anxiety disorders Flashcards
anxiety facts
-approx18% in US -> >40 mil adults
-treated by PCP 90% of time
-high rates of comorbid psychiatric disorders, especially Depressive Disorder (50%)
-High rates of comorbid alcohol and drug abuse
-high rates of suicide attempts
-MC mental health illness in USA
-5X more likely to seek medical care for a variety of conditions
-6X more likely to be hospitalized for a psychiatric condition
-Affects 1/8 children -> strong genetic component
-Children -> increased risk of truancy, substance abuse, being bullied and poor school performance
anxiety as normal and abnormal response
-Some amount of anxiety is “normal” and is associated with optimal levels of functioning.
-Adaptive response to threat to self or environment
-when anxiety begins to interfere with social or occupational functioning is it considered “abnormal.”
-can affect school, work, social relationships and physical health.
social effects of anxiety
-Prolonged anxiety can result in Major Depression
-less involved with family/friends the way you used to be
-Lowered quality of relationships
-Low energy, lethargy, dysphoria
-Lack of motivation to do the things you once looked forward to doing
-Unable to convey the person that you are
-Fear and avoidance of situations where previous attacks occurred
what is anxiety: clinically, anthropologically, psychiatrically
-Clinical Answer:
-unpleasant emotional and physical state characterized by fear, apprehension, restlessness, tension, over-activity of the autonomic nervous system, cardiac and pulmonary sensations, and the expectation of impending disaster.
-Anthropological Answer:
-“stress response” hardwired into the brain of most mammals triggered when survival is threatened.
-Psychiatric Answer:
-Catecholamines: Decreased activation of serotonin and increased activation of norepinephrine
-Increased autonomic activity: increases HR, BP, force of cardiac contractions, and dilates airways in lungs
what is anxiety disorder
-illness that often manifests with psychological and somatic symptoms
-produces:
-Intense, excessive, and prolonged states of apprehension and fear
-Autonomic arousal (elevated pulse, elevated BP, diaphoresis, rapid breathing)
-Physical discomfort (headache, dizziness, nausea, abdominal pain, diarrhea, myalgias, arthralgias)
developmentally normal fears
-birth-6 months- Loud noises, loss of physical support, rapid position changes, rapidly approaching other objects
-7-12 months- Strangers, looming objects, unexpected objects or unfamiliar people
-1-5 year- Strangers, storms, animals, dark, separation from parents, objects, machines with loud noises
-6-12 year- Supernatural, bodily injury, disease, burglars, failure, criticism, punishment
-12-18- Performance in school, peer scrutiny, appearance, performance
types of anxiety disorders
-Generalized Anxiety Disorder
-Social Anxiety Disorder
-Phobia
-Panic Disorders
-PTSD
-OCD
generalized anxiety disorder
-excessive anxiety and worry
-worry occurs more often than not for at least 6 MONTHS and is clearly excessive
-worry is very hard to control
-worry can shift from one topic to another
-anxiety are accompanied 3+ of following (in children, only 1 is necessary for dx of GAD):
-edginess or restlessness
-tiring easily, more fatigued than usual
-impaired concentration or feeling as though the mind goes blank
-irritability (may or may not be observed by others)
-increased muscle aches or soreness
-difficulty sleeping (due to trouble falling asleep, staying asleep, restlessness at night, unsatisfying sleep)
GAD example
Nick is a 52 yr old pharmacist who can’t remember a time when he was not feeling anxious. Although he is competent at his job, he gets extremely anxious about work and feels that he might make mistakes. This worry also extends to his personal life where he is always worrying about his kids academic performance and if they are getting bullied.
He often has nightmares and feels tired and restless all the time. Although he has a great marriage, he worries constantly that he may not be able to provide for his family which causes him to have sleepless nights
social anxiety disorder
-6 MONTHS or longer AND
-cause personal distress and impairment of functioning in 1+ domains -> interpersonal or occupational functioning
-anxiety specific to social settings
-person feels noticed, observed, scrutinized,
-men = women
-adults- first date, job interview, meeting someone for the first time, delivering an oral presentation, speaking in class or meeting
-children- settings with peers (NOT adult interactions), showing age appropriate distress -> cringing, crying, fear, discomfort
-fear that anxiety will display and have social rejection
-social interaction consistently provoke distress
-social interactions are avoided OR reluctantly endured
-anxiety will be grossly disproportionate to actual situation
social anxiety disorder example
-Bill is a 34 yr old accountant who was recently promoted to a mid level management position at his bank. Bill was wary about this promotion but felt he had not choice but to accept it. His fear stem from the fact that he has to make presentations to the senior management regarding projects his team is involved in.
-Weeks before any presentation, he has nightmares about how he might screw up, feels extremely anxious and his work starts suffering. Although he knows his anxiety is unreasonable, he just cannot help it.
phobic disorder
-unreasonable, excessive fear
-triggered by specific object or situation
-out of proportion to actual danger
-instantaneously reacts when presented with object or situation
-goes out of way to avoid or endures with extreme distress
-significantly impacts the individuals school, work, or personal life
-at least 6 MONTH duration
-not caused by another disorder- first need to rule out similar conditions -> agoraphobia, OCD, separation anxiety -> before dx specific phobia
phobia: subtypes
-Animal
-Natural environment
-Blood-injection-injury
-Situational
-Other
-The anxiety, panic attack, or phobic avoidance associated with the specific object or situation is not better accounted for by another mental disorder.
-Symptoms for all ages must have a duration of at least 6 months
phobic disorder example
-Phyllis works at her dream job as a marketing executive for a multinational firm. Recently her firm was acquired by another company which requires her to travel to distant sites for work reasons.
-Phyllis is extremely scared of flying due to a childhood incident when she endured extreme turbulence in an airplane, which led to an emergency landing. Her frequent attempts to delay flying to places has led to disciplinary action and she is seriously contemplating leaving her current job, which she loves.
agoraphobia
-Anxiety about being in places or situations from which escape might be difficult or embarrassing in event of a panic attack.
-Person engages in avoidance behaviors to avoid the fear and/or a related panic attack
-DSM 5: last more than 6 MONTHS
-Examples:
-Enclosed Places
-Driving
-Public Transportation
-Crowds
-Shopping Malls and Supermarkets
