Anxiety Disorder

Question 1

Prevalence

Answer 1

How many people in population have disorder?

Question 2

incidence

Answer 2

How many new cases occur during a given period?

Question 3

Sex ratio

Answer 3

Proportion of male and female individuals have disorder

Question 4

Onset

Answer 4

At what age and how does the disorder normally manifest itself

Question 5

Course-prognosis

Answer 5

What pattern does disorder follow

Question 6

Comorbidity

Answer 6

presence of more than one disorder at the same time.

Question 7

Differential Diagnosis

Answer 7

Process that leads to the exclusion of other

Question 8

Arousal

Answer 8

increased physiological and psychological activation. Increased (faster) heart rate, perspiration, and rapid breathing

Question 9

Anxiety

Answer 9

“emotion characterized by feelings of tension, worried thoughts anf physical changes like increased blood pressure”. (APA)

Question 10

Anxiety and Fear

Answer 10

• The fight flight freeze response
• Fear is response to threats here and now
• Anxiety is future focused fear

Question 11

Genes

Answer 11

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

Question 12

Neurtotransmitter system with anxiety

Answer 12

• 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

Question 13

behavioural inhibition system through limbic system (amygdala and hippocampus)

Answer 13

• Responsible for inhibitory behaviours when presented with novel stimuli
• Active we have the tendency to freeze, experience anxiety

Question 14

Psychological contributions:

Answer 14

• 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.

Question 15

Environmental contributions

Answer 15

• Life stressors
• Family effects that promote a sense of uncontrollability (e.g., overprotective parents

Question 16

Generalized Anxiety Disorder

Answer 16

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

1. Restlessness or feeling keyed up or on edge
2. Being easily fatigued
3. Difficulty concentrating or mind going blank
4. Irritability
5. Muscle tension
6. 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

Question 17

Clinical Description

Answer 17

• 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

Question 18

Panic Disorder

Answer 18

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

1. Palpitations, pounding heart, or accelerated heart rate
2. Sweating
3. Trembling or shaking
4. Sensations of shortness of breath
5. Feeling of discomfort
6. Nausea or abdominal distress
7. Feeling dizzy, unsteady, light-headed or faint
8. Chills or heat sensations
9. Paresthesias
10. Derealization
11. Fear of losing control or “going crazy”
12. Fear of dying

Question 19

Clinical description

Answer 19

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

Question 20

What can Panic disorder cause

Answer 20

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

Question 21

Specific psychological contribution:

Answer 21

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

Question 22

Specific Phobia

Answer 22

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

1. Traumatic event – real danger activates an alarm response
2. Unexpected panic attack in specific situation may lead to a phobia of that specific situation
3. Someone else experiencing a traumatic event – emotional contagion leads to vicarious learning
4. Hear about danger – being warned repeatedly may be sufficient to develop phobia (information transmission)

Question 23

Why do we have phobias

Answer 23

“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)

Question 24

Social anxiety disorder

Answer 24

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

Question 25

Anxiety disorder (OCC)

Answer 25

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)

Question 26

Anxiety Treatment

Answer 26

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)

Question 27

Anxiety Pharmalogical treatment

Answer 27

• 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)

Question 28

Long term treatments

Answer 28

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

Question 29

Exposure exercises

Answer 29

• 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