Anxiety Disorders

Question 1

What areas of the brain tend to be the most involved in anxiety?

Answer 1

Locus ceruleus (fight or flight) and amygdala (fear processing)

Question 2

What brain structure causes fear/panic/phobias?

Answer 2

Amygdala

Question 3

What brain structures cause worry, apprehension, obsessions and anxious misery?

Answer 3

Cortico-striatal-thalamic circuit

Question 4

Define the clinical criteria for a Panic Attack

Answer 4

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

Question 5

What is a panic disorder?

Answer 5

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

Question 6

Panic Disorder

Age of Onset and Course

Answer 6

Avg age: 24 (late teens to early 20s)

Course; waxes and wanes without treatment

Question 7

Panic Disorder

Comorbidities

Answer 7

GAD, Agoraphobia, or MDD

Question 8

Panic Disorder

First and second line treatments

Answer 8

1st- SSRIs, SNRIs

2nd- TCAs, MAOIs

While waiting for antidepressants to work, use benzodiazepines

Cognitive behavioral therapy

Question 9

Agoraphobia

Describe the clinical criteria

Answer 9

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

Question 10

Agoraphobia

Onset and Course

Answer 10

Onset: late teens/20s

Often have chronic course with comorbid mental illness

Question 11

Agoraphobia

Treatment

Answer 11

Systematic desensitization

SSRIs/SNRIs/TCAs

Question 12

What is GAD?

Answer 12

Excessive worry/anxiety about many things

Question 13

GAD

Course

Answer 13

Waxes and wanes
Persistent
Full remission is low

Question 14

GAD

Treatment

Answer 14

Antidepressants
CBT
Baenzos
Buspirone

Question 15

What is a specific phobia?

Answer 15

Fear/anxiety about a specific object or situation

Question 16

Specific Phobia

How many do people tend to have? What might they fear? Prevalence of these fears?

Answer 16

Tend to have >1. Avg = 3

Natural environment, animals, blood/injection/injury

F > M for almost all EXCEPT blood/injection/injury M=F

Question 17

Specific Phobia

Treatment

Answer 17

Cognitive Behavioral Therapy

Systematic Desensitization

Question 18

What is Social Anxiety?

Answer 18

Fear/anxiety from social situations where one is exposed to scrutiny and judgment of others

Blushing

Question 19

Social Anxiety Treatment

Answer 19

Antidepressants
Cognitive Behavioral Therapy
Propranalol

Question 20

Separation Anxiety Disorder

What is it? Who gets it?

Answer 20

Anxiety triggered by separation from home or major attachment figure

Kids under 12, more in females

Question 21

Separation Anxiety Disorder

Course

Answer 21

Most kids with this are totally fine later. May develop anxiety disorders. Can be seen in adults.

Question 22

Selective Mutism

What is it? Who gets it?

Answer 22

Failure to speak in social situations where they are expected to (like school)

Kids under 5
M=F

Question 23

In general, how should you go about diagnosing anxiety disorders?

Answer 23

Rule out substance-related and medical causes of the anxiety, then characterize the anxiety disorder

Question 24

What big 3 psychiatric comorbidities tend to come with an anxiety disorder?

Answer 24

1. other anxiety disorder
2. MDD
3. Substance abuse

Question 25

Adjustment Disorder

What is it?

Answer 25

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

Question 26

Exposure to actual or threatened death, injury, or violence may cause…

Answer 26

Acute Stress Disorder

PTSD

Question 27

Acute Stress Disorder

Duration

Answer 27

3 days to 1 month

Question 28

PTSD

Duration

Answer 28

Over 1 month (may last years)

Question 29

PTSD Symptoms

Answer 29

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

Question 30

PTSD

Who gets it?

Answer 30

F > M

Abused kids, battered women, raped adults, military veterans, firefighters, police

Question 31

PTSD

Cormorbidities

Answer 31

Mood disorders

Substance abuse (M>F)

Anxiety disorder

Question 32

PTSD

Treatment

Answer 32

Antidepressants

NO BENZODIAZEPINES

Question 33

OCD

What are obsessions and compulsions?

Answer 33

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

Question 34

OCD

Onset and Course

Answer 34

Mean age of onset: 19
F>M (slightly)

Course: chronic waxing and waning

Question 35

OCD

Treatment

Answer 35

1st- SSRIs (high doses)
2nd- Venlafaxine, Clomipramine

-Note: Need HIGH DOSES

CBT (Exposure Therapy)

Question 36

What is CBT? How does it work for OCD patients?

Answer 36

Cognitive Behavioral Therapy

Used to help OCD patients not respond to their obsessions with the compulsive behavior

Takes a long time