Anxiety Disorders Flashcards
Define fear
Emotional response to real or perceived imminent threat
Define anxiety
Anticipation of a future threat
What is most a/w ANS arousal - fear or anxiety?
Fear
What is anxiety most associated with in relation to body response?
Hyper-vigilance and muscle tension in preparation for future danger
How do anxiety disorders differ from general fear/anxiety?
Anxiety disorders are excessive or persist beyond developmentally appropriate periods (a 4 yr old being scared of monster in the closet is appropriate vs. a 51 yr old)
Who is MC affected by generalized anxiety disorder (GAD)?
- Females 2:1
- Diagnosis peaks in middle age (decreases in later years)
Etiology of GAD
- Learned
- Cognitive theory (anxiety results from incorrect views of oneself, the environment, future)
- Neurobiology (abnormal functioning of serotonin and cortisol, increased NE)
Proposed neurobiological model of GAD?
- Hyperactive amygdala results in hyperactive ANS activity and cortisol secretion
- Chronically increased cortisol results in increased serotonin uptake and other changes
Clinical presentation of GAD
- Excessive and persistent worrying
- Hyperarousal, muscle tension
- HAs, neck/shoulder pain w/o specific cause
How to diagnose GAD?
- 3 or more symptoms (present on more days than not) for over 6 months
- GAD 7 scale (99% negative predictive value)
Treatment of GAD
Psychotherapy/CBT (along with some meds)
Pharm treatment of GAD
Use anxiolytics (short acting)
- BZD used with SSRI/SNRI
- Buspirone (no abuse potential, no cognitive impairments, takes longer than BZDs, may work better w/SSRI or SNRI)
- SSRIs and SNRIs
Define panic disorder
Recurrent unexpected panic attacks
Define panic attack
Abrupt surge of intense fear/discomfort that reaches a peak within minutes and 4 or more specific symptoms occurs
Types of panic attacks?
Expected and unexpected
Define unexpected panic attack
No obvious cue or trigger (when relaxing, waking up)
Define expected panic attack
Obvious cue or trigger at time of occurrence (spiders, public speaking)
DSM V panic disorder definition
BOTH 1 and 2
- Recurrent, unexpected panic attacks
- At least one panic episode has been followed by at least 1 month of: persistent worry about additional attacks or maladaptive behavior related to attack
* Also panic attacks are NOT related to substance abuse or other medical condition
Who is MC affected by panic disorder?
- Females 2:1
- Onset usually 15-35 yo
If person 40 or older presents with panic attacks, what should be considered?
Think depression or medical cause - onset of panic disorder is usually younger
Treatment of panic disorder
- Psychotherapy alone for mild disease
- Meds are started if functionally impaired
Pharm treatment of panic disorder
- SSRIs
- TCAs (many side effects though)
- MAOis (low tyramine diet to avoid HTN crisis)
- BZDs
Define agoraphobia
Fear and/or avoidance of places or situations where escape may be difficult or embarrassing or help may not be available
What often occurs concurrently with agoraphobia?
Panic disorder
Diagnosis of agoraphobia
Marked fear/anxiety about 2 or more of:
- Using public transportation
- Being in open spaces
- Being in enclosed spaces
- Standing in line or a crowd
- Being outside of home alone
Treatment of agoraphobia
Same as panic disorder
Define social phobia
- Clinically significant anxiety provoked by certain social or performance situations
- Often leads to avoidance behavior
Clinical presentation of social phobia
Psychological AND physiologic symptoms
- Panic attacks
- Anticipatory anxiety
- Avoidance of social situations (or endured w/extreme embarrassment)
Treatment of social phobia
- Psychotherapy (exposure therapy w/videotape feedback)
- Meds (SSRIs, BZDs, MAOis)
What meds are used for general social phobias vs. specific phobias?
- General social: SSRIs, BZDs, MAOis
- Specific: BBs 1 hr before, can give small BZD dose w/it
What is the MC mental disorder in the US?
Specific phobias
Define specific phobia
Clinically significant and EXCESSIVE anxiety/panic provoked by a specific feared object/situation
Treatment of specific phobias (including pharm tx)
- Exposure therapy
- Hypnosis
- Insight oriented psychotherapy
- BZDs, BBs
Define obsession
Intrusive, repetitive thoughts/desires/urges (losing things, harming someone, anxiety of contamination)
Define compulsion
Repetitive mental or behavioral acts that an individual feels driven to perform (in response to an obsession or rigidly held belief)
What does anxiety in OCD arise from?
Interruption or suppression of rituals
Treatment of OCD
- Insight psychotherapy
- Exposure therapy
- CBT (best outcome w/pharm tx)
Pharm treatment of OCD
- SSRIs
- SNRIs
- TCA (Clomipramine)
- BZD (limited, short term use for acute anxiety)
- Antipsychotics (Risperdal w/SSRI)
Last resort treatment of OCD?
Neurosurgery (deep brain stimulation)
Define PTSD
Re-experiencing of an extremely traumatic (out of range of normal human experience) event
Types of trauma at risk for PTSD?
- Military combat
- Rape
- Childhood sexual abuse
- ICU hospitalization
Diagnosis of PTSD
Symptoms must be present x 1 month with significant clinical, occupational disruption
Classification of PTSD
- Acute (less than 3 months from exposure)
- Chronic (over 3 months)
- Delayed onset (greater than 6 months)
Describe ASD vs. PTSD
- ASD has PTSD-like symptoms
- ASD has complete recovery by 30 days after stress exposure
What are PTSD and ASD associated with?
Dissociative disorder
Define dissociative disorder
Interruption of integrated functions of memory, identity or perception of the environment (from severe trauma)
Types of dissociative disorder
- Dissociative amnesia
- Dissociative fugue
- Dissociative identity disorder
- Depersonalization disorder
Define dissociative amnesia
Pt cannot recall traumatic event w/no other cognitive deficit
Define dissociative fugue
Pt assumes new identity with impulsive sudden relocation away from home and no recall of prior life/identity
Define dissociative identity disorder
- Multiple personality disorder
- Greater than 2 personalities (usually approx 8 for men, 15 for women)
- A/w severe child abuse
Define depersonalization disorder
Persistent, recurrent sense of detachment from oneself (dreamlike) - derealization
Define derealization
Sense of strangeness of external world
Primary treatment of PTSD
Exposure therapy to trigger stimuli
-Goal is to tolerate avoidance behavior and associate these w/positive emotions/outcomes
Debriefing treatment of PTSD
- Asked to recount what happened to them
- Does NOT work (might make things worse)
Pharm tx of PTSD
- SSRIs for anxiety
- BBs for tremors
- Prazosin for nightmares
- Cautious use of BZDs
Why are BZDs not helpful in PTSD treatment?
- Addictive
- Impedes behavior modification w/exposure therapy and psychotherapy
