Anxiety Disorders

Question 1

Types of Anxiety

Answer 1

panic anxiety '
generalized anxiety
conditioned anxiety
anticipatory anxiety
social anxiety
situational anxiety

Question 2

DSM-IV Anxiety Disorders

Answer 2

Panic Disorder
Generalized Anxiety Disorder
Social Phobia
Obsessive Compulsive Disorder
Post-Traumatic Stress Disorder
Simple Phobia
Agoraphobia without Panic

Question 3

Biological Theories of Anxiety

Answer 3

Sympathetic system
- Simple autonomic dysregulation unlikely
- Locus coeruleus
-Dysregulated noradrenergic function
GABA-benzodiazepine system
-Decreased BZD receptor binding in hippocampus in panic patients
-Decreased BZD receptor binding in prefrontal cortex during panic attack Neurocircuitry of Fear
-Integrates neurochemical, imaging, and treatment findings
Fear Generation – Amygdalocortical interactions
Fear Extinction – Orbitofrontal Cortex & Prefrontal Cortex

Question 4

Styles of Clinical Presentation of

Depression and Anxiety in Primary Care

Answer 4

Psychologizer

“Doctor – I’ve been really anxious lately.” Initial Somatizer

“Doctor – I’ve been really tense and fatigued lately. Could it be anxiety?” Facultative Somatizer

“Doctor – I’ve been really tense and fatigued lately.”

“Have you been feeling anxious?” Persistent Somatizer

“Doctor – I’ve been really tense and fatigued lately.”

“Have you been feeling anxious?”

“No! I’ve just been tense and fatigued!”

Question 5

Panic Disorder

Answer 5

Sudden overwhelming episodes of anxiety that include both somatic and psychic elements - along with worry about either the implication of the attack or about having future attacks
Can occur with or without agoraphobia
Lifetime prevalence = 1.5% - 3.5%
Female:Male = 2:1
Age of Onset = typically early adulthood

Question 6

Symptoms of Panic Attack

Answer 6

Palpitations, pounding heart, or tachycardia shortness of breath or sensation of smothering
sweating
trembling or shaking
feeling of choking
chest pain or discomfort nausea or abdominal distress
dizziness, feeling faint
paresthesias chills or hot flushes
derealization or depersonalization fear of losing control or going crazy
fear of dying

Question 7

Differential Diagnosis of Panic

Answer 7

Hyper/hypothyroidism Hyperparathyroidism Mitral valve prolapse Cardiac arrhythmias
Coronary insufficiency
Pheochromocytoma Hypoglycemia True vertigo
Drug/Alcohol withdrawal
Cannabis intoxication

Question 8

Panic Disorder rx

Answer 8

Pharmacologic treatment
Benzodiazepines
Tricyclic antidepressants
Monoamine oxidase inhibitors
 Serotonin specific reuptake inhibitors
 Serotonin Norepinephrine reuptake inhibitors
Non-pharmacologic treatment
Cognitive behavioral therapy (Panic Reduction Therapy)

Question 9

Generalized Anxiety Disorder epi

Answer 9

Excessive worry and more generalized somatic symptoms of anxiety (Worry, Anxiety, Tension)
Approximately 75-90% comorbid with other psychiatric disorders (most commonly depression)
Chronic condition with estimated lifetime
prevalence = 5.1%
Female:Male = 2:1

Question 10

Generalized Anxiety Disorder rx

Answer 10

Pharmacologic Treatment
 Benzodiazepines
 Buspirone
 TCAs
 MAOIs
 SNRIs
 SSRIs
Non-pharmacologic Treatment
 Cognitive behavioral therapy