Anxiety Disorders Flashcards
What areas of the brain tend to be the most involved in anxiety?
Locus ceruleus (fight or flight) and amygdala (fear processing)
What brain structure causes fear/panic/phobias?
Amygdala
What brain structures cause worry, apprehension, obsessions and anxious misery?
Cortico-striatal-thalamic circuit
Define the clinical criteria for a Panic Attack
Abrupt surge of fear or discomfort peaking within 10 min
4 or more of…
Palpitations, Pounding chest, Paresthesias
Abd discomfort
Nausea, Numbess
Intense fear of dying, Lightheadedness
Chest pain, Choking, Chills, Disconnectedness
Sweating, Shaking, SOB, Smothering
What is a panic disorder?
Recurrent, unexpected panic attacks without identifiable trigger
AT least one attack with ONE MONTH or more of either….
- Anticipatory Anxiety
- Significant maladaptive change in behavior
Panic Disorder
Age of Onset and Course
Avg age: 24 (late teens to early 20s)
Course; waxes and wanes without treatment
Panic Disorder
Comorbidities
GAD, Agoraphobia, or MDD
Panic Disorder
First and second line treatments
1st- SSRIs, SNRIs
2nd- TCAs, MAOIs
While waiting for antidepressants to work, use benzodiazepines
Cognitive behavioral therapy
Agoraphobia
Describe the clinical criteria
Marked fear or anxiety about 2 or more of…
- Being on public transpo
- Open spaces
- Enclosed spaces
- Waiting in line, being in a crowd
- Being outside home alone
Fear/Anxiety/Avoidance for over 6 months
Agoraphobia
Onset and Course
Onset: late teens/20s
Often have chronic course with comorbid mental illness
Agoraphobia
Treatment
Systematic desensitization
SSRIs/SNRIs/TCAs
What is GAD?
Excessive worry/anxiety about many things
GAD
Course
Waxes and wanes
Persistent
Full remission is low
GAD
Treatment
Antidepressants
CBT
Baenzos
Buspirone
What is a specific phobia?
Fear/anxiety about a specific object or situation
Specific Phobia
How many do people tend to have? What might they fear? Prevalence of these fears?
Tend to have >1. Avg = 3
Natural environment, animals, blood/injection/injury
F > M for almost all EXCEPT blood/injection/injury M=F
Specific Phobia
Treatment
Cognitive Behavioral Therapy
Systematic Desensitization
What is Social Anxiety?
Fear/anxiety from social situations where one is exposed to scrutiny and judgment of others
Blushing
Social Anxiety Treatment
Antidepressants
Cognitive Behavioral Therapy
Propranalol
Separation Anxiety Disorder
What is it? Who gets it?
Anxiety triggered by separation from home or major attachment figure
Kids under 12, more in females
Separation Anxiety Disorder
Course
Most kids with this are totally fine later. May develop anxiety disorders. Can be seen in adults.
Selective Mutism
What is it? Who gets it?
Failure to speak in social situations where they are expected to (like school)
Kids under 5
M=F
In general, how should you go about diagnosing anxiety disorders?
Rule out substance-related and medical causes of the anxiety, then characterize the anxiety disorder
What big 3 psychiatric comorbidities tend to come with an anxiety disorder?
- other anxiety disorder
- MDD
- Substance abuse
Adjustment Disorder
What is it?
Development of emotional or behavioral symptoms in response to an identifiable stressor within 3 months
- Marked distress
- Impairment in social, occupational, or other area of functioning
Commonly caused by romantic relationships, job stress, marital problems, business crisis
Exposure to actual or threatened death, injury, or violence may cause…
Acute Stress Disorder
PTSD
Acute Stress Disorder
Duration
3 days to 1 month
PTSD
Duration
Over 1 month (may last years)
PTSD Symptoms
Intrusion symptoms – unwanted memories of trauma; flashbacks
Avoidance Symptoms- avoid reminders of the trauma
Arousal symptoms – chronic arousal of sympathetic NS; insomnia, irritability, trouble concentration, hypervigilence, easy startling
Negative alteration in mood and cognition
PTSD
Who gets it?
F > M
Abused kids, battered women, raped adults, military veterans, firefighters, police
PTSD
Cormorbidities
Mood disorders
Substance abuse (M>F)
Anxiety disorder
PTSD
Treatment
Antidepressants
NO BENZODIAZEPINES
OCD
What are obsessions and compulsions?
Obsessions– recurrent and persistent thoughts, images, urges
Often related to 5 D’s (Dirt, Doubts, Disorder, Dangerous, Disgusting)
Compulsions– repetitive behaviors or mental acts done in response to an obsession to reduce distress
OCD
Onset and Course
Mean age of onset: 19
F>M (slightly)
Course: chronic waxing and waning
OCD
Treatment
1st- SSRIs (high doses)
2nd- Venlafaxine, Clomipramine
-Note: Need HIGH DOSES
CBT (Exposure Therapy)
What is CBT? How does it work for OCD patients?
Cognitive Behavioral Therapy
Used to help OCD patients not respond to their obsessions with the compulsive behavior
Takes a long time
