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Anxiety Disorders Flashcards

1
Q

HPA activation - hypothalamic pituitary adrenal activation

A

Affects multiple brain regions
Affects every organ system in the body - blood pressure, clots, etc
Concepts related to HPA activation: Stress, Fear, Panic, Anxiety
Essential for survival

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2
Q

Stress

A

Response to perceived demands (problems)
A certain amount is healthy, but too much overwhelms the ability to deal with it
Objectively demonstrable problem
Outweigh coping abilities

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3
Q

Fear

A

Present-oriented
Response to actual danger
Surge in sympathetic nervous system (fight or flight response)
Strong urge to escape

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4
Q

Panic

A

Sudden rush of intense fear and physiological symptoms (fight or flight) - same thing as fear, but with no reason for it - excessive
False alarm

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5
Q

Anxiety

A

Future-oriented (apprehension)
Future threat
Physical tension

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6
Q

When does anxiety become a disorder?

A 
Must be
High Intensity
High Frequency 
Excessive/unreasonable - over exaggerated threat perception (must be this to be disorder)
Distress and/or impairment
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7
Q

Anxiety disorder is Ubiquitous

A

AD are present in all cultures

Prevalence/ life time prevalence varies

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8
Q

Anxiety Disorder cultural prevalence

A

Highest in US = 22%
europeans are more at risk than latinos, asians and africans
Canada = 6%

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9
Q

Research issues for culture

A

Definitions of culture, ethnic heritage are blurry
Differences between generations of immigrants
Difficult to group heritage groups

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10
Q

Prevalence of Anxt.Ds - general pop

A

ADs are the single largest mental health problem in North America

  1. 7% Lifetime prevalence (usually mildly imparing)
  2. 3% 12 month prevalence
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11
Q

Prevalence of Anxt.Ds - Patients in primary care settings

A

18% (even excluding specific phobias)
Non-cardiac chest pain: 40% have Panic Disorder
Focal epilepsy: 19% incidence of AD (especially PD)

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12
Q

Impairment of anxiety disorders

A

Disrupts school and work
>20% can’t work because of ADs
Social withdraw and interpersonal problems
Personal distress

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13
Q

Anxiety disorders are Chronic

A

OCD, Social phobia , GAD -more likely for these

Can be lifelong conditions that wax and wane depending on situational factors

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14
Q

Risk Factor for anxiety disorders

A

Depression intertwined with AD - they share many symptoms
More likely to have Substance abuse
Greater risk for PTSD in response to trauma

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15
Q

Anxiety disorders Under-treated

A

Most receive medication that doesn’t work long term

Only 20-30% receive evidence based psychological treatments or counseling - usually not covered by public health care.

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16
Q

Etiology of Anxiety disorders

A 
Genetics 
Biochemical 
Brain Circuits
Parenting styles
Modeling/vicarious learning (parental anxiety)
Peer influences
Individual learning experiences
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17
Q

Genetic influences of anxiety disorder

A

People inherit a non-specific, generalized predisposition - prone to experience Negative affectivity - bad emotions (formerly “neuroticism”)
Overly active physiological response
Shared with depression

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18
Q

Evidence for genetic influence on Anxiety disorders

A

Evidence = family studies,

twin studies - 12-26% for MonoZygotic - Higher heritability for some phobias

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19
Q

Biochemical factors

A

Neurohormonal systems. example: People prone to anxiety have a Hyper-reactive HPA
Neurotransmitters - serotonin, underactive gaba, more sensitive to norepinephrine
Brain regions associated with anxiety

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20
Q

Brain regions associated with anxiety

A

Amygdala hyperactivity
Ventromedial prefrontal cortex (insufficient function?)
Hippocampus - memory and detection of stimuli

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21
Q

Hypothesizes links with AD

A

Abnormal amygdala responsivity = abnormal threat assessment

insufficient vmPFC function = Inability to recall extinction information (i.e. absence of aversive stimulus)

Abnormal hippocampal function= Reduced capacity to distinguish safe and dangerous cues, more fear, Cortisol changes

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22
Q

2.5% and 5% of children meet criteria for an anxiety disorder. May cause

A
  • Family problems
  • Bullying at school
  • Other disorders later
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23
Q

The big 3 parenting behaviors

A

Over-protective, over-controlling parenting = anxiety worse
Critical - hostile parenting - risks for every internalizing disorders altogether
Neglectful parenting

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24
Q

Barlow’s Triple vulnerability Model (IMPORTANT)

ANXIETY

A

Genetic, physiological predisposition (biological) LEADS TO General psychological vulnerability (life events take the physiologically reactive person and gives them a sense of helplessness - the world is dangerous and there is nothing I can do. Lack of self-efficacy) LEADS TO specific psychological vulnerability (unique learning experiences, this leads to different anxiety disorders) LEADS TO Anxiety Disorder

25
DSM-5 Changes in anxiety disorder categories
They were all together DSM1 = neuroses, DSM4 - All anxiety - but separated bc of different patterns of brain activations a. Anxiety disorders b. Obsessive-compulsive disorder and related conditions c. Trauma and stressor related disorders
26
DSM-5 anxiety disorders
``` Panic disorder Specific phobia Agoraphobia Social phobia Generalized Anxiety Disorder (GAD) ```
27
Panic Disorder | Diagnostic features
Recurrent, unexpected panic attacks (with insufficient reason for panic) which are Sudden, Intense and Peaks within minutes
28
Physical symptoms of a panic attack
palpitations, pounding heart, or accelerated heart rate; Shortness of breath, smothering; chest pain, feeling of choking, Dizzy, unsteady, lightheaded, or faint, Nausea or abdominal distress, Trembling or shaking, Sweating, Paresthesias (numbness or tingling sensations), Chills or hot flushes
29
Psychological symptoms of a panic attack
Derealization or depersonalization, Fear of losing control, going crazy or dying
30
Diagnosis of Panic Disorder
Anticipatory anxiety and Worry about the consequences of the attack (or i'm going crazy) Significant behaviour change - Situational or avoidance of Internal sensations Safety behaviors - e.g. carry benzodiazepines (does decrease anxiety), avoiding places with low O2
31
Subtypes of Panic Attacks
Cued (situationally bound) - in certain situations = always. Situationally predisposed - predisposed for attack is certain situations = sometimes Unexpected - Panic comes out of nowhere (required for diagnosis) Limited symptom attacks - not PD - but still debilitating
32
Prevalence of panic attacks and PD
1 in 3 people experience a panic attack | 3% Meet criteria for panic disorder
33
Biological challenge studies of Panic disorders to study the difference between people who have PA and those with PD
Manipulations that increase CO2 in the body. More CO2 has been shown to cause panic attacks more often in people with PD.
34
Biological theories of Panic disorder are about
Neurochemical disturbance - related to more sensitivity to CO2 - 30-40% genetically transmitted e.g. suffocation false alarm theory (Klein) = more chemoreceptors = panic
35
Cognitive model of PD
Catastrophic misinterpretations of one’s physical sensations (Clark) → People interpret body changes as a threat, which leads to panic If they are informed about it = less likely to panic
36
Panic attack trigger explanation - Barlow and Clark
Barlow and Clark - internal or external Perceived threat Leads to Apprehension Which leads to Bodily sensations (anxiety) --> Catastrophic misinterpretations → fear of the bodily sensations (cognitive interpretation) Leads to panic attack
37
Treatment of Panic Disorder
CBT is first line treatment - Education → tell patients what is going on with them Interoceptive (internal sensation) exposure (with professional) In vivo exposure → Person does the exposure to these bodily sensations in daily life
38
Diagnosis of specific phobias
Marked and persistent fear that is excessive and unreasonable Cued by the presence or anticipation of a specific object or situation
39
Types of phobias
Animal Natural environment (like hydrophobia, acrophobia) Blood-injury injection (has a physiological cause) Situational (fear of elevators, planes and claustrophobia) Other (coulrophobia, kinemortophobia - due to uncanny valley - biological explanation. Or trypophobia and more)
40
Prevalence of Phobias
General population: specific fears are common | 6.7% of population meet diagnostic criteria
41
Genetic vulnerabilities for Phobias
Blood-injury-injection phobia - higher heritability | Biological Preparedness - Evolutionary influence
42
2-factor learning theory for specific phobias
Phobias develop through 2 step process Step 1: Classical conditioning - development of fear response Step 2: Operant conditioning - anxiety leads to anxiety reduction through avoidance
43
Problems with 2-factor learning theory for specific phobias
- Sometimes there is an Absence of conditioning event - There are Individual differences in conditionability (some people are harder to condition to fears) - Stimuli specificity - not every object is as easily conditioned - Cognitive interpretations influence - people interpret situations differently
44
Rachman: 3 pathways - 3 ways of learning phobias
Direct conditioning - direct experience of aversive event Vicarious conditioning - by watching Informational transmission - self conditioning
45
Etiology of phobias
Interaction (Association) between innate vulnerability and learning experiences is the cause Results in exaggerated threat perceptions - overestimated danger Leads to avoidance and other safety behaviors
46
Safety behavior
major role in anxiety disorder development Deliberate - Adopted to prevent negative outcome Unnecessary Animals also use safety behaviors
47
First line treatment for Phobias
In vivo Exposure Graduated (step-wise) - little baby steps use of imagined exposure
48
Phobia treatment - reconsolidation
reactivate the fear memory and store/reconsolidate the memory with fewer emotion connection. Relationships with fear decays.
49
Phobia treatment - extinction learning
Develop new memory store associated with feared stimulus.
50
Phobia treatment - Cognitive change
Reduce the selective attention to threat. Done through safety learning
51
Agoraphobia
Anxiety about being in places/situations where escape might be difficult or embarrassing or were help may not be available Has to be in Multiple situations (versus simple phobia) These situations are either avoided completely, entered with a safe person or endured with marked distress One can have agoraphobia without panic and vice-versa
52
Commonly avoided situations in agoraphiobia
Buses, bridges, enclosed spaces, crowds, malls, movie theaters, standing in line-ups
53
Clinical picture of agoraphobia
Prevalence: 1.7% Heritability: 61% - highest out of anxiety disorders (except for blood phobia) Impairment: Safezone: housebound + Interpersonal problems (dependent on safe person) Chronic course - only 10% remit without treatment
54
Treatment of Agoraphobia
CBT is first-line treatment | Education + In vivo exposure +Safety behavior fading - take safety away slowly +Relaxation and breathing instructions
55
Social Anxiety disorder (Social Phobia)
Marked or persistent fear of one or more social situations Fears doing something humiliating or embarrassing and being negative evaluated Subtype: performance only
56
Clinical picture
High prevalence in North America (8% CAD - 2% EU) crystallizes in puberty, decrease with age. Onset 13yrs more common in women Taijin Kyofusho (Japan, Korea) - fear of offending people Social and occupational impairment Comorbidity with substance abuse and depression
57
Genetic contributors for social anxiety
Nonspecific vulnerability Behavioral inhibition: Innate hypersensitivity to environmental change (high heart rate etc) and angry/disgusted faces (Jerome Kagan). Overprotective parents worsen this.
58
Cognitive-behavioral (Learning) contributors
Negative life events, self-beliefs and predictions leads to Selective attention which leads to Judgmental biases which leads to Safety behaviors - may impair people by making them emotionally closed. They create the difficulties they are afraid of. This leads to negative predictions again. Cycle.
59
Treatment for social Anxiety
Serotonin reuptake inhibitors (SSRI) - high relapse if discontinued CBT - lower relapse if discontinued Treatment outcomes = Time course and relapse rates differs

Psych 300 (8 decks)

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