Anxiety Disorders Flashcards
when is anxiety abnormal
when its intensity and duration are disproportionate to potential for harm, occurs in harmless situations, or occurs without recognizable threat
experience of anxiety
awareness of physiological sensations (sweating, shaking, palpitations), awareness of being nervous or frightened, and may be increased by a feeling of shame
medical causes of anxiety
hyperthyroid, pulmonary emboli, cardiac arrhythmias, acute MI, brain tumor in 3V, temporal lobe epilepsy, post-concussion syndrome, alcohol withdrawal*
behavioral theory of anxiety
anxiety is a conditioned response from pairing a neutral stimulus with an aversive one
cognitive theory of anxiety
risk/resources ratio: distorted or maladaptive thinking patterns
an exaggerated attribution of risk
psychodynamic theory of anxiety
failure to adequately repress painful memories, impulses, or thoughts
internal conflict
biological theory of anxiety: major NTs involved
NE, 5HT, GABA
NE in anxiety
may have poorly regulated NE system with occasional bursts of activity
*may be why SNRIs work
5HT in anxiety
likely involved because SSRIs have therapeutic effects
GABA in anxiety
? abnormal functioning of GABA-a receptor
supported by effectiveness of BZD in tx which enhance GABA activity at GABA-a
physiologic response to fear or anxiety
CRH released from hypothalamus –> ant pit, inc ACTH release into bloodstream
ACTH -> adrenal cortex = release GCs like cortisol
how do early stressful life events alter brain
cause permanent change in CRH-containing neurons and brain structures, increasing vulnerability to experience chronic anxiety and depression
psychodynamic vs. cognitive-behavioral psychotherapy
PD: describes emotions and behavior in abstract humanistic/ philosophical manner
CB: describes thoughts and behaviors in a more concrete and scientific manner
focus/goal of psychodynamic therapy
reveal the unconscious content of psyche to alleviate psychic tension
goal: provide insight into problems
focus/goal of cognitive-behavioral therapy
solve problems through goal-oriented and systematic procedure
evidence that it is useful in mood, anxiety, personality, eating, substance abuse, and psychotic disorders
panic disorder
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
criteria for panic attack
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
agoraphobia
anxiety in situations where sufferer perceives difficulty escaping, often wide-open spaces or uncontrollable situations (airport, mall, bridge)
prevalence of panic disorder and agoraphobia
2% men, 5% women
agoraphobia w/o panic: 3.5% men, 7% women
tx for panic disorder and agoraphobia
SSRIs, SNRIs, tricyclics, BZDs, gabapentin (off label)
behavioral: cognitive therapy, applied relaxation/ respiratory training, exposure hierarchy (agoraphobia)
criteria for specific phobia
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
common types of specific phobias
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.
prevalence of specific phobia and tx options
6.7% men, 15.7% women
med: little benefit, sometimes BZD used
CBT with exposure component
social phobia
marked and persistent fear of 1+ social situations where exposed to unfamiliar people or scrutiny
fear of humiliation
*includes public speaking
prevalence of social phobia and tx options
11.1% men, 15.5% women
SSRI, SNRI, BZD, TCA, BBs, MAOIs
CBT, exposure treatment, social skills training (role play)
OCD: obsessions and compulsions
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
4 common forms of OCD
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”
tx for OCD
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
generalized anxiety d/o
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
prevalence GAD and tx
3.6% men, 6.6% women
BZD, azapirones (buspirone), SSRI, TCA, SNRI (venlafaxine)
CBT or psychodynamic therapy
PTSD inciting event characteristics
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
PTSD criteria tetrad
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
acute vs. chronic vs. delayed onset PTSD
acute: less than 3 mos
chronic: 3+ mos
DO: sx start 6+ mos after event
acute stress d/o
sx occur w/i 4 wk of event and last 3d-4w
sx include intrusive thoughts, negative mood, dissociation, avoidance, hyperarousal
predisposing factors to acute stress disorder
presence of childhood trauma certain personality d/o traits (cluster B) inadequate support system genetic vulnerability to psych illness recent stressful life changes
prevalence of PTSD and co-morbidities
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)
PTSD tx
CBT with exposure therapy exposure therapy SSRIs ? debriefing *NOT BZD - worse outcomes
