Anxiety Disorder Flashcards
Prevalence
How many people in population have disorder?
incidence
How many new cases occur during a given period?
Sex ratio
Proportion of male and female individuals have disorder
Onset
At what age and how does the disorder normally manifest itself
Course-prognosis
What pattern does disorder follow
Comorbidity
presence of more than one disorder at the same time.
Differential Diagnosis
Process that leads to the exclusion of other
Arousal
increased physiological and psychological activation. Increased (faster) heart rate, perspiration, and rapid breathing
Anxiety
“emotion characterized by feelings of tension, worried thoughts anf physical changes like increased blood pressure”. (APA)
Anxiety and Fear
- The fight flight freeze response
- Fear is response to threats here and now
- Anxiety is future focused fear
Genes
When we talk about biological causes we need to answer this question. There are genes or groups of gene responsible for the emergence of these disorders
- Genes are associated with specific personality traits (irritable, uptight or high strung) common in those with anxiety
- Genes influence anxiety-related brain responses with thus can increase vulnerability
Neurtotransmitter system with anxiety
- More GABA leads to reduction in anxiety systems
- More serotonin leads reduction in anxiety symptoms
- More Noradreline leads increase in anxiety symptoms
- More corticoptropin releasing factor (one of the hormones active in HPA axis) leads to increase in anxiety symptoms
behavioural inhibition system through limbic system (amygdala and hippocampus)
- Responsible for inhibitory behaviours when presented with novel stimuli
- Active we have the tendency to freeze, experience anxiety
Psychological contributions:
- Sense of uncontrollability
- Anxiety sensitivity: Tendency to respond to fear to anxiety inducing symptoms the belief that symptoms of anxiety can be dangerous and potentially lead to devastating outcomes fear of fear.
Environmental contributions
- Life stressors
- Family effects that promote a sense of uncontrollability (e.g., overprotective parents
Generalized Anxiety Disorder
A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, number or events or activities
B. Individual finds it difficult to control the worry
C. Associated with three (or more) of the following six symptoms
- Restlessness or feeling keyed up or on edge
- Being easily fatigued
- Difficulty concentrating or mind going blank
- Irritability
- Muscle tension
- Sleep disturbance (difficulty falling or staying asleep, or restless or unstable
D. Anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupation or other important areas of functioning
E. Disturbance is not attributable to the physiological effects of a substance or another medical condition
F. Not better explained by another mental disorder
- Worry and anxiety which is hard to control
- 3 physical, behavioural, emotional disturbance
- Duration: many days for at least 6 months
Clinical Description
- Concern is related to everyday life events/situation:
- Adults – children, family, job, household chores, punctuality
- Children – academic, social, athletic performance
- Older adults – health and problem sleeping
Panic Disorder
A. Recurrent unexpected panic attacks, it is a surge of intense fear or intense discomfort that reaches peak within minutes. Time four (or more) of following symptoms
- Palpitations, pounding heart, or accelerated heart rate
- Sweating
- Trembling or shaking
- Sensations of shortness of breath
- Feeling of discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, light-headed or faint
- Chills or heat sensations
- Paresthesias
- Derealization
- Fear of losing control or “going crazy”
- Fear of dying
Clinical description
may be associated with agoraphobia (40% of individuals) – Panic attack with agoraphobia – fear or anxiety at least two of these 5 situations
1. Using public transportation
2. Being in open spaces
3. Being in enclosed spaces
4. Standing in line or being in a crowd
5. Being outside of home alone
What can Panic disorder cause
Some individuals use alcohol or drugs to cope with panic
60% individuals with PD experience nocturnal panic – starts when people sink into deepest stage of sleep (delta-wave sleep)
Frequency may vary
FFFS heavily involved in disorder
Specific psychological contribution:
Develop anxiety over the possibility of having another PA
- To avoid feeling anxious, individuals with PD may display interoceptive avoidance or avoidance of internal physical sensations – removing oneself from situations or activities that might produce the physiological arousal that resemble the beginnings of PA
Specific Phobia
A. Fear or anxiety about a specific object or situation
B. Phobic object or situation always provokes immediate fear or anxiety
C. Phobic object is actively avoided
D. Dear is out of proportion to the actual danger
E. Avoidance is persistent, lasting 6 months
F. Avoidance causes clinically significant distress or impairment and important areas of function
G. Disturbance is not better explained by the symptoms of another mental disorder, including fear, anxiety, and avoidance.
Constant - Fear about a specific object – leads avoidance of phobic object
Excessive – Fear about a specific object – Interferes with everyday functioning
Duration; at least 6 months
- Traumatic event – real danger activates an alarm response
- Unexpected panic attack in specific situation may lead to a phobia of that specific situation
- Someone else experiencing a traumatic event – emotional contagion leads to vicarious learning
- Hear about danger – being warned repeatedly may be sufficient to develop phobia (information transmission)
Why do we have phobias
“events” are associated to a biological and psychological vulnerability develop certain phobia. (perceiving a target or situation as dangerous and being susceptible to developing anxiety by focusing on the possibility that the event will happen again)
Social anxiety disorder
Interpersonal transaction cycle
Individuals with SAD tend to: attend to negative social information, more “upwards” than “downwards” comparison which lead to more anxiety, maladaptive behaviours.
Behaviours evoke negative reactions in others – individuals with SAD are perceived more negatively and other people are less likely to desire future interaction with them
Negative reactions likely reinforce the biased social perceptions of people with SAD
Anxiety disorder (OCC)
Onset: Early adult life for Panic Disorder and GAD age 10-15 for Phobia and Social Anxiety
Course: PD relapsing course, every other disorder tend to have chronic course
Comorbidity: anxiety disorder, mood disorder, substance use disorder (men with PD)
Anxiety Treatment
Onset: Early adult life for Panic Disorder and GAD age 10-15 for Phobia and Social Anxiety
Course: PD relapsing course, every other disorder tend to have chronic course
Comorbidity: anxiety disorder, mood disorder, substance use disorder (men with PD)
Anxiety Pharmalogical treatment
- Selective serotonin reuptake inhibitor (SSRI) and SNRI (selective norepinephrine inhibitor, they work to increase the level of serotonin in synapse – reduce the hyperactivity of amygdala - reduce anxiety
Side effect: nausea, dizziness and other physical symptoms
Pharmacological Treatment
- Benzodiazepine increase GABA – increase relaxation and reduce anxiety.
Side effect: impair cognitive and motor functioning may lead to dependence (better short term)
Long term treatments
More effective than drugs long term, Focus on:
- Processing of threatening information and anxiety feeling associated with this information
- Acquiring relaxation techniques to reduce muscle tension
- Re-evaluation of usefulness of worrying
CBT most effective CBT leads to increase GABA signals
Exposure Treatments – arranged conditions in which patient can face feared situation and learn there is nothing to fear
Anxiety-reducing coping mechanism: (relaxation, breathing, retraining)
Panic Control treatment – Exposing patients to the cluster of interoceptive sensations the remind them of their panic attacks
Exposure exercises
- Single session 2-6h
- Exercises rewire the brain – reduce activation in amygdala, insula, cingulate cortex, and increase control from prefrontal regions
- Virutal reality
Cognitive behavioural group therapy: group of patients rehearse of role-play their socially phobic situations in front of one another, in the group acting as audience, therapist condition cognitive therapy to change the unconscious perceptions of danger
Social mishap exposure: help the individuals face the actual consequences of the feared event
Family – based treatment – involving parents; these treatment outperform individuals treatment
