Anxiety disorders Flashcards
General Traits- Anxiety Disorders
Most common mental disorder in the US.
-29% develop one of mental disorders at some point in lives
-1/3rd of individuals seek treatment
-Fear and anxiety are the most common symptoms
-Most develop in childhood and persist into adulthood
-Misappraisal of body sensations
Which demographics have a higher prevalence of anxiety
-Females
-Individuals of a lower SES
-High comorbidity with depression
Fear
A natural response by a specific threat
Anxiety
No specific threat, an over-estimation of danger for a particular situation
Generalized Anxiety Disorder (GAD)
A persistent and excessive feeling of anxiety and worry about numerous events and activities
-Easily fatigued
-Difficulty in concentrating
-Underlying irritability
-Self conscious
-A frequent need for reassurance
-Sleep problems
-Shaky, twitchy
Features of GAD
-Chronic
-Prevalence peaks in middle-age
-Frequently occurs with depression, other anxiety problems, alcohol dependence
Why is alcohol dependence common in people with GAD
Alcohol has the same effect on GABA receptors as depressants
Genetic contributions to GAD
-An inherited vulnerability to be tense.
-15% of individuals with GAD also have a biological family member with GAD
-1/3 of the risk for experiencing GAD comes from genetic factors
Fear circuit (neuropsychological contribution)
-Prefrontal cortex
-Anterior cingulate cortex
-Insula
-Amygdala
Environmental contributions of GAD
-Early learning from experiencing uncontrollable events and/or overprotective parents
-Low SES
Behavioural/Psychological contributions to GAD
-Irrational beliefs and assumptions about the world (catastrophic thinking)
-Erroneous beliefs about worry (positive and negative)
-Intolerance for uncertainty (fear of negative events)
-Negative problem orientation (problems are threats)
-Cognitive avoidance (avoid thinking)
CBT - GAD
-Traditional: change maladaptive assumptions and thinking
-Self efficacy training: decrease unrealistic expectations, give self-confidence
-New age: Mindfulness, acceptance, commitment therapy.
Behavioural Therapy (GAD)
-Excercise
-Relaxation training and meditation
Barbituates
Drug arose in the 50’s marketed towards housewives
Benzodiazepenes
-Targets GABA receptors, sedative effects in large doses and often used as sleeping pills. Most effective when anxiety is reactive and acute
-Similar effects of alcohol
-Increase fall risks in older people
-Serious risk of addiction and withdrawal symptoms
SSRI’s
Function by increasing serotonin and norepinephrine in the nervous system
-Serotonin hypothesis
-Effects unclear
Antipsychotics
-Reduce dopamine in the nervous system, considered major tranquilizers.
-Typically not started on antipsychotics
Antihistamines
Calming effect on the brain and gut, can increase appetite.
-no addicting effects
Beta-blocker
can stop effects if symptom is panic attack
-Block norepinephrine
Buspironine
No effects on the GABA systems, no sedative effects
-ideal for elderly
Specific Phobias
An unreasonable fear of a specific object or situation
-Marked, persistent, disproportionate fear of a particular object or situation
-Exposure to the object produces immediate fear
-Avoidance of the feared situation
Specific Phobias - Features
-PYP: 9%
-Lifetime Prevalence: 14%
-Onset in childhood
-32% seek treatment
Causes of SP
-Learning through traumatic experiences, conditioning, and vicarious learning
-Evolutionary preparedness (arachnophobia)
Treatment for SP
-Systematic desensitization
-Flooding
-Modelling
-Virtual reality
Social Anxiety Disorder (SAD)
Fearful, anxious, or avoidant of social situations that involve the possibility of being scrutinized
-pronounced, disproportionate, repeated anxiety about social situations in which the individual could be exposed to scrutiny by others
-fear of being negatively evaluated or offensive to others
-exposure to social situation almost always produces anxiety
-avoidance of feared situations
Features - SAD
-PYP: 8%
-Lifetime Prev: 14%
-Often begins in late childhood or adolescence and persists into adulthood
-40% seek treatment
-More extreme symptoms will more likely persist and if participant has temperament that supports inhibition
-often report low quality of life
Demographic SAD most prevalent in
-People who have never been married
-Divorced
-Not completed post-secondary
-Low SES
-Chronic condition
-Low social support
-More common in caucasians
Cognitive causes - SAD
-Dysfunctional belief
-Perfectionism in society
-Socially undesirable
-Socially unskilled/inadequate
-Behaviour will lead to catastrophic events
-No control over anxiety in social situations
-Anxiety of anticipation and dread of social situations
-Dread and inhibition
Behavioural Factors - SAD
-Modelling behaviours indicative of social avoidance
-Helicopter parenting
Genetic/Environment factors
-underlying genetic propensity to be shy
-increased sensitivity or possible instability of ANS
-prepared learning
-people with social anxiety tend to pay attention to negative cues tend to interpret ambiguous situations more negatively
-some children more socially inhibited
panic attacks
periodic/short bouts of panic that occur suddenly, reach a peak within minutes and gradually pass
-heart palpitations
-tingling in hands/feet
-shortness of breath
-sweating
-hot and cold flashes
-trembling
-chest pains
-choking sensations
-faintness
-dizziness
-feelings of unreality
Agoraphobia
Avoidant behaviours occur as a result of panic attacks. Fear of open spaces, scared to be out in the world for fear of not being able to escape
-unforseen panic attacks occur repeatedly
-at least a month of continual concern
Features - Agoraphobia
-PYP: 3.1%
-LP: ~5%
-Late adolescence into early childhood
-59% seek treatment
-Lower in non-western countries
-can wane and wake
Genetic Causes - Agoraphobia
-Individuals with PD tend to have parents with anxiety or mood disorder
Neuro Causes - Agoraphobia
-Panic circuit ; unstable PNS
Environmental Causes - Agoraphobia
-Higher reports of people with PD with children who experienced sexual/physical abuse. First panic attack linked to environmental stressor and can become more generalized
Psychological causes - Agoraphobia
-Overall negative affectivity (mood), early exposure to cigarette smoke, misinterpretation of body signals
-More likely to feel body sensations
-Avoidance behaviours begin to occur with misinterpretation of panic signals
Obsessive compulsive disorder (OCD)
-A reoccurrence of unwanted, obsessive intrusive thoughts
-Repeated ritualistic actions or mental compulsions designed to neutralize an unwanted thoughts
-basic themes of contamination, violence, orderliness, religious themes, sexuality
-no pleasure arises from mental acts
-often develop over time
-cleaning, checking, order, balance, touching, verbalizing, counting
Genetic Causes - OCD
-Increased first rates among immediate parents, monozygotic high prevalence of heritability
Biological causes - OCD
-Head injury, brain tumour, infection
-Unstable or overreactive peripheral nervous system
-SSRI’s, SNRI’s
Cognitive causes - OCD
-High degrees of perfectionism
-overestimate the threat of negative consequences
-overimpulsion of thoughts or thought control, negative outcome is controlled by behaviour
-Belief system is arbitrary and can change outcomes
-memory
environmental causes - OCD
-Some kind of psychological stressor that occurs
-reassurance component
CBT - OCD
-exposure with response prevention, gradual and somewhat extreme
