anxiety disorder 1

Question 1

objectives of the lecture

Answer 1

1. understand the etiology and neurobiological underpinings of anxiety disorders
2. be able to differentiate amongst anxiety disorders
   - Generalized anxiety disorder (GAD)
   - Panic disorder (PD)
   - Specific phobia and Social Anxiety Disorder
   - Obsessive compulsive disorder
   - Acute stress and Post Traumatic Stress Disorder
3. Understand first line treatments for anxiety disorders

Question 2

what are the physical manifestations of anxiety disorder?

Answer 2

1. sympathetics NS: diaphoresis, mydriasis, tachycardia, tremor
2. GI/GU symptoms (diarrhea, increased urinary freq.)
3. Hyperventilation –> dizziness and syncope, parasthesia
4. Numbness and tingling in the extremities and around the mouth

Question 3

what are some psychological manifestations of anxiety disorder?

Answer 3

1. restlessness
2. irritability
3. trouble concentrating
4. worry

Question 4

what are the symptoms that need to present to diagnose anxiety?

Answer 4

1. be persistent (more than 6 months)
2. interfere with normal functioning (work, job, marriage)
3. cause significant distress
   - -> otherwise we may begin to declare normal anxiety and fear responses as pathological (shorter duration for children)

Question 5

to diagnose general anxiety disorder

Answer 5

1. excessive anxiety/worry, occurring more days than not for more than 6 months, about more than 1 event/activity
2. difficult to control worry
3. associated with more than 3 of the following symptoms
   1) restlessness
   2) easily fatigued
   3) difficulty concentrating
   4) irritability
   5) muscle tension
   6) sleep disturbance
4. Causes significant impairment

Question 6

physical manifestation of anxiety

Answer 6

1. sympathetic –> diaphoresis, mydriasis, tachycardia –> tremor
2. GI/GU symptoms –> diarrhea, increased urinary freq.
3. hyperventilation –> dizziness and syncope, parasthesia
4. numbness and tingling in the extremities and around the mouth

Question 7

for anxiety make sure you check both

Answer 7

1. physical manifestation

2. psychological manifestation

Question 8

what are the psychological manifestation of anxiety?

Answer 8

Restlessness, Irritability, Trouble concentrating, worry

Question 9

just b/c you see the word “panic” don’t assume it’s panic disorder

Answer 9

it could be social phobia

Question 10

gender bias in anxiety disorder?

Answer 10

Gender bias (disorder dependent) in that women > men are affected (Except OCD)

Question 11

neurotransmitter for anxiety disorder?

Answer 11

Neurobiological Factors
↓ Serotonin(5-HT) and ↓ GABA activity
↑ NorEpi and ↑ Glutamate activity

Question 12

for GAD what is the non-medication treatment?

Answer 12

Cognitive Behavioral Therapy or Psychodynamic (CBT)

Question 13

mech of increasing NE to treat GAD?

Answer 13

Increases SR or NE or both, downregulates or desensitizes receptors

Question 14

Buspirone (a 5HT1a receptor agonist)

Answer 14

Initially lowers SR activity as these autoreceptors are stimulates but eventually renders them onactive allowing increases in SR output

Question 15

Beta blocker is NOT used for GAD

Answer 15

Beta Blockers. For symptomatic relief of performance anxiety, not GAD!!!
–> beta block is only used in social performance phobia

Question 16

treatment for panic disorder (Agoraphobia)?

Answer 16

Treatment
1. Therapy
Cognitive Behavioral Therapy
Systemic desensitization or flooding
Psychodynamic Therapy
2. Medication
Emergency treatment: fast-acting benzodiazepines (alprazolam)
Long Term 1st line: SSRI/SNRI 
Intermediate or long acting benzos (not 1st line 2nd to addiction potential…)
3. Combination treatment

Question 17

treatment for specific phobia?

Answer 17

Specific Phobia
1. Therapy (1st line): Flooding, systemic desensitization (CBT)
Psychodynamics (signal anxiety)
2. Medication: sedatives???

Question 18

treatment for social anxiety disorder?

Answer 18

Social Anxiety Disorder (Social Phobia)
1. Therapy: CBT, Assertiveness training, group therapy
2. Medication:
SSRI /SNRI(1st line): Paroxetine,/Venlafaxine ER
MAOI: Phenelzine,Tranylcypromine
Beta Blockers (propranolol) – 1st line for performance only variant

Question 19

beta blockers (propranolol) is

Answer 19

a 1st line for public performance only anxiety