Anxiety Disorder

Question 1

anxiety vs fear

Answer 1

fear is natural reaction to stimulus in trying to protect ourselves, anxiety is when we worry too much about things (fear is normal, anxiety is one step too much)

Question 2

normal to worry about scores, car accident, etc, but:

Answer 2

once it impairs your life or the quality of your life, it is too much, now pathologic anxiety

Question 3

primariy anxiety response is a result of:

Answer 3

norepinephrine from locus corrulius, can also be a result of increase CO2, sodium lactate, etc (these things induce anxiety) yohimbine

Question 4

anxiety disorders in DSM5:

Answer 4

Specific Phobia
Social Anxiety Disorder (Social Phobia)
Generalized Anxiety Disorder
Panic Disorder 
Agoraphobia
(same anxiety with different stimuli that evokes their image)

Question 5

TEST: multiple anxiety disorders (panic, ocd, ptsd, social, etc) all have anxiety but the difference is:

Answer 5

difference which things induce it, and different how we respond to different things

Question 6

TEST: specific phobia:

Answer 6

Marked fear or anxiety about a specific object or situation
Phobic stimulus is avoided or endured with intense fear or anxiety
Anxiety is out of proportion
The person recognizes that the fear is excessive or unreasonable
Generally last more than 6 months
Associated with distress of dysfunction
fear of snake (wear boots), scare of planes they drive everywhere, making extra effort to avoid stressor (especially airplane)

Question 7

usually starts around:

Answer 7

age 10, more common females than males 2/3, usually last more than 6 months

Question 8

social anxiety disorder vs personality disorder

Answer 8

personality disorder is less symptomatic or severe and social anxiety disorder is the next level of dabillitation of symptoms

Question 9

social anxiety disorder:

Answer 9

2:1 females, 75% between 8-15 yr old

Question 10

general anxiety disorder:

Answer 10

mean onset is 30 yr old. Excessive anxiety and worry more days than not for at least 6 months
Individual finds it difficult to control the worry
Associated with restlessness, being easily fatigues, difficulty concentrating, irritability, muscle tension, and sleep disturbance
Causes distress or dysfunction

Question 11

panic attack:

Answer 11

Recurrent unexpected Panic Attacks
and
1 month or more of persistent concern or worry about additional panic attacks or their consequence (“anticipatory anxiety”)
or
Maladaptive behavioral change (“avoidance behavior”)
don’t wear same clothes as when panic attack happened, don’t go to same place, eat same food, etc
crescendo to feeling as if you are dying on the spot (heart attack, etc)
terrifying, worse ever!!!
choking, tingling, out of body experience, shit crazy!
lasts 5-10 minutes

Question 12

panic attacks:

Answer 12

usually can be measured by how many ED visits in a time period. They usually get progressively worse as time goes on

Question 13

agoraphobia:

Answer 13

fear of not being able to escape a situation; love elton john but can’t go for fear of being stampeded and dying at colloseum

Question 14

how to treat anxiety?

Answer 14

up or downstream: after it happens or before it happens: antidepressents ssri, tricyclic, benzodiazpines (horrible dependency, but effective in 5 minutes) beta blockers (treating downstream to blood vessels, not upstream to brain).

Question 15

the treatment that actually helps anxiety the most by fixing the root of the problem is:

Answer 15

CBT cognitive behavioral therapy

Question 16

TEST: CBT

Answer 16

trying to control our emotions, thoughts and behavior and understanding that they must all be put together and work well together for us to be able to function properly

Question 17

desensitization:

Answer 17

first meet and talk about flying, then go see an airplane, then go sit in an airplane on the ground, then sit and ride short, etc (opposite is flooding-not preferred) Problem is that flooding induces a full blown panic attack

Question 18

GAD:

Answer 18

normal things that normal people worry about, but instead of just crossing your mind, it dabilitates people and they can’t function

Question 19

Benzos:

Answer 19

favorable side effects in some ways, but then again undesirable side effects

Question 20

TEST: OCD:

Answer 20

multiple worries that are just outside of reality (something will happen to my kids, my dogs, my house, etc) so they find some magical action that protects them from bad things happening (coming hair certain way, eating food certain way, walking certain way, etc)

Question 21

obsessions are ____ and compulsions are ______

Answer 21

the unwanted thoughts that are affecting your mind that you don’t want; the actions that you do to prevent the bad obsession from happening

Question 22

ocd personality disorder vs ocd

Answer 22

ocd personality disorder feels foreign to the person, while ocd is just “this is me and this is how I behave”
ocd is much much higher level disability and much more dabilitating than oc personality disorder

Question 23

oc personality disorder is:

Answer 23

much more prevelant in medical field (i.e. check lists, starting on same side of procedure each time, etc) while ocd is disabiling

Question 24

often ocd rituals are:

Answer 24

progressive, they start off just one thing, (checking the lights), then checking all the lights 2x, then 3x, then backgwards, etc

Question 25

comorbidities of ocd:

Answer 25

Other Anxiety Disorders
Panic disorder, phobias
Eating Disorders
Major Depressive Disorder
Questionable relationship to Tourette’s disorder

Question 26

TEST phobia:

Answer 26

“Excessive fear of a specific object, circumstance  or situation
Three types of phobias
Agoraphobia
Specific Phobias
Social Phobia
For diagnosis of a Disorder, the fear must interfere with functioning or cause marked distress
must be dabilitating
Fear is circumscribed to a specific object/situation
Types
Animal type
Natural environment type
Blood-injection type
Situational Type
Other
no 1, public speaking

Question 27

Social phobia:

Answer 27

eating in public, public restroom, shy teen agers, not usually in adults

Question 28

our body can imitate a panic attack in the case of:

Answer 28

Endocrine disorders
Hypo- and hyperthyroid states
Hyperparathyroidism
Pheochromocytomas
Episodic hypoglycemia associated with insulinomas

Question 29

anxiety disorder often causes:

Answer 29

ent to refer patients with vestibular problems to psychiatrist (I don’t feel I can walk, I might fall, that would cause embarassment, etc)

Question 30

TEST: most important medical condition that can cause anxiety disorder:

Answer 30

asthma and copd (after that would be vestibular problem or schwannoma)

Question 31

medicine induced anxiety:

Answer 31

steroids, cocaine, oral contraceptives, etc

Question 32

48 yr old woman has an overwhelming fear of spiders. She has had this her entire life and now its increased bc she lives in a wooded area with lots of spiders. What should you do?

Answer 32

have the patient create a hierarchical list of feared situations involving spiders.

Question 33

when a feared stimulus is presented paired with a behavior that induces a state incompatible with anxiety (deep muscle relaxation), the phobia stimulus loses its power to create anxiety ________. This pairing of feared stimulus with a state incompatible with anxiety is called ___________. For __________ to work, the anxiety elicited by the exposure has to be low. Treatment starts stimuli with higher anxiety potential. ____________ refers to the concept that behavior can be modified by changing the antecedents or the consequences of the behavior (contingency management). Flooding is another exposure-based treatment fo rphobia, based on extinctino rather than counterconditiong.

Answer 33

(counterconditioning), reciprocal inhibition, desensitization, Operant conditionaing

Question 34

35 yr old has a history of being afrain to speak in public. He normally handles his fear by avoiding this activity or by keeping the size of the audience to a minimum. He is required to give a presentation in front of a large audience in 2 weeks and has been extremely anxious about it to the point where he cannot sleep. Although the public speaking event is new, he says he has had similar fears most of his life (>6 months). The clinician would also want to rule out substance use issue or other medical coniditions that may be related to anxiety. The patient is afraid he will somehow embarrass himself in in front of the audience.

Answer 34

SAD; treat with CBT: Relatxation training followed by progressive desensitization. Pharmacologic ineterventions include benzos beta blockers. Currently, the longer lasting drugs are SSRI (sertraline, fluxoxetine)

Question 35

diagnostic for SAD

Answer 35

persistant fear for 6 mo of at least one social situation or performance situation

Question 36

Social anxiety Disorder has to be a fear of speaking in public that has existed for a duration of ______

Answer 36

6 months or more