Anxiety disorders

Question 1

Biological theories of anxiety

Answer 1

Sympathetic system (dysregulated noreadrenergic function), GABA-benzo system (decreased benzo binding in hippocampus and PFC in panic attack), disrupted fear neurocircuitry (generation = amygdalocortical; extinction = OFC/PFC)

Question 2

Panic attack

Answer 2

sudden overwhelming episode of anxiety that includes somatic and psychic elements

Question 3

Panic disorder

Answer 3

panic attacks + worry of either the implication of attack or about having future attacks

Female:male = 2:1
Early adulthood

Question 4

DDx of panic

Answer 4

Hyper/hypothyroidism, hyperparathyroidism, mitral valve prolapse, arrhythmias, coronary insufficiency, pheochromocytoma, hypoglycemia, true vertigo, drug/alcohol withdrawal, cannabis intoxication

Question 5

Tx of panic d/o

Answer 5

Pharm: benzo, TCADs, MAOi, SSRI, SNRI

Nonpharm: CBT

Question 6

Generalized Anxiety Disorder

Answer 6

WAT (Worry, Anxiety, Tension)
75-90% comorbid with other psych dx (depression)
Females 2:1

Question 7

GAD treatment

Answer 7

Pharm: Benzo, Buspirone, TCADs, MAOIs, SNRIs, SSRIs

Non-pharm: CBT

Question 8

Social phobia

Answer 8

overwhelming anxiety in situations where one has to interact with others, be the center of attention, or perform in front of a crowd

Question 9

Social phobia treatment

Answer 9

Pharm: Benzos, B-blockers, MAOIs, SSRIs

Non-pharm: CBT

Question 10

OCD

Answer 10

Late adolescence/early adulthood
10 year lag between onset of sx and dx
High comorbidity with Tourettes (Basal ganglia d/o)

Question 11

Cause of 25% of childhood OCD

Answer 11

PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Strep)

Question 12

OCD circuit

Answer 12

Cortex (neo and limbic) to striatum (caudate) and directly to thalamus

From caudate –> direct and indirect basal ganglia path –> inhibitory/disinhibitory effects on thalamus

Question 13

Abnormal OCD circuit

Answer 13

imbalance between direct/indirect basal ganglia path (tendency toward greater BG tone) –> thalamic disinhibition –> further activation of OFC –> further direct BG path stimulation

Question 14

OCD treatment

Answer 14

Pharm: Clomipramine, SSRIs, atypical antipsychotics

Non-pharm: Exposure therapy, neurosurgery

Question 15

PTSD

Answer 15

exposure to extreme stressor –> re-experiencing, avoidance, hyperarousal

Highest prevalence in war vets and sex assault victims

Women > men

Question 16

Acute stress d/o

Answer 16

sx less than 1 month post-trauma

Question 17

Acute PTSD

Answer 17

sx less than 3 months post-trauma

Question 18

Chronic PTSD

Answer 18

> 3 mo post-trauma

Question 19

Delayed-onset PTSD

Answer 19

onset > 6 mo post-trauma

Question 20

PTSD comorbidities

Answer 20

Substance abuse, depression, other anxiety d/o