowed, sep, divorced, low income, loss, illness, victim of sex assault, hx childhood abuse, financial or work problem,s, intoxication.
Etiology - genetical vulnerability, developmental theory by behavioral inhibition, non supportive patterns of family interactions, domineering parent, quarrels between parents, treats of physical harm between parent, threats of abandonment, overprotective.
comorbid with medical d/o and personality disorders, mdd, ptsd, bipolar.
Panic do without and with agoraphobia.
TX - psychotherapy and pharmacotherpy. CBT, psychodynamic, supportive. First line SSRI, SNRI (paroxetine, sertraline, fluoxetine, venlafaxine. 2nd TCS, 3rd - benzos.
