Anxiety Disorders Flashcards
Fxn of amygdala
Processing emotionally salient stimuli (central in anxiety)
Fxn of medial PFC
Includes ACC, subcallosal cortex, and medial frontal gyrus, modulates affect
Fxn of hippocampus
Memory encoding and retrieval
Psychodynamic model of anxiety
Anxiety is a signal of presence of danger in unconscious – result of psychic conflict between sexual/aggressive wishes and corresponding threats from superego or external reality (never verified)
Behavioral model of anxiety
Anxiety is a conditioned response to a specific stimulus
Cognitive behavioral model of anxiety
On top of behavioral model, also has to do with how one perceives threats (overpercieves danger and underestimates coping skills)
CBT is effective for…
Panic, social anxiety, PTSD
Exposure therapy is effective for…
Agora and specific phobias
Exposure therapy + response prevention is effective for…
OCD
Medical conditions assc w anxiety
Endocrinopathies, cardiac, respiratory
Medications that can cause anxiety
Corticosteroids, OCP, inhalers, decongestants, SSRIs
Drugs of abuse that can cause anxiety
CAFFEINE, cocaine, MJ, MDMA, alcohol
W/drawals assc. w anxiety
CAFFEINE, cocaine, MJ, alcohol, beta blockers, corticosteroids
Panic attack criteria
Discreet period of intense fear/discomfort w/ 4+ of following developed quickly and peaking in minutes:
- Palpitations, pounding heart
- Sweating
- Trembling, shaking
- SOB or smothering
- Choking feeling
- Chest pain/discomfort
- Dizziness
- Abdominal distress
- Chills/hot flashes
- Feelings of unreality
- Fear of losing control or going crazy
- Fear of dying
- Paresthesias
Panic Disorder criteria
- Reccurent, unexpected panic attacks
- At least 1 mo of persistent concern about another attack, worry about possible implications/consequences, or significant behavioral change re: to attacks
- Panic attacks not due to physiologic effects of substance/med condition
- Attacks not accounted for by another disorder
Neurotransmitters involved in panic
NE, 5HT, GABA
Neuroanatomy of panic
Brain stem: fires to create ANS symptoms
Amygdala/limbic system: anticipatory anxiety
PFC: phobic avoidance
Panic Tx
- Elimination of alcohol/drugs/caffeine/OTC stims etc from diet
- CBT
- SSRIs, Venlafaxine, TCAs, benzos
- FDA APPROVED: Fluoxetine, Paroxetine, Sertraline, Alprazolam, Clonazepam
Agoraphobia criteria
Marked fear/anxiety for 6+ mo about 2+: - Public transportation - Open spaces - Encloses spaces - Standing in line/in a crowd - Being outside of the home alone Because escape may be difficult or help unavailable
Agoraphobia tx
Exposure therapy, CBT (NO MEDS!)
Specific phobia tx
Systematic desensitization (delayed by alcohol)
Social anxiety disorder criteria
Fear/avoidance of social situations where individuals exposed to scrutiny by others – fears that they will act in a way or show anxiety –> negative evaluation; feared situations avoided or endured w/ extreme fear/anxiety and interferes w/ work, social, family activities; persists 6+ mos
Social anxiety disorder tx
- Social skills training, behavior therapy
- CBT
- FDA APPROVED: Paroxetine, sertraline (SSRIS) and venlafaxine
Generalized anxiety disorder criteria
Excessive anxiety and worry more days than not for 6+ mos about many events that is difficult to control, 3+ of:
- Restlessness/feeling keyed up or on edge
- Easily fatigued
- Difficulty concentrating
- Irritability
- Muscle tension
- Sleep disturbance
And causes significant distress/impairment
GAD Tx
Medications: Busipirone, benzos, antidepressants (SSRIs, venlafaxine, imipramine)
CBT
PTSD Diagnostic criteria
Exposure to actual or threatened death in 1+ of the following:
- Direct experiencing of event
- Witnessed in person event as it occured to others
- Learning event happened to someone close to them
- Experiencing repeated/extreme exposure to aversive details of trauma
After the event, 1+:
- Recurrent, involuntary and intrusive memories of event
- Recurrent trauma-related nightmares
- Dissociative rxns
- Intense physiological distress at cue exposure
- Marked physiological reactivity at cue exposure
Persistent avoidance by one or both:
- Avoidance of distressing memories, thoughts, feelings of event
- Avoidance of external reminders that arouse memories of event
Negative alterations in mood assc w events as evidenced by 2+:
- Inability to remember important aspect of event
- Persistent distorted cognitions about cause/consequence of event that lead to blame of self or others
- Persistent negative emotional state
- Marked diminished interest
- Feeling detached from others
- Persistent inability to experience positive emotions
Marked alterations in arousal/reactivity w/ 2+:
- Irritable behavior and angry outbursts
- Reckless/self-destructive behavior
- Hypervigilence
- Exaggerated startle response
- Problems w/ concentration
- Sleep disturbance
Duration of disturbance is greater than 1mo and causes significant impairment in fxn
PTSD Specifiers
Dissociative symptoms (derealization or depersonalization) Delayed expression (don't meet criteria until >6mos after event)
Biologic considerations in PTSD
Increased activity of NE system and hyperregulation of HPA axis
PTSD Tx
CBT, exposure, trauma informed CBT
Group therapy
Medications – antidepressants, mood stabilizers, beta blockers, clonidine, prazosin
Acute stress disorder criteria
> 9 checks from PTSD features of intrusion, negative mood, dissociation, avoidance, and arousal related to trauma, but duration is 3days to 1mo after trauma; significant impairment
Acute stress disorder tx
CBT…maybe beta blockers
Adjustment disorders criteria
Development of emotional/behavioral symptoms in response to an identifiable stressor w/in 3 mos of stressor
Symptoms are clinically significant and evidenced by 1+ of:
- Marked distress out of proportion to severity/intensity of stressor
- Significant impairment in social, occupational, or other important areas of fxning
When stressor is terminated, symptoms do not last more than 6 mos
Adjustment disorder specifiers
W/ depressed mood: low mood, tearfulness/feelings of hopelessness predominant
W/ anxiety: nervousness, worry, jitteriness, or separation anxiety predominant
W/ mixed anxiety and depression: combination predominant
W/ disturbance of conduct: DOC predominant
W/ mixed disturbance of emotion and conduct
Adjustment disorder tx
Counseling/supportive therapy, crisis interventions, family/group therapy, CBT; pharmacotherapy for brief symptomatic tx of anxiety or sleep disturbance
OCD Criteria
Obsessions defined by:
- Recurrent/persistent thoughts, urges, or images that are experienced at some point during the disturbance as intrusive/unwanted and cause marked anxiety or distress
- Individual attempts to ignore/suppress thoughts or neutralize them w/ other thought/action (i.e. compulsion)
Compulsions as defined by:
- Repetitive behaviors (e.g. hand washing) or mental acts (e.g. counting) that the person feels driven to perform in response to an obsession/according to rigidly applied rules
- Behaviors/acts aimed at reducing disress or preventing some dreaded event or situation, but not connected realistically w/ what they’re designed to fix or are excessive
Obsessions/compulsions are time consuming or cause clinically significant distress/impairment in fxn
Specify if w/ good/fair insight, poor insight, or absent insight
PANDAS
Pediatric Autoimmune Neuropyschiatric Disorders Associated w Streptococcus infxns
OCD Tx
Behavioral: exposure + response prevention
Pharmacotherapy: Comipramine and SSRIs
Neurosurgery: cingulotomy (tx refractory), or capsulotomy
Body dismorphic disorder criteria
Preoccupation w perceived defect(s) or flaw(s) in physical appearance that are not observable or appear slight to others
At some point in course of disorder, repetitive behaviors or mental acts in response to appearance concern
Specify if good or fair or poor insight, w/ w/o delusional beliefs
BDD tx
CBT, SSRIs (not FDA app)
Hoarding disorder criteria
Persistent difficulty discarding/parting w/ possessions regardless of actual value
Difficult is due to perceived need to save the items and distress assc w discarding them
Possessions accumulate to congest/clutter libing areas and compromise intended use of areas
Hoarding disorder tx
Behavioral therapies, SSRIs (not FDA app)
Tricotillomania criteria
Recurrent pulling out of ones hair resulting in hair loss
Repeated attempts to stop hair pulling
Trichotillomania perpetuating behaviors
Negative emotions – hair pulling is a way of dealing w/ negative or uncomfortable feelings
Positive reinforcement – hair pulling provides sense of relief
Trichotillomania tx
Psychotherapies, no FDA indicated tx (maybe clomipramine or SSRIs)
Excoriation disorder criteria
Recurrent skin picking resulting in lesions
Repeated attempts to decrease or stop skin picking
Excoriation disorder tx
CBT, acceptance and commitment therapy, no FDA app meds (but SSRI’s – fluoxetine, fluvoxamine, and escitalopram)
