Anxiety Disorders Flashcards
Stress Diathesis Model
Chronic stress and anxiety leads to increased cortisol and adrenaline and decreased brain-derived neurotrophic factor (BDNF) (kind of like brain fertilizer) which can lead to atrophy of the hippocampal size and volume because of neuron death.
BDNF
Brain-derived neurotrophic factor
Acts on neurons in the CNS and PNS and is needed to help support the survival of existing neurons and encourage the growth and differentiation of new neurons and synapses in the brain. It is particularly active in the hippocampus, cortex, and basal forebrain.
BDNF is important for long-term memory.
What Systems does Anxiety Affect?
Pain
Cardiac
Metabolism
Pretty much everything…
Seperation Anxiety Disorder
More common in children, however a substantial number of adults report onset of seperation anxiety after the age of 18.
Inappropriate and excessive fear or anxiety related to seperation from those who the individual is attached.
Can manifest as adults not wanting to sleep without others, or not willing to let their kids go out etc.
Selective Mutism
Failure to speak in specific situations.
There is nothing physically wrong or mentally wrong but they cannot articulate. Much more common in kids, and rare in adults.
Must rule out hearing and language problems first.
Specific Phobia
Marked fear or anxiety about a specific object or situation that almost always provokes immediate fear or anxiety.
The phobic object or situation is actively avoided or endured with intense fear or anxiety and is out of proportion to the actual danger posed.
Common specific phobias include animals, natural environments (heights, storms, etc), blood/injection injury, situational (airplanes, elevators, enclosed spaces)
Social Anxiety Disorder
Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. The individual fears that they will act in a way or show anxiety symptoms that will be negatively evaluated (be humiliated or embarrassed) and will lead to rejection of offending others. As a result, the social situations are avoided or endured with intense fear and anxiety.
Most prevalent anxiety disorder.
Physical signs include blushing, flushing, sweating, minimal eye contact, fidgeting.
Tx: SSRIs, SNRIs, +/- benzos (short-term)
Panic Disorder
A. Recurrent, unexpected panic attacks with normal anxiety levels between attacks. Then, there is a discrete period of fear/discomfort with 4 or more symptoms within a few minutes –> STUDENTS Fear the 3Cs
Sweating
Trembling
Unsteadiness / dizziness
Depersonalization
Excessive HR
Nausea
Tingling
SOB
Fear of dying
Chest pain
Chills
Choking
B. Greater than 1 attack has been followed by one month of fear of additional attacks or worries about the implications of attacks.
C. Not better explained by substance or other medical conditions.
The actual panic attack is usually 15-30 minutes.
Tx: SSRIs, SNRIs, +/- benzos (short term)
Length of a Panic Attack
15-30 minutes
If it is lasting significantly longer than that, you want to re-consider whether this is actually a panic attack.
Agoraphobia
A marked fear or anxiety about 2 or more of the following 5 situations…
Public transportation
Being in open spaces
Being in closed spaces
Standing in line or being in a crowd
Being outside of the home alone
Fear of inability to escape or get help in case of a panic attack.
Tx: SSRIs, SNRIs, CBT
Generalized Anxiety Disorder
A. Excessive anxiety and worry occuring more days than not for greater than 6 months about a number of events or activities (work, school, life)
B. Individual finds it difficult to control the worry
C. Greater than or equal to 3 of… restlessness, fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance
D. Clinically significant distress
E. Not better explained by other stuff
Inv: GAD7 score
Tx: SSRIs, SNRIs, +/- benzos (short-term), +/- pregabalin
GAD7 Score
Used for scoring the severity of symptoms in generalized anxiety disorder.
Contains 7 questions.
GAD and Depression
There is a lot of overlap between GAD and depression.
Things that don’t really occur with straight GAD but do occur with depression are sadness, loss of interest/pleasure, and excessive or inappropriate guilty, as well as significant changes in appetite.
PHQ9
Patient Health Questionnaire
Seen as the “HbA1c” of depression.
Designed specifically for primary care and is highly Sn and Sp for the diagnosis of depression. It is also very useful in monitoring treatment response.
Substance-Induced Anxiety Disorder
Evidence from history, PE and lab investigations that the panic or anxiety disorder developed during or soon after substance intoxification or withdrawal or after exposure to medication.
Substances that can cause anxiety include: EtOH, tobacco, caffeine, corticosteroids, opioids, stimulants, cannabis, hallucinogens, cocaine, amphetamines, anxiolytics, etc.
