Anxiety Disorders

Question 1

when is anxiety abnormal

Answer 1

when its intensity and duration are disproportionate to potential for harm, occurs in harmless situations, or occurs without recognizable threat

Question 2

experience of anxiety

Answer 2

awareness of physiological sensations (sweating, shaking, palpitations), awareness of being nervous or frightened, and may be increased by a feeling of shame

Question 3

medical causes of anxiety

Answer 3

hyperthyroid, pulmonary emboli, cardiac arrhythmias, acute MI, brain tumor in 3V, temporal lobe epilepsy, post-concussion syndrome, alcohol withdrawal*

Question 4

behavioral theory of anxiety

Answer 4

anxiety is a conditioned response from pairing a neutral stimulus with an aversive one

Question 5

cognitive theory of anxiety

Answer 5

risk/resources ratio: distorted or maladaptive thinking patterns
an exaggerated attribution of risk

Question 6

psychodynamic theory of anxiety

Answer 6

failure to adequately repress painful memories, impulses, or thoughts
internal conflict

Question 7

biological theory of anxiety: major NTs involved

Answer 7

NE, 5HT, GABA

Question 8

NE in anxiety

Answer 8

may have poorly regulated NE system with occasional bursts of activity
*may be why SNRIs work

Question 9

5HT in anxiety

Answer 9

likely involved because SSRIs have therapeutic effects

Question 10

GABA in anxiety

Answer 10

? abnormal functioning of GABA-a receptor

supported by effectiveness of BZD in tx which enhance GABA activity at GABA-a

Question 11

physiologic response to fear or anxiety

Answer 11

CRH released from hypothalamus –> ant pit, inc ACTH release into bloodstream
ACTH -> adrenal cortex = release GCs like cortisol

Question 12

how do early stressful life events alter brain

Answer 12

cause permanent change in CRH-containing neurons and brain structures, increasing vulnerability to experience chronic anxiety and depression

Question 13

psychodynamic vs. cognitive-behavioral psychotherapy

Answer 13

PD: describes emotions and behavior in abstract humanistic/ philosophical manner
CB: describes thoughts and behaviors in a more concrete and scientific manner

Question 14

focus/goal of psychodynamic therapy

Answer 14

reveal the unconscious content of psyche to alleviate psychic tension
goal: provide insight into problems

Question 15

focus/goal of cognitive-behavioral therapy

Answer 15

solve problems through goal-oriented and systematic procedure
evidence that it is useful in mood, anxiety, personality, eating, substance abuse, and psychotic disorders

Question 16

panic disorder

Answer 16

recurrent spontaneous, unexpected occurrence of panic attacks followed w/i 1 month by 1+ of:
persistent concern about attacks, worry about implication of attack, and/or significant change in behavior related to attacks

Question 17

criteria for panic attack

Answer 17

discrete period of fear or discomfort accompanied by 4+ of:
palpitations, sweating, trembling, SOB, choking feeling, chest pain, nausea, dizzy, derealization, depersonalization, fear of losing control, fear of dying, numb/tingling, chills or hot flashes

Question 18

agoraphobia

Answer 18

anxiety in situations where sufferer perceives difficulty escaping, often wide-open spaces or uncontrollable situations (airport, mall, bridge)

Question 19

prevalence of panic disorder and agoraphobia

Answer 19

2% men, 5% women

agoraphobia w/o panic: 3.5% men, 7% women

Question 20

tx for panic disorder and agoraphobia

Answer 20

SSRIs, SNRIs, tricyclics, BZDs, gabapentin (off label)

behavioral: cognitive therapy, applied relaxation/ respiratory training, exposure hierarchy (agoraphobia)

Question 21

criteria for specific phobia

Answer 21

marked and persistent excessive or unreasonable fear d/t presence or anticipation of specific object or situation
exposure –> anxiety response (may be a panic attack)
*person knows fear is unreasonable but avoids situation if possible

Question 22

common types of specific phobias

Answer 22

animal type - animal or insect
natural env type - storms, height, water
blood-injection-injury - seeing blood, etc.
situational - tunnels, bridges, elevators, flying, etc.
other - loud sounds, etc.

Question 23

prevalence of specific phobia and tx options

Answer 23

6.7% men, 15.7% women
med: little benefit, sometimes BZD used
CBT with exposure component

Question 24

social phobia

Answer 24

marked and persistent fear of 1+ social situations where exposed to unfamiliar people or scrutiny
fear of humiliation
*includes public speaking

Question 25

prevalence of social phobia and tx options

Answer 25

11.1% men, 15.5% women
SSRI, SNRI, BZD, TCA, BBs, MAOIs
CBT, exposure treatment, social skills training (role play)

Question 26

OCD: obsessions and compulsions

Answer 26

ob: persistent disturbing intrusive thoughts or impulses that pt finds inappropriate and cause anxiety/distress but realizes are a product of own mind
com: conscious, standardized, recurrent thought or behavior in response to obsession - not connected to obsession in realistic way

Question 27

4 common forms of OCD

Answer 27

washers - fear contamination and have cleaning compulsions
checkers - repeatedly check things like door lock, oven, etc.
hoarders - fear throwing things away
counters and arrangers - certain numbers or colors or patterns are “bad”

Question 28

tx for OCD

Answer 28

clomipramine, SSRIs (high dose)
CBT with exposure and response prevention
*problems with compliance
neurosurgery: cingulotomy and orbito-medial lesions - improves 25-40% pts with severe and intractable OCD

Question 29

generalized anxiety d/o

Answer 29

anxiety and worry for more days than not for 6 mos+, about many events or activities
difficult to control worry
a/w 3+ most days: restlessness, easy fatigue, difficulty concentrating, irritability, mm tension, sleep disturbance

Question 30

prevalence GAD and tx

Answer 30

3.6% men, 6.6% women
BZD, azapirones (buspirone), SSRI, TCA, SNRI (venlafaxine)
CBT or psychodynamic therapy

Question 31

PTSD inciting event characteristics

Answer 31

exposure to traumatic event that involved actual or threatened death or serious injury or physical threat to self or others and initial response involved fear, helplessness, or horror

Question 32

PTSD criteria tetrad

Answer 32

1- traumatic event involving threat or actual harm to self or others or death of others
2- re-experiencing of event
3- avoidance of stimuli a/w traumatic event
4- negative thoughts/emotions
5- increased arousal (difficulty sleeping, hypervigilance, etc.)
*disturbance lasts more than 1 month

Question 33

acute vs. chronic vs. delayed onset PTSD

Answer 33

acute: less than 3 mos
chronic: 3+ mos
DO: sx start 6+ mos after event

Question 34

acute stress d/o

Answer 34

sx occur w/i 4 wk of event and last 3d-4w

sx include intrusive thoughts, negative mood, dissociation, avoidance, hyperarousal

Question 35

predisposing factors to acute stress disorder

Answer 35

presence of childhood trauma
certain personality d/o traits (cluster B)
inadequate support system
genetic vulnerability to psych illness
recent stressful life changes

Question 36

prevalence of PTSD and co-morbidities

Answer 36

5% men, 10% women but trauma exposure 60% men, 51% women

co-m: mood d/o, substance abuse d/o, personality d/o (esp. cluster B)

Question 37

PTSD tx

Answer 37

CBT with exposure therapy
exposure therapy
SSRIs
? debriefing
*NOT BZD - worse outcomes