Anxiety Disorders Flashcards
How is an anxiety disorder different from normal anxiety?
anxiety in disorder is a prominent, persistent, and disruptive aspect of daily life
How common is anxiety?
25% of US population
Anxiety commonly comorbid with _______.
major depression
Anxiety associated with increased risk of ______.
suicide
triad of symptoms in anxiety
emotional (fear, nervousness)
cognitive (worry, sense of doom, derealization)
physical (muscle tension, tachycardia, dizziness, insomnia)
Possible causes of anxiety
biologic: GABA receptors, neurotransmitters, adrenergic system
Psych stressors
Maladaptive cognitions (overestimate danger or underestimate coping)
Environmentally conditioned (ex: driving + stress + fear = fear of driving)
Risk factors for anxiety disorders
female, young, single or divorced, low socioeconomic status, low education, white, stressful life events, childhood maltreatment, modeling stressful parents, genetics
Comorbidities of anxiety disorder
other anxiety d/o, personality d/o, substance use d/o, physical problems (CV, respiratory, arthritis, migraines)
Duration of generalized anxiety d/o
at least 6 months
Generalized anxiety disorder symptoms
- anxiety triad
- multiple domains of worry (school, work, travel, relationships, health, etc.)
- often comes to clinic with somatic complaints
Average age of dx’d generalized anxiety d/o
20-30s
Generalized anxiety disorder treatment
1st line: SSRIs or SNRIs
Benzos for acute management
ex: Diazepam 5-10 mg PO BID prn or IV in ICU
Main features of social anxiety disorder
Marked fear of social and performance situations, often resulting in avoidance
- Fear of saying or doing something to result in embarrassment or humiliation
- Core fear “not measuring up”
Physical symptoms that can arise in social anxiety d/o
blushing, profuse sweating, trembling, nausea, difficulty talking
Duration of social anxiety d/o
continuous and lifelong
Social anxiety d/o treatment
- CBT to include desensitization
- SSRI/SNRIs (sertraline, paroxetine, venlafaxine)
- Short-acting benzos if infrequent causes (Alprazolam)
- Beta blockers sometimes useful (propranolol 1 hr prior to exposure)
What is a panic attack?
Discrete period of intense fear accompanied by abrupt cognitive and somatic symptoms
Diagnosis criteria of panic disorder
recurrent, uncued panic attacks along with either
1) worry about possibility of future attacks
OR
2) development of phobic avoidance, or other changes in behavior due to attacks
Cognitive symptoms in a panic attack
racing thoughts, preoccupation with health concerns, catastrophic misinterpretation of somatic symptoms, believing one is going insane
Somatic symptoms in panic attack
choking sensation, racing heartbeat, sweating, “jelly” legs, nausea, shaking, chest pain, numbness, feeling detached or unreal
Panic disorder treatment
Start with low dose SSRI and titrate with gradual dose increase (Paroxetine)
- 4-6 weeks to clinically meaningful response
- 12-16 weeks for optimal response
If no response -> try another SSRI or try SNRI
If partial response -> consider adjunct with benzo or other anti-anxiety (Buspirone)
Benzos also possible
- Can use as adjunct to SSRI or SNRI for immediate relief; then taper as SSRI or SNRI takes effect
- High abuse potential, esp in patient with alcohol or drug history
CBT very effective in anxiety disorders
Type of anxiety seen in agoraphobia
Anxiety about 2 or more of the following situations:
1) using public transportation
2) being in open spaces
3) being in enclosed places
4) standing in line or being in a crowd
5) being outside of the home alone
Does agoraphobia occur with panic disorder?
common consequence of panic disorder, but can exist as own disorder
Why is there anxiety in agoraphobia?
fear of being incapacitated, unable to escape, unable to get help if physical symptoms arise
Least panic disabling of anxiety disorders
specific phobias
specific phobia characteristics
- Predictability
- Actively avoided or endured
- Fear/anxiety
- Persistent (6+ months)
- Significant distress or impairment
- NOT better explained by another anxiety disorder
symptoms of specific phobia
- Heart-racing, tremors, shortness of breath
- Vasovagal response seen in blood-injection-injury
Treatment of specific phobias
- CBT with desensitization
- Pharmacotherapy not established
- Short-acting benzos prior to exposure if no complex performance requirements
separation anxiety
childhood to adult; anxiety associated with separation or threat of separation
selective mutism
person who is normally capable of speech does not speak in specific situations or to specific people
Most common anxiety disorder
specific phobia
Behavior Therapy
relaxation, stress reduction; directive therapy (may include homework)
good for: anxiety, somatic disorders
Cognitive therapy (CBT)
Goal: change negative/distorted thoughts to reduce symptoms of depression or anxiety
Good for: depression, anxiety, substance abuse
Supportive Therapy
Assumes improvement with someone to talk to who is validating. Avoids interpreting the unconscious or addressing “transference”
Good for: any emotional disorder or life problem
Duration: short-term
widely practiced, little research on effectiveness
