Anxiety Disorders

Question 1

General Features (6)

Answer 1

• Somatic & cognitive symptoms
• Prevalence 2-17%
• Onset in late adol/early adulthood
• Risk Factors
  
  • Young, female, family hx, traumatic life events, substance abuse, low resilience, low support
• Course = chronic, wax and wane
• Tx = benzos for short term (side effects and potential for abuse) & SSRIs for prevention/maintenance

Question 2

Brain Structures Involved

Answer 2

• Amygdala - evaluates emotional significance of events and initiates response
• Hippocampus - declarative memory; modulates amygdala
• Cingulate - closely associated w/ PFC; involved in emotional responses and cognition; output to amygdala
• Hypothalamus - gets input from amygdala then outflow to pituitary and ANS; homeostasis and neuroendocrine function (sleep and circadian rhythms)

Question 3

Bran Circuits Involved (Direct v. Indirect)

Answer 3

• Direct- internal/external source of anxiety —> amygdala —> locus cereleus (NE) + hypothalamus + periaqueductal gray (IMMEDIATE UNCONSCIOUS RXN TO STIM)
• Indirect - internal/external source of anxiety —> thalamus —> PFC/cingulate —> amygdala —> locus cereleus (NE) + hypothalamus + periaqueductal gray (HIGHER ORDER PROCESSING)

Question 4

OCD Loop Involved

Answer 4

• OFC —> anterior cingulate —> caudate —> GP/SN —> thalamus —> OFC

Question 5

Panic Disorder

Answer 5

• Individual anxiety attacks of 15-20 min
• Somatic + cognitive (worried about death)

-PFC unable to regulate hyperactive amygdala

Tx - SSRIs for long term and benzos for short term attacks
(Usually go away w/ tx but harder to get rid of avoidance of situations that may trigger attacks)

Question 6

Generalized Anxiety Disorder

Answer 6

• 6+ mo of worry causing impairment
• Musc tension, poor conc, insomnia
• Not so much amygdala involvement
• Chronic, wax and wane
• Tx - Short term benzo; long term SSRIs; CBT

Question 7

Specific Phobias

Answer 7

• Fear/avoidance of specific thing (may be due to past trauma)
• Somatic symptoms are rapid
• Often only mild functional impairment so do not present
• Straight behavioral approach NOT SSRIs

Question 8

Social Anxiety

Answer 8

-Fear crowds b/c afraid of humiliation or embarrassment

Tx - CBT (esp in groups), SSRIs, Beta blockers for performance

Question 9

OCD

Answer 9

Intrusive thoughts (obsession) & rituals/behaviors (compulsions)

Tx - HIGH dose SSRIs & ERP

Question 10

Body Dysmorphic Disorder (BDD)

Answer 10

• Preoccupied w/ imagined body defect
• 1/3 become home bound
• 80% have co-morbid mood disorder
• Tx - HIGH dose SSRIs & ERP