Anxiety Disorders Flashcards
____ is the emotional response to real or perceived imminent threat.
Fear
often associated with surges of autonomic arousal necessary for fight or flight, thoughts of immediate danger, and escape behaviors
______ is anticipation of future threat.
Anxiety
often associated with muscle tension and vigilance in preparation for future danger and cautious or avoidant behaviors
_____ _______ feature prominently within the anxiety disorders as a particular type of fear response.
Panic attacks
trigger of fear response without an actual reason
Panic Disorder prevalence ?
Men = Women ~4.7% of US and 44.8% classified as “severe”
Panic Disorder etiology and risk factors ?
Men = Women average of onset 24 yrs old
Unknown etiology ( it just happens)
Panic Disorder genetics ?
High correlation (20-40%) with 1st degree relatives
Panic Disorder DDx ?
Metabolic (i.e. hyperthyroidism, ( makes heart beat fast and makes reactions sharp and quick, eye stick out, hot) hypoglycemia ( sweaty palms and shaky and vomiting ), many medical causes)
Seasonal Affective Disorder (SAD)
Agoraphobia or specific phobia ( scared of something)
Panic Disorder prognosis ?
Very good with treatment
**check TSH
chest pain - get an EKG**
Panic Disorder medications ?
SSRI (i.e. Paxil, Zoloft) possibly benzodiazepines (i.e. Xanax- short term), Hydroxyzine (Vistaril)
** if they have a shit ton of panic attacks then meds and therapy but only once in a while then just therapy or maybe benzos
prozac can make the anxiety worse in some people
non addictive - hydroxyzine - AH that worse well for anxiety ( non addictive sleep aid) **
Panic Disorder procedures / therapy / surgery ?
Avoid stimulants (i.e. caffeine and nicotine and sports supplements)
Increase exercise - cause it can burn off nervous energy
Cognitive behavioral therapy - introduce to fear so you diminish response
Obsessive Compulsive Disorder prevalence ?
~1.7-4% in the U.S.
Obsessive Compulsive Disorder etiology and risk factors ?
Exact cause unknown
Obsessive Compulsive Disorder genetics ?
Strong heritability with a genetic influence of 45-65%
Monozygotic twins may be strikingly concordant for OCD (80-87%)
Obsessive Compulsive Disorder DDx ?
Major depressive disorder / GAD / Panic disorder
Body dysmorphic disorder / Trichotillomania
Social phobia and simple phobia
ADHD
Tourette syndrome (5-7%) / Other tic disorders (20-30%)
Substance abuse / Eating disorders
Obsessive Compulsive Disorder prognosis ?
~70% of patients entering treatment experience a significant improvement in their symptoms. However, OCD remains a chronic illness
Obsessive Compulsive Disorder medications ?
SSRIs are mainstay of treatment – may take 6-10 weeks
Obsessive Compulsive Disorder procedures / therapy / surgery ?
Behavioral Therapy
Sertraline (Zoloft) ?
Sertraline (Zoloft): selectively inhibits presynaptic serotonin reuptake at the neuronal membrane.
It is FDA approved for the treatment of OCD, posttraumatic stress disorder, panic disorder, and social anxiety disorder.
Fluvoxamine (Luvox) ?
enhances serotonin activity by selective reuptake inhibition at the neuronal membrane. It does not significantly bind to alpha-adrenergic, histamine, or cholinergic receptors and thus has fewer adverse effects than TCAs.
It is FDA-approved for OCD in children (8-17 y) and adults.
Trichotillomania prevalence ?
1%-2% in the U.S. F > M
Trichotillomania etiology and risk factors ?
Family history
Young age usually 11 to 13 years old
Negative emotions (stress, depression, anxiety)
Positive reinforcement (anxiety relief when pulling hair)
Other mental illness such as OCD
Trichotillomania DDx ?
Alopecia Ariata
Anxiety Disorder: Obsessive-Compulsive Disorder
Monilethrix (genetic “beaded hair”)
Tinea Capitis
Traction Alopecia
Trichotillomania prognosis ?
Variable with reasonable prognosis however may revert under stress
Trichotillomania medications ?
Little evidence of effectiveness of
Medications
Maybe SSRIs to treat underlying mental illness
Trichotillomania procedures / therapy / surgery ?
CBT
Habit reversal training
Post Traumatic Stress Disorder prevalence ?
PTSD has a lifetime prevalence of 8-10% and accounts for considerable disability and morbidity.
Approximately 30% of men and women who have spent time in a war zone experience PTSD
Post Traumatic Stress Disorder etiology and risk factors ?
Highly variable on factors such as:
Characteristics of the trauma and the individual
Post trauma factors
Post Traumatic Stress Disorder genetics ?
Possible predisposition but poorly understood
Post Traumatic Stress Disorder DDx?
Anxiety Disorders / Obsessive-Compulsive Disorders
Schizophrenia
Post Traumatic Stress Disorder prognosis ?
Highly variable and often chronic condition
High correlation to substance abuse
Post Traumatic Stress Disorder medications ?
SSRIs, Benzodiazepines
Prazosin may help with nightmares
** read this E medicine article!
more in depth oil the tx.**
Post Traumatic Stress Disorder procedure / therapy / surgery ?
Cognitive Behavioral Therapy
EMDR
Prazosin (Minipress, Vasoflex, Lentopres and Hypovase) ?
is a sympatholytic drug used to treat HTN and BPH. Off label used to treat PTSD and possibly helps with nightmares). Test questions usually present as someone with HTN and BPH and you need to select a drug. Other similar medications: Terazosin, and Doxazosin for HTN and BPH.
EMDR ?
The goal of EMDR is to reduce the long-lasting effects of distressing memories by developing more adaptive coping mechanisms. The therapy uses an eight-phase approach that includes having the patient recall distressing images while receiving one of several types of bilateral sensory input, such as side to side eye movements. EMDR was originally developed to treat adults with PTSD; however, it is also used to treat other conditions and children.
Generalized Anxiety Disorder prevalence ?
Slightly more women than men
Generalized Anxiety Disorder etiology and risk factors ?
Generally starts early in life
High rate of comorbidity with depression
Related to neuroticism
Generalized Anxiety Disorder genetics ?
Mild to moderate familial component
Generalized Anxiety Disorder DDx ?
Major Depression and OCD a strong link
Generalized Anxiety Disorder prognosis ?
Variable with waxing and waning pattern
Comorbid conditions contribute to chronicity
Pharmacologic agents help, but GAD usually returns when d/c
Generalized Anxiety Disorder medications ?
Sertraline (Zoloft)
Paroxetine (Paxil)
Hydroxyzine (Vistaril)
Buspirone (Buspar)
Benzodiazepines (i.e. Xanax)
Generalized Anxiety Disorder procedures / therapy / surgery ?
Behavioral Therapy and Cognitive Behavioral Therapy
Paroxetine (Paxil) ?
is a potent selective inhibitor of neuronal serotonin reuptake. It also has a weak effect on norepinephrine and dopamine neuronal reuptake.
Buspirone (Buspar) ?
is an antianxiety agent not chemically or pharmacologically related to the benzodiazepines, barbiturates, or other sedative or anxiolytic drugs. It is a 5-HT1 agonist with serotonergic neurotransmission and some dopaminergic effects in the CNS. Note no black box warning.
Specific Phobia prevalence ?
7-9% over 12 months,
5% in children,
16% in 13-17 year olds
Specific Phobia etiology and risk factors ?
Female
Family Hx
Environment- parental overprotection, loss of parent, abuse, preceding negative event
Temperament (i.e. neuroticism, anxiety disorders
Physiological-Vasovagal fainting-needle injections
Genetics- 1st degree relative increased risk
Increased Risk of Suicide-60% more likely
Specific Phobia DDx?
Agoraphobia
Social Anxiety/Separation anxiety
Panic Disorder
OCD
Eating disorder/ trauma stress
Disorders
Specific Phobia prognosis ?
Often persist through life. Fear response decreases with age.
Often respond to treatment with GOOD prognosis
Specific Phobia medications ?
6-12 months of medications
SSRIs (Paroxetine, Sertraline)
SNRIs (venlafexine)
Benzodiazepines
Specific Phobia procedure / therapy / surgery ?
CBT including exposure therapy
Social anxiety disorder prevalence ?
6-8% average of onset 13 yo
Social anxiety disorder etiology and risk factors ?
Female
Family Hx
Environment / Learned
Behavior
Temperament (i.e. Timid children)
Health conditions (i.e. disfigurements)
Social anxiety disorder genetics ?
1st degree relative 2-3x risk
Social anxiety disorder DDx ?
Generalized anxiety disorder (GAD)
Panic Disorder
Autistic Spectrum Disorder
Avoidant Personality Disorder
Social anxiety disorder prognosis ?
Good to very good
Social anxiety disorder medications ?
SSRIs (i.e. Paroxetine, Sertraline)
Benzodiazepines
Social anxiety disorder procedures / therapy/ surgery ?
CBT including exposure therapy
Agoraphobia prevalence ?
1.2-8.4% - Avg. age of onset 20 yo
Agoraphobia etiology and risk factors ?
Having panic disorder
Stressful life events such as sexual / physical abuse
Agoraphobia genetics ?
30-40% concordance MZ twins
Agoraphobia DDx ?
Generalized anxiety disorder
Social anxiety disorder
PTSD
Agoraphobia prognosis ?
Good to very good
Agoraphobia medications?
SSRI (i.e. Paxil, Celexa) possibly benzodiazepines (i.e. Xanax- short term)
Agoraphobia procedures / therapy / surgery ?
CBT
Combined treatment for GAD and Panic Disorder can be very effective at treating agoraphobia
Acute Stress Disorder prevalence ?
20-50% of cases follow interpersonal traumatic events (eg, assault, rape, and witnessing a mass shooting);
13-21% of motor vehicle accidents; 19% of assaults; 10% of severe burns
Acute Stress Disorder etiology and risk factors ?
Depending on underlying exposure
Acute Stress Disorder genetics ?
N/A
Acute Stress Disorder DDx?
Anxiety / Depression / PTSD / Adjustment Disorder
Dissociative Disorders
Brief psychotic episode
Substance abuse
Acute Stress Disorder prognosis ?
Generally good
Acute Stress Disorder medications ?
SSRIs
Benzodiazepines
Acute Stress Disorder procedure / therapy / surgery ?
Reduce stress by all possible means
Ensure that survivors have a safe environment
Promote contact with loved ones and other sources of support (eg, religious and/or social organizations)
Acute Stress Disorder note ?
If greater than 1 month then consider PTSD.
