Anxiety Disorders

Question 1

fear

Answer 1

*a response to a real or perceived imminent threat
*triggers “fight or flight” response (reflexive autonomic sympathetic arousal)
*generally produces escape behavior

Question 2

anxiety

Answer 2

*involves anticipation of a future threat
*is a normal part of life and can be adaptive
*associated with muscle tension and vigilance
*generally produces cautious and avoidant behavior

Question 3

curve of anxiety

Answer 3

*anxiety follows an inverted, U-shaped curve
*a minimum threshold of anxiety is necessary for arousal, vigilance, and motivation
*beyond an optimum point, anxiety leads to disorganization and impaired performance

Question 4

pathological anxiety

Answer 4

criteria for which anxiety becomes a disorder:
-when anxiety is excessive or out of proportion for the situation
-when anxiety persists (generally longer than 6 months)
-associated with distress and/or dysfunction

Question 5

neuroimaging correlates of anxiety

Answer 5

areas of greater brain activity in persons with anxiety disorder compared to controls:
-amygdala
-insula
-anterior cingulate gyrus

Question 6

epidemiology of pathological anxiety

Answer 6

*most common psychiatric condition in the US
*1 in 4 people meet the criteria for at least 1 anxiety disorder
*women are more likely to have than men
*prevalence is inversely related with SES
*suicide risk 18x higher

Question 7

separation anxiety disorder (SAD)

Answer 7

*individual experiences excessive anxiety regarding separation from home or from people to whom the individual has a strong emotional attachment
*natural part of development ages 6 mo - 3 years
*median age of illness 16 years of age

Question 8

selective mutism

Answer 8

*consistent failure to speak in specific social situations despite speaking in other situations
*interferes with achievement or social communication
*lasts at least 1 month
*usually before 5 years but can show up when school starts

Question 9

treatment for selective mutism

Answer 9

*behavioral therapy
-eliminate negative reinforcement for remaining mute
-provide positive reinforcement to speak
-modeling
-response initiation

Question 10

social anxiety disorder

Answer 10

*marked fear or anxiety about 1+ social situations where an individual is exposed to possible scrutiny by others
*lasts 6+ months
*significant impairment concerns

Question 11

treatment for social anxiety disorder

Answer 11

*psychotherapy + pharmacotherapy (beta blocker or SSRI)
*CBT (cognitive restructuring and social rehabilitation)

Question 12

panic attack

Answer 12

*sudden intense feelings of severe anxiety with accompanying physical symptoms
*“crescendo”
*anxiety develops abruptly and reaches a peak within seconds to minutes
*usually lasts 10-20 minutes
*s/s: sweating, dizziness, increased HR, chest pain, chills or hot flashes, hyperventilation, trembling or feeling numb, nausea, fear of losing control or dying

Question 13

panic disorder

Answer 13

*at least 1 unexpected panic attack must be followed by 1 month or more of:
-persistent worry/concern about an additional panic attack or their consequences
-significant, maladaptive changes in behavior related to panic attack

Question 14

panic disorder treatment

Answer 14

CBT and pharmacotherapy (SSRIs, benzos, etc)

Question 15

agoraphobia

Answer 15

*associated with fear of not being able to escape or not control oneself resulting in embarrassment
*avoidance of at least 2 of the following:
-using public transportation
-being in open spaces
-being in enclosed spaces
-standing in line or being in a crowd
-being outside of the home alone
*6 months or more in duration

Question 16

agoraphobia treatment

Answer 16

CBT:
-address catastrophizing cognitions
-exposure therapy (expose to agoraphobic situations; graded exposure/systematic desensitization)
*homework exposure
*relaxation training
*breathing training

Question 17

generalized anxiety disorder (GAD)

Answer 17

*excessive anxiety and worry, occurring a majority of the days for at least 6 months about a variety of events and activities
*individual has difficulty controlling these worries
*anxiety + worry associated with 3+ of the following for more days than not:
-restlessness
-fatigue
-difficulty concentrating
-irritability
-muscle tension
-sleep disturbance

Question 18

generalized anxiety disorder - treatment

Answer 18

*most effective: psychotherapy (esp CBT), pharmacotherapy, and support
*benzos, SSRIs, buspirone, venlafaxine
*lifelong tx recommended

Question 19

obsessive-compulsive disorder (OCD)

Answer 19

*presence of obsessions or compulsions or both
*obsessions: recurrent persistent thoughts, impulses, or images experienced at some point in the disorder as intrusive; person attempts to ignore or suppress them
*compulsions: repetitive behaviors that person is driven to perform in response to an obsession; aimed at reducing distress but may not be connected in a realistic way with what they are trying to prevent
*EQUAL RATE B/W MEN AND WOMEN; typically starts in adolescence or early adulthood

Question 20

OCD treatment

Answer 20

*CBT
*exposure prevention therapy
*pharmacotherapy: SSRI
*neurosurgery and DBS in resistant cases

Question 21

specific phobia

Answer 21

*marked fear or anxiety about a specific object or situation
*phobic stimulus is avoided or endured with intense fear or anxiety
*anxiety is out of proportion, recognizes that the fear is excessive or unreasonable
*generally lasts more than 6 months

Question 22

specific phobia - treatment

Answer 22

*rare for patients to seek treatment
*exposure therapy = main form of tx

Question 23

treatment approach in anxiety - pharmacological

Answer 23

*antidepressants
*benzodiazepines
*buspirone
*noradrenergic suppressors
*antihistamines

Question 24

treatment approach in anxiety - non-pharmacological

Answer 24

*cognitive behavioral therapy (CBT)
*desensitization
*psychodynamic psychotherapy

Question 25

advantages of antidepressants for anxiety

Answer 25

*can be quite effective
*no risk of abuse or dependence
*can be taken long-term with no obvious detrimental effects

Question 26

disadvantages of antidepressants for anxiety

Answer 26

*troubling side effects
*delayed response (2-3 weeks)
*partial effectiveness

Question 27

advantages of benzodiazepines for anxiety

Answer 27

*tolerable
*rapidly effective
*particularly indicated for rapid resolution of panic attacks in panic disorder

Question 28

disadvantages of benzodiazepines for anxiety

Answer 28

*sedation
*psychomotor impairment
*dependence
*abuse potential
*memory/cognitive impairment

Question 29

cognitive behavioral therapy for anxiety

Answer 29

*clarify the nature of the disorder and symptoms
*eliminate cognitive distortions (e.g. catastrophic thinking)
*self-monitor and identify patterns
*create sense of control (plan B)
*relaxation training
*breathing exercises

Question 30

desensitization

Answer 30

*progressive exposure, especially useful for phobias, including agoraphobia
*involves progressive approximations of the feared activity (ex. gradual introduction to driving or going to mall)
*group therapy may be more helpful with social anxiety due to desensitization effect of the group + acceptance
*flooding = extreme exposure