Anxiety Disorders Flashcards
Define fear
An emotional response to perceived imminent threat or danger associated with urges to flee or flight.
Define anxiety
Apprehensive anticipation of future danger or misfortune accompanies by a feeling of worry, distress, and/or somatic symptoms of tension.
What are the DSM 5 criteria for GAD?
(A) Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities
(B) Individual finds it difficult to control worry
(C) Anxiety and worry are associated with three (or more) of the following six symptoms (only 1 required in children)
R - restlessness, keyed up, on edge
E - easily fatigued
M - muscle tension
D - difficulty concentrating/mind going blank
I - irritability
S - sleep disturbance
(D) the anxiety, worry or physical symptoms cause clinically significant distress or impairment in social, occupational and other areas of functioning
(E) not attributable to physiological effects of a substance or another medical condition
(F) not better explained by another mental disorder
What is a good scale for the assessment of anxiety?
Hamilton Anxiety Rating Scale
Comment on the pharmacotherapy for GAD
- Choice of drug should be informed by tolerability, co-morbidity, stage of life, patient preference, personal or family history of drug response
- SSRIs and SNRIs are first choice - Fluoxetine/Citalopram or Venlafaxine/Duloxetine
- once there is improvement in the symptoms, continue for at least 12 months at dose of improvement. Thereafter, discontinue the drug gradually
- if resistance or refractory, can switch to a different agent or augment with an atypical antipsychotic
Comment on the psychotherapeutic treatment of GAD
CBT is the 1st line psychotherapy
Relaxation therapy - muscle relaxation and breathing exercises
Desensitization or exposure therapy
Mindfulness based therapy
List the DSM criteria for panic disorder
(A) Recurrent unexpected panic attacks. A panic attach is an abrupt surge of intense fear or intense discomfort that reaches a peak withing minutes, and during which time four (or more) of the following symptoms occur:
(symptoms in separate card)
(B) at least one of the attacks has been followed by 1 month (or more) of one or both of the following:
1. persistent concern or worry about additional panic attacks or their consequences
2. a significant maladaptive change in behavior related to the attacks
(C) disturbance is not attributable to the physiological effects of a substance or another medical condition
(D) the disturbance is not better explained by another mental disorder
What is a panic attack?
An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur.
The abrupt surge can occur from a calm state or an anxious state
- palpitations, pounding heart or accelerated heart rate
- sweating
- trembling or shaking
- sensations of shortness of breath or smothering
- feelings of choking
- chest pain or discomfort
- nausea or abdominal distress
- feeling dizzy, unsteady, light-headed or faint
- chills or heat sensations
- paresthesias
- derealization or depersonalization
- fear of losing control or going crazy
- fear of dying
Panic attack mnemonic
S - sweating
T - trembling/shaking
U - unsteady/dizzy
D - derealization/depersonalization
E - elevated HR, palpitations, pounding heart
N - nausea, abdominal discomfort
T - tingling, numbness
S - shortness of breath/smothering
Fear - losing control, going crazy, dying
3Cs - chest pain, choking, chills
Comment on the pharmacotherapy for panic disorder
SSRIs are first line
- may inhibit amygdala hyperactivity and thus modulates the conditioned fear network
- also decreased noradrenergic action which relieves the cardiovascular symptoms of panic attack, including tachycardia and palpitations
(Fluoxetine, paroxetine, sertraline)
Second line is
- a different SSRI or SNRI (venlafaxine/duloxetine)
- TCA (clomipramine/imipramine)
- Benzodiazepine (alprazolam, clonazepam, lorazepam, diazepam)
What are the DSM 5 criteria for social anxiety disorder?
(A) Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others
(B) The individual deaths that he or she will act in a way or show anxiety symptoms than will be negatively evaluated
(C) The social situations almost always provoke fear or anxiety
(D) The social situations are avoided or endure with intense fear or anxiety
(E) The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context
(F) The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more
(G) The fear, anxiety or avoidance causes clinically significant distress or impairment in social, occupational or other important areas of functioning
(H) Not attributable to effects of substance or other medical condition
(I) Not better explained by other mental disorder
(J) If another medical condition is present, the fear, anxiety or avoidance is clearly unrelated or is excessive.
What is the only specifier for social anxiety disorder?
The performance only type in which the fear is restricted to speaking or performing in public.
What are the DSM 5 criteria for agoraphobia?
(A) Marked fear or anxiety about two (or more) of the following five situations:
1. Using public transportation
2. Being in open spaces
3. Being in enclosed places
4. Standing in line or being in a crowd
5. Being outside of the home alone
(B) The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic like symptoms or other incapacitating or embarrassing symptoms
(C) The agoraphobic situations almost always provoke fear or anxiety
(D) The agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety
(E) The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the sociocultural context
(F) The symptoms are persistent lasting 6 months or more
(G) Symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning
(H) If another medical condition is present, the symptoms are clearly excessive
(I) Not better explained by symptoms of another mental disorder
