Anxiety disorders Flashcards
Kyhal (wind) attacks
an asian culture syndrome where they get neck soreness and tingling
Level 1 mild anxiety
Normal level of anxiety that everyone experiences. It motivates us to function. Vital signs normal, pupils constricted, maybe a little increase in muscle tension. Perceptual field and awareness are heightened.
Level 2 moderate anxiety
Still a normal level of anxiety, but it’s an increased level in response to a significant stressor. Vitals are mostly the same, but the heart rate might be a little faster. A little more muscle tension.
Subjective feeling of worry and a narrowed perception.
Level 3 severe anxiety
This is a pathological level. Autonomic nervous system is activated (fight or flight response), pupils dilated, vitals increased, sweating, rigid muscles hearing decreases, pain tolerance increases, urinary frequency, diarrhea
Perception is greatly narrowed, difficulty with problem solving, distorted perception of time, selective inattention, dissociative sensations, automatic behavior
Level 4 panic anxiety
Pale, hypotensive, poor hand-eye coordination, muscle pains, hearing is very decreased, dizzy, short of breath.
Scattered perception, illogical thinking, hallucinations, delusions
Freud’s theory of anxiety
It starts at birth when the person must deal with the new environment. Anxiety continues because of unconscious conflicts (especially conflicts about the sexual drive). They fear they’ll be punished for doing something wrong. They overuse defense mechanisms, and this over use is the behaviors we see in anxiety disorders.
Interpersonal theory of anxiety
This theory comes from Harry Stack Sullivan. It explains that people are goal-directed, and work toward achieving satisfaction and security needs.
Satisfaction and security needs are normally achieved through interpersonal relationships, but when these needs are not met, you get anxiety.
Anxiety starts when needs are not met in the first relationship, which is child and mother.
When needs are not met, the person feels rejected, and inferior.
Neurobiological theory of anxiety
Deficits in the limbic system, midline brainstem, and sections of the cortex
There could also be a problem with the HPA. Normally, when there is stress the amygdala tells the hypothalamus to release CRH. The pituitary releases adrenocorticotropic hormone. The adrenal glands are then stimulated, which shuts off the alarm system. However, in anxiety disorders, the amygdala does not shut off the alarm because it’s overactive, or there might not be enough cortisol to stop the fight or flight response.
Another deficit could be low levels of GABA and high levels of NE.
Serotonin and GABA are the transmitters that are supposed to suppress the HPA axis.
Anxiety stats
28% of the population
Except for OCD and social phobia, anxiety disorders are more common in females
Most anxiety disorders start in the teens or early adulthood
Lab findings of anxiety
they may have results that reflect compensated respiratory alkalosis:
- Decreased carbon dioxide levels
- Decreased bicarbonate levels
- Normal pH
Most medications known to improve symptoms of anxiety act directly or indirectly on the ___ system
GABA
SSRIs
First line med for chronic anxiety disorders.
They act on serotonin and indirectly on GABA
Benzos Use has been associated with a_____
alzheimer’s
Buspirone
20 to 60 mg
Must be taken regularly, not as a PRN
Dizziness, insomnia, tremor, akathisia, GI, dry mouth
Tiagabine
4 to 56 mg
Dizziness, somnolence, GI, tremors, dry mouth
Gabapentin
300 to 3600
Ataxia, decreased coordination, sedation, disequilibrium
Can also be used as an anti-craving medication
Propranolol
10 to 20 mg
Bradycardia, hypotension
Clonidine
Can be used for anxiety for children.
.003 to .01 mg/kg/day
Guanfacine
For anxiety for children
.015 to .05 mg/kg/day
Y-BOCS
Yale-Brown Obsessive Compulsive Scale
Panic disorder
They are often intolerant or overly concerned with medication side effects.
They’re ashamed that they can’t control their emotions
In 2/3 of the cases, major depression occurs first, follow by panic disorder
In 1/3, panic disorder precedes depression
Panic disorder differential dx
Hyperthyroid Hyperparathyroid Pheochromocytosis Vestibular dysfunction Seizure disorders Arrhythmias
If they appear to have a panic disorder, it may actually be a medical condition if
It starts after age 45
If they have symptoms like: Vertigo Loss of consciousness Incontinence Headache Slurred speech Amnesia after the attack
Agoraphobia
50% of them report panic attacks or had panic disorder before getting agoraphobia
Specific phobias
In adults (but not children) they are aware that the fear is excessive.
Risk factors:
Trauma
Excessive information transmission (parents scaring you with too many warnings)
Genetics
The onset peaks in childhood, then peaks again in mid 20s
Most common types of phobias for adults
- Situations (flying, driving, enclosed spaces)
- Natural/environmental (water, heights, lightening)
- Blood (they might have an increase in blood pressure and heart, followed by a drop in both)
- Animals
- Other
Pharm management of phobias
SSRIs
TCAs
Short term benzos
Social Anxiety (Phobia) disorder
3 to 13%
Symptoms must persist for more than 6 months
Onset is usually in the teens, after something embarrassing happens
The anxiety is not relieved by having a trusted friend with them in the situation
Common descriptions of them: hypersensitive to criticism negative self-evaluation sensitive to rejection low self esteem lack of assertiveness
The distress can be so bad (dreading something) that it can be associated with SI
Pharm management for Social Anxiety
SSRIs
Benzos
Beta blockers
GAD
Worrying more days than not, for over 6 months
There’s a waxing and waning pattern
For children, anxiety can manifest as overly conforming or overly seeking approval
Separation Anxiety Disorder
Occurs after age 4`
OCD
Obsessions are an ego-dystonic experience and the obsession is an alien thought.
If a child has a sudden onset of OCD symptoms, consider that they may have PANDAS (pediatric autoimmune neuropsychiatric disorders associated with strep infections)
Only one or the other (O or C) is needed for dx.
The person has insight.
Pharm treatment for OCD
SSRIs at a high dose
TCAs, especially clomipramine
2nd gens such as resperidone (off label)
OCD in children
commonly associated with learning disorders, disruptive behavior disorders, tourette’s syndrome, Group-A beta hemolytic strep infections
More common in boys than girls
Washing, checking, and ordering are most common
OCD in older adults
More obsessions than compulsions
Often obsess about dying
PTSD
A 1st degree relative with MDD increases risk of PTSD.
There are 3 subtypes:
Acute- lasts less than 3 months
Chronic- lasts 3 months or longer
Delayed onset: Doesn’t start for at least 6 months
The symptoms have to last for at least a month.
Pharm treatment of PTSD
SSRIs
TCAs
Benzo are not recommended
Antipsychotics may be used during flashbacks
PTSD in children
They may have disorganized or agitated behavior
Repetitive play with trauma themes
Nightmares, but without specific content
Dissociative disorders
- Dissociative amnesia
- Depersonalization
- Dissociative Identity disorder (like the others, it’s related to trauma)
Dissociating is a defense mechanism. It causes a gap in their memory.
Depersonalization and derealization can have physical or psychological cause.
Body dysmorphic disorder and Hoarding disorder, how is their insight
Ranges from good to absent (fixed delusional)
