Anxiety disorders Flashcards
simple definition of adjustment disorder
symptoms within 3 months of a stressor
simple definition of acute stress disorder
symptoms within 1 month of a trauma
simple definition of PTSD
symptoms lasting more than a month after the trauma
simple definition of social anxiety/specific phobia
Fear of social situations or specific object
Panic disorder with or without agoraphobia
Recurrent unexplained panic attack and other symptoms
simple definition of OCD
time consuming or interfering obsessions and compulsions
Mnemonic for GAD symptoms: Watchers
Worry and can't stop Anxiety is excessive Tension in muscles Concentration impaired Hyperarousal (irritable) Energy loss Restlessness Sleep disturbance
(Both of the first 2 must be present)
Prevalence of GAD
Women to men is 2:1
Onset is late adolescence or early adulthood
Course and prognosis of GAD
The patients often present with somatic complaints
The course/prognosis is hard to predict
Negative life events affect the onset
Neurotransmitters involved in GAD
Serotonin, norepinephrine, GABA, glutamate
Psychotherapy and GAD
therapy may be a first line treatment in some people who are psychologically minded.
CBT has the best evidence
Medication and GAD
Be careful about prescribing medication on the 1st visit.
Good options are SSRIs, SNRIs, Buspar
Benzos may be used for the 1st 2 to 3 weeks
Some people will be on meds for 6 to 12 months, others for life
Physical symptoms of panic attacks (besides the obvious ones)
Feeling of choking
Feeling faint
Paresthesias
Chills of hot flashes
Criteria for panic disorder with or without agoraphobia
- Recurrent/unexpected panic attacks
- One or more of the following:
- afraid of having another attack
- afraid that the attacks will have a consequence (going crazy, having a heart attack, etc)
- Significant change in behavior
Criteria for agoraphobia
Fear about 2 or more of these:
-public transportation, open spaces, enclosed spaces, standing in lines/crowds, being outside alone
They’re afraid that they won’t be able to get help in that situation
The situations almost always cause fear and are avoided
causes clinically significant distress
Panic disorder prevalence
Occurs 2 to 3 times more in women
Course and prognosis of panic disorder
It’s usually chronic but the the course is variable
panic disorder comorbidities
90% of people with panic disorder have another disorder
Panic disorder etiology
Abnormal regulation of of the noradrenergic system; it involves NE, serotonin, and GABA.
Abnormalities in the temporal lobes, hippocampus, and amygdala
Involves the brainstem, limbic system, and prefrontal cortex
can involves genetic, substances, and psychologic triggers.
Best psychotherapy for panic disorder
CBT and deep breathing/relaxation techniques
Meds for panic disorder
first-lines are Venlafaxine and SSRIs (but be careful with fluoxetine because of agitation).
Second-line is clomipramine (TCA)
Adjunct meds are benzos and buspirone
In general, start low (half the normal dose). If you increase too quickly it can worsen panic.
What are 2 very long acting benzos
clonazepam and diazepam (diazepam is the longest of the 2)
Benzo withdrawal
Timing varies by individual (short acting meds are usually 1 to 2 day, long acting are usually 5 to 10 days)
Can be mild (insomnia, agitation, headache, muscle ache, diaphoresis, tachycardia) to severe (seizures, delirium, coma)
