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
