Anxiety Disorders

Question 1

Most common mental disorder?

Answer 1

Anxiety disorders (as high as 28.8% lifetime prevalence)
Females greater than males

Question 2

Most common anxiety disorders

Answer 2

Panic disorder
Specific phobia
Social anxiety disorder
Generalized anxiety disorder

Question 3

Panic disorder

Answer 3

Recurrent unexplained panic attacks with anticipatory anxiety. Greater than 1 month concern about having attacks. Generally accompanied by agoraphobia

Question 4

Elements of a panic attack

Answer 4

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

Question 5

What is the cardinal symptom of panic

Answer 5

Hyperventilation

Question 6

Agoraphobia

Answer 6

Fear of going out in public because escape may be difficult if panic attack occurs.

Question 7

Mean age of onset of panic disorder?

Answer 7

3rd decade

Question 8

Do all panic disorder patients hav symptoms between attacks?

Answer 8

No, course is highly variable. Association between panic disorder and suicide

Question 9

Comorbidities with panic disorder

Answer 9

MDD, other anxiety disorder, alcohol use disorder

Question 10

Generalized anxiety disorder diagnosis

Answer 10

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

Question 11

GAD epidemiology

Answer 11

Females>males. Onset in 3rd decade. Chronic course with fluctuating symptomology. Some can go on to develop panic disorder.

Question 12

Social phobia

Answer 12

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.

Question 13

Epidemiology of social phobia

Answer 13

No difference between men and women, typical onset in late childhood/early adolescence. Tends to be chronic

Question 14

Psychoanalytic theory of anxiety disorders

Answer 14

A signal of danger in the unconscious – result of conflict between unconscious sexual or aggressive wishes and corresponding threats from the superego.

Question 15

Cognitive-Behavioral Theories of Anxiety Disorders

Answer 15

Learned response from parental behavior. Classical conditioning.

Question 16

Role of the amygdala in anxiety disorders in animal models and inhuman

Answer 16

Amydala must be present for fear conditioning. In humans, amygdala activity is higher in panic disorder patients.

Question 17

Fear network and panic

Answer 17

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.

Question 18

Hippocampus and anxiety disorders

Answer 18

Formation of contextual memory – necessary for phobic avoidance.

Question 19

Serotonergic dysfunction in panic disorder

Answer 19

Decreased 5HT1A receptor binding in cingulate and raphe. SSRIs are useful. 5HT will quiet the PAG and LC, preventing them from activating fear behavior.

Question 20

Noradrenergic dysfunction in panic disorder

Answer 20

Increased NE transmission from LC in panic disorder. Increasing NE concentration increases panic and anxiety.

Question 21

GABA system in panic disorder

Answer 21

Decreased GABAa binding in hippocampus and amygdala in panic disorder. Lower concentrations of cortical GABA. in panic disorder patients

Question 22

What happens to the cortex when a panic patient is stressed?

Answer 22

Less cortical activity. Cannot think clearly.

Question 23

Behavioral inhibition

Answer 23

Reticence when faced with novel situations/people. Linked to risk for social phobia and other panic disorders.

Question 24

Treatment for panic disorder

Answer 24

SSRI, SNRI, CBT

Question 25

How does CBT work?

Answer 25

Operates upstream from amygdala, trains cortical projections to assert reason over automatic behavioral responses.