Anxiety disorders Flashcards
Anxiety vs. Fear
state of uneasiness in future uncertainties vs. (fear: ) State of uneasiness in IMMINENT DANGER
Characteristics of Pathological Anxiety
- Excessive
- Maladaptive – if you get anxious and you decide that the way to coop with it is to run into traffic
- Illogical – ex. get anxious when sparrows are around
- causes inappropriate avoidance
What are the two ways that anxiety can manifest?
- Psychic anxiety : comprises cognitive and emotional components of anxiety
- Somatic anxiety : bodily sensation associated with nervousness –> muscle tension, sweating, and nausea.
Biological Theory behind anxiety: who is at the center of the “fear circuit”?
Amygdala
-receives signals from senses and memory centers (hippocampus) and is somewhat controlled by the prefrontal cortex.
- sends output to neural and neuroendocrine structures
1. increase in NE, serotonin, dopamine
2. increase in motor activity
3. Analgesia
4. Sympathetic and parasympathetic arousal
5. High cortisol (stress hormone)
Complete fear circuit?
Sensory afferents Hippocampus Amygdala Prefrontal cortex Hypothalamus
What are some neurotransmitters associated with anxiety
low GABA
High NE and Dopamine
Low doses of Serotonin = Anxiety
What are the two ways that anxiety may be learned?
- Classical: learning by association
- bitten by a dog, now you are afraid of anything to do with dogs – house where dog lives, a bark - Operant : learning by consequences
- if you don’t study then you get a bad grade
What is cognitive theory behind Anxiety?
Anxiety is explained by cognitive distortions = errors in thinking
Negative emotions = negative thoughts
- jumping to conclusion
- overestimating severity of event
- Underestimating coping abilities
General Anxiety Disorder
- definition
- Criteria for diagnosis
- Who is mostly likely patient?
- Complications from symptoms?
- treatment?
- persistent, excessive anxiety for EVERYDAY or Real life Stressors (aka “free floating anxiety”)
DSM 5:
- at least 6 months occurring more days than not. AND… anxiety is NOT confined to having another mental disorders (fears of having a panic attack). NOT due to substance abuse or other condition/disorder.
- may present with somatic symptoms
Known to present late in life
Mostly seen in FEMALES
50% present with irritable bowel syndrome
Treatment : SSRIs, SNRIs
Panic Disorder
- definition/criteria
- Common in who? age?
- Common co-morbid?
Spontaneous, recurrent Panic attack ( abrupt surge of intense fear or discomfort)
Cause:
- worry of having another panic attack
- significant behavioral changes to prevent attacks
- 2x common in women, onset is early 20’s
- MDD, other anxiety disorders, agoraphobia, substance use
Agoraphobia
- definition/critera
- Common in who? age?
- Common co-morbid?
Fear or avoidance of being helpless in a place where escape may be difficult or embarrassing
Fear in 2 out of the following:
- public transportation
- open spaces (parking lots)
- closed spaces ( shops)
- Standing in line or being in a crowd
- outside of home alone
Can be associated with panic disorder
Specific Phobias
- definition
- types
- treatments
unreasonable fear for a particular object or situation
- Situational (closed spaces – elevators/ airplanes)
- Nautral Evironment type (heights, water)
- Blood- injection- Injury
- Animals
- “other”
Treatment:
- graded exposure
- short term benzodiazepines
- strong genetic component
- 7-9% show a 12 month prevalence
Social Anxiety disorder (aka Social phobia)
- definition
- treatment
Persistent rear of social or performance situations
* performance anxiety is specifier for social anxiety disorder
Treatment: Beta-blockers : improve subjective and objective performance
Benzodiazepines (diazepam/ alproazolam) improved subejctive performance but worsened objective performance
Obsessive Compulsive Disorder
- definition of obsessive vs. compulsive
- `general definition of OCD
- Is also a post-infection syndrome of what?
Obssesive: recurrent or persistent thoughts/ impulses or images that are experienced as intrusive and unwanted and that provoke activist
Compulsion: repetitive behaviors (mental rituals) engaged in with the goal of reducing anxiety associated with obsession
OCD causes significant distress and interferes with functioning.
Very time consuming >1 hr a day
Specifier = Tic disorder
they are aware that odd is a product of his or her mind.
PANDAS: pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection
Hoarding disorder
Difficulty parting with possessions, regardless of actual value
- 3rd party usually gets involved.
