Anxiety Disorders Flashcards
Most common mental disorder?
Anxiety disorders (as high as 28.8% lifetime prevalence) Females greater than males
Most common anxiety disorders
Panic disorder
Specific phobia
Social anxiety disorder
Generalized anxiety disorder
Panic disorder
Recurrent unexplained panic attacks with anticipatory anxiety. Greater than 1 month concern about having attacks. Generally accompanied by agoraphobia
Elements of a panic attack
Abrupt surge of intense fear that builds to a crescendo. Sudden onset peak within minutes. Emotional symptoms (fear of dying, fear of losing control). Can occur in other disorders besides panic disorder
What is the cardinal symptom of panic
Hyperventilation
Agoraphobia
Fear of going out in public because escape may be difficult if panic attack occurs.
Mean age of onset of panic disorder?
3rd decade
Do all panic disorder patients hav symptoms between attacks?
No, course is highly variable. Association between panic disorder and suicide
Comorbidities with panic disorder
MDD, other anxiety disorder, alcohol use disorder
Generalized anxiety disorder diagnosis
Excessive anxiety and worry, most days, for at least 6 months. Difficult to control the worry. At least 3 of the following: Restlessness Poor Concentration Muscle Tension Fatigue Irritability Sleep disturbances
GAD epidemiology
Females>males. Onset in 3rd decade. Chronic course with fluctuating symptomology. Some can go on to develop panic disorder.
Social phobia
Fear of 1 or more social or performance situation in which exposed to unfamiliar people or to possible scrutiny by others. Exposure to feared situation provokes anxiety. Fear or anxiety out of proportion to actual threat. Avoid situations usually. Duration usually greater than six months.
Epidemiology of social phobia
No difference between men and women, typical onset in late childhood/early adolescence. Tends to be chronic
Psychoanalytic theory of anxiety disorders
A signal of danger in the unconscious – result of conflict between unconscious sexual or aggressive wishes and corresponding threats from the superego.
Cognitive-Behavioral Theories of Anxiety Disorders
Learned response from parental behavior. Classical conditioning.
Role of the amygdala in anxiety disorders in animal models and inhuman
Amydala must be present for fear conditioning. In humans, amygdala activity is higher in panic disorder patients.
Fear network and panic
May originate in an abnormally sensitive fear network which includes the PFC, amygdala, Insula. Deficit in these pathways leads to inappropriate activation of the fear network.
Hippocampus and anxiety disorders
Formation of contextual memory – necessary for phobic avoidance.
Serotonergic dysfunction in panic disorder
Decreased 5HT1A receptor binding in cingulate and raphe. SSRIs are useful. 5HT will quiet the PAG and LC, preventing them from activating fear behavior.
Noradrenergic dysfunction in panic disorder
Increased NE transmission from LC in panic disorder. Increasing NE concentration increases panic and anxiety.
GABA system in panic disorder
Decreased GABAa binding in hippocampus and amygdala in panic disorder. Lower concentrations of cortical GABA. in panic disorder patients
What happens to the cortex when a panic patient is stressed?
Less cortical activity. Cannot think clearly.
Behavioral inhibition
Reticence when faced with novel situations/people. Linked to risk for social phobia and other panic disorders.
Treatment for panic disorder
SSRI, SNRI, CBT
How does CBT work?
Operates upstream from amygdala, trains cortical projections to assert reason over automatic behavioral responses.
