Anxiety Disorders 2 Flashcards
1
Q
Psychiatric
- Alcohol abuse (from self-treatment) is common ~20%
- Increased risk for major depression, bipolar disorder, and other anxiety disorders (esp. agoraphobia)
- ~25% have OCD
A
Comorbidity of Panic Disorder
2
Q
- Childhood history of behavior inhibition or shyness
- 1st degree relative w/ disorder
A
Risk factors for Social Anxiety Disorder
3
Q
•no obvious cure or trigger – attack occurs “out of the blue”
A
Unexpected panic attack/disorder
4
Q
•Often associated with other anxiety disorders, major depressive disorder, substance abuse disorders
A
Social Anxiety Disorder
5
Q
- F:M 2:1
- Incidence peaks in late adolescence and early adulthood
A
Agoraphobia
6
Q
- Elevated rates of school dropout
- Decreased
- Employment
- Workplace productivity
- Socioeconomic status
- Quality of life
A
Social Anxiety Disorder
7
Q
Risk factors
•Negative events in childhood
- Separation, death of a parent
- Attacked or kidnapped
•Childhood behavioral inhibition and anxiety sensitivity
•Overprotective parents
Heritability 61%
A
Agoraphobia
8
Q
- Median age of onset 24 years
- Individuals will often recall “fearful spells” in their childhood
A
Panic Disorder
9
Q
- Social interactions → having a conversation, meeting unfamiliar people
- Being observed → eating or drinking)
- Performing in front of others → giving a speech
•Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.
A
Social Anxiety Disorder
10
Q
- Nocturnal panic attack – waking from sleep in a state of panic, which differs from panicking after fully waking from sleep
- Relatively INTOLERANT to medication side effects
A
Panic Disorder
11
Q
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
(e.g. fear of falling in the elderly; fear of incontinence
A
Agoraphobia
12
Q
2 types of social anxiety
A
- Anticipatory
- Situational
13
Q
- Increased likelihood of being single, unmarried, or divorced and with not having children
- Impeded leisure activities
A
Social Anxiety Disorder
14
Q
The _____ situations almost always provoke fear or anxiety.
A
Agoraphobic
15
Q
- Palpitations, pounding heart
- Sweating
- Feelings of choking
- Parasthesias
A
Panic Attacks
16
Q
The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
•Judged as anxious, weak, crazy, stupid, boring, intimidating, dirty, or unlikable
A
Social Anxiety Disorder
17
Q
- May demonstrate rigid body posture, inadequate eye contact, or speak in overly soft voice
- May be shy or withdrawn
- May seek employment in jobs that do not require social contact
- May live at home longer
A
Social Anxiety Disorder
18
Q
•Essential feature → marked, or intense, fear or anxiety of social situations in which the individual may be scrutinized by others
A
Social Anxiety Disorder
19
Q
- Patterns can range from a few situations (e.g. driving and crowds) to multiple situations
- Something terrible may happen
- Escape may be difficult
- Help may be unavailable
- “Panic-like symptoms”
A
Agoraphobia
20
Q
Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others.
A
Social Anxiety Disorder
21
Q
Associated with high levels of social, occupational, and physical disability
- Considerable economic cost
- Frequently absent from work or school
- Highest number of medical visits among the anxiety disorders
A
Panic disorder
22
Q
•Fear of trembling hands → avoid drinking, eating, writing or pointing in public
A
Social anxiety disorder
23
Q
Tx for Agoraphobia
A
•CBT
•SSRI or SNRI → considering tapering after ~1 year
- Sertraline (Zoloft) – 50mg/day – increase dosage after 6 weeks
- Venlafaxine (Effexor) – 37.5 mg/day – increase dosage after 6 weeks
- Partial response after 8 – 12 week trial consider adding clonazepam (Klonopin)
24
Q
Safety behaviors
- Travelling with a familiar person
- Carrying a cell phone
- Carrying medications
- Carrying a water bottle
- Sitting close to an exit or a door
- Taking a medication prophylactically (e.g. anti-diarrheal)
- Carrying a paper bag (in case of hyperventilation
A
Agoraphobia
25
If another medical condition *(e.g., inflammatory bowel disease, Parkinson’s disease)* is present, the fear, anxiety, or avoidance is clearly excessive.
Agoraphobia
26
Performance only → fear is restricted to speaking or performing in public
Social Anxiety Disorder
27
* F:M 2:1
* If untreated, follows a waxing and waning course
Panic disorder
28
The social situations almost always provoke fear or anxiety.
•***Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.***
Social Anxiety Disorder
29
•Performance type → performance fears that cause impairment in professional lives (e.g. musicians, performers, athletes) or public speaking
Social Anxiety Disorder
30
•Development may follow stressful or humiliating experience (e.g. being bullied, vomiting during a public speech) or insidious
Social Anxiety Disorder
31
**SSRI or SNRI** → considering tapering after \_\_\_\_.
* Sertraline (Zoloft) –increase dosage after 6 weeks
* Venlafaxine (Effexor) –increase dosage after 6 weeks
* Partial response after 8 – 12 week trial consider adding clonazepam (Klonopin)
* 1 year
* Tx for Social Anxiety Disorder
32
Recurrent \_\_\_\_\_\_. 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:
•***Note: The abrupt surge can occur from a calm state or an anxious state.***
Unexpected panic attacks
33
* Men may delay marrying and having a family
* Blushing is a hallmark physical response
* Self-medication with substances is common → drinking before going to a party
Social Anxiety Disorder
34
•Essential feature → recurrent (\>1) unexpected
Panic disorder
35
Individuals often anticipate catastrophic outcome from a mild physical symptom
* Chest pain → heart attack
* Headache → brain tumor
* Patients often undergo emergency medical evaluation (e.g. for heart attack) before diagnosis is made
Panic Disorder
36
The fear, anxiety, or avoidance is persistent, lasting for at least \_\_\_months or more.
(social anxiety)
6 months
37
38
Severe forms can cause individuals to become completely homebound→ ~1/3 of patients
* Become dependent upon others for services or assistance
* Unable to work
Agoraphobia
39
Shyness
* Non-technical term
* Feelings of apprehension or awkwardness, and inhibited behavior when in proximity to others→ does not imply pyschopathology
Social Anxiety Disorder
40
* Demoralization and depressive symptoms are common
* Common for individuals to have a “safe zone”
* Home
* Perimeter around their neighborhood
Agoraphobia
41
**Majority have comorbid mental disorders**
* Anxiety disorders → panic disorders, specific phobias, social anxiety disorder
* Post traumatic stress disorder
* Major depressive disorder → secondary
* Alcohol abuse disorder → secondary
Agoraphobia
42
**Higher prevalence of certain medical illnesses**
* Asthma
* Coronary artery disease
* Hypertension
* Ulcer
* Interstitial cystitis
* Migraine headaches
Comorbidities of Panic Disorder
43
The _____ situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety.
Agoraphobic
44
**Risk factors**
* Neuroticism→ proneness to experiencing negative emotions
* Anxiety sensitivity → disposition to believe that anxiety symptoms are harmful
* Childhood sexual and physical abuse
* Smoking
* Life stress
Panic Disorder
45
• obvious cure or trigger (e.g. phobic stimulus)
Expected panic attack/disorder
46
**Marked fear or anxiety about two (or more) of the following five situations:**
* Using public transportation (e.g. automobiles, buses, trains, ships, planes).
* Being in open spaces (e.g. parking lots, marketplaces, bridges).
* Being in enclosed places (e.g. shops, theaters, cinemas).
* Standing in line or being in a crowd.
* Being outside of the home alone.
Agoraphobia
47
* What is the median age of onset of Social Anxiety Disorder?
* What sex is it more common in?
* 13 y/o
* Females
48
•Essential feature → marked, or intense, _fear_ or _anxiety_ _triggered by the real or anticipated exposure_ to a wide range of situations
Agoraphobia
49
The disturbance is not attributable to the physiological effects of a substance
Panic Disorder
50
Tx for Panic Disorder
**•CBT**
**•SSRI or SNRI** → considering tapering after ~1 year
* Sertraline (Zoloft) – 50mg/day – increase dosage after 6 weeks
* Venlafaxine (Effexor) – 37.5 mg/day – increase dosage after 6 weeks
* Partial response after 8 – 12 week trial consider adding clonazepam (Klonopin)
51
At least one of the attacks has been followed by _____ of one or both of the following:
* _Persistent concern or worry about additional panic attacks or their consequences_ (e.g. losing control, having a heart attack, “going crazy”) → anticipatory anxiety
* _A significant maladaptive change in behavior related to the attacks_ (e.g. behaviors designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations).
1 month or more
52
* Commonly occurs in conjunction with panic disorder (~30%)
* Majority show signs of anxiety and _____ prior to onset of panic disorder
Agoraphobia
53
The fear, anxiety, or avoidance is persistent, lasting for at least 6 months or more.
Agoraphobia
54
•Despite the extent of distress and social impairment only 50% seek treatment and tend to do so only after 15-20 years
Social Anxiety Disorder
55
**Behavior inhibition**
•Childhood temperament in which young children manifest fear and withdrawal when introduced to novel situations or unfamiliar persons
Social Anxiety Disorder
56
* more durable response
* Therapist works with patient to identify and challenge maladaptive cognitions associated with social situations
CBT (cognitive behavioral therapy) for pts w/ Social Anxiety Disorder
57
What is the tx for "performance only" Social Anxiety Disorder?
* **CBT** – 1st line
* **Beta blocker** – propranolol (Inderal) 20 to 60 mg for patients with prominent physiological symptoms (tachycardia or tremor)
* **Benzodiazepine** – clonazepam (Klonopin) 0.25 to 1 mg 30 to 60 minutes prior to performance (this med acts quickly)
