Anxiety Disorders Flashcards
How are anxiety disorders classified in the DSM-5?
These disorders are characterized by: Fear = emotional response to real or perceived imminent threat. Anxiety = anticipation of future threat.
How are trauma and stressor-related disorders classified in the DSM-5?
Exposure to traumatic or stressful event is required for the diagnosis of these disorders, which are characterized by a variable combination of:
- Anxiety or fear
- Anhedonia & dysphoria
- Aggressiveness
- Dissociative symptoms.
How are obsessive compulsive disorders classified in the DSM-5?
These disorders are characterized by: Obsessions = recurrent persistent thoughts, urges, or images that are experienced as unwanted. Compulsions = repetitive behaviours or mental acts performed in response to obsessions or according to rigid rules.
What is a fear response?
Fear is an adaptive response. Reaction involves several components: Psychological (feelings) Physiological (i.e. HR) Cognitive (attention, concentration etc) Behavioural (freezing or running away).
What are the anxiety disorders outlined in the DSM-5?
♣ Separation Anxiety Disorder – babies being separated from mums
♣ Selective Mutism – normally children display this, choosing not to speak
♣ Specific Phobia
♣ Social Anxiety Disorder (social phobia) [where do we draw the line?]
♣ Panic Disorder* (specifier for other disorders)
♣ Agoraphobia – being afraid of being in open spaces
♣ Generalized Anxiety Disorder (GAD)
♣ Substance/Medication-Induced Anxiety Disorder
♣ Anxiety Disorder due to another medical condition
♣ Other Specified Anxiety Disorder
♣ Unspecified Anxiety Disorder
*Highly comorbid but differentiated from each other.
What is the prevalence of anxiety disorder?
12 month - 18.1%. Lifetime - 28.85% (USA), 13.6% (EU).
What did Stahl, 2013 find?
Core features are anxiety and worry. Then can have a combo of other symptoms to distinguish between different anxiety disorders. For MDD, core features are depressed mood and anhedonia.
What are the core features of social anxiety disorder?
Core features are social/performance anxiety/fear and worry about exposure. This is associated with expected panic attacks and phobic avoidance/behavioural change.
What are the core features of GAD?
Core symptoms of generalised anxiety/fear and generalised worry. Associated with concentration problems, fatigue, irritability, muscle tensions, sleep deprivation.
What are the core features of panic disorder?
Core features are anticipatory anxiety/fear and worry about panic attacks. Associated with unexpected panic attacks and phobic avoidance/behavioural change.
What are core features of PTSD?
Core symptoms are anxiety/re-experiencing event and worry. Associated with arousal, lack of sleep and avoidance.
What are specific phobias?
Triggered by specific objects or situations (Blood-injury-injection phobia – does the opposite to normal phobia, as blood pressure goes down and people faint, as opposed to other phobia where heart rate increases etc.). Most common is arachnophobia. Twice as many females compared to males. Fear varies with proximity – active avoidance. Usually multiple diagnoses (on average 3 diagnoses). 75% fear more than one things/situations.
Why do we fear?
Loud noises frighten everyone, animals, heights, or separation from loved ones. J.B. Watson: Fears are learned – if we see others being afraid, we are going to learn to be afraid of it also. Exaggerated fear for not so threatening events or things.
What did Clark, 1986 say about panic disorder?
Very sensitive to their bodily functions, e.g. accurate at detecting heart rate, and wrongly misinterpret small changes (catastrophic interpretation) which causes fear and anxiety. Associated with the development of anticipatory anxiety and agoraphobia.
What is the heritability of anxiety disorders?
Panic disorder - 43%. GAD - 28%. Not highly heritable, lots of room for environmental input.
What are risk factors for anxiety disorders?
Environmental and genetic factors (interaction). Across anxiety disorders. Negative Affect (Neuroticism) is believed to be a risk factor. Childhood experiences (exception GAD) – is it just one experience or continuous exposure?Panic disorders - smoking and stressors preceding the 1st panic attack. Sexual dimorphism – lots more women than men (COMT gene). Heritability varies, i.e. 61% agoraphobia, SAD 2-6x greater risk for first degree relatives.
What is COMT?
Degrades dopamine in the prefrontal cortex. Has different variations - Met or Val alleles. Met (low activity COMT thus more DA in the PFC) - makes them more susceptible to worry and be diagnosed with anxiety disorder. Women are more likely to carry this. Val (high activity of COMT thus less DA in the PFC) - able to battle anxiety and survive a stressor.
What are BDNF polymorphisms?
Allele Val66Met has been associated with increased risk for anxiety disorders (Yu et al 2009). Atypical activity in frontal cortex and amygdala. Impaired extinction of conditioned fear memory
Harrisberger et al 2015 - Meta-analysis: confirmed that neuropsychiatric patients had smaller hippocampal volumes compared to healthy controls, regardless of the genotype – doesn’t seem to be related.
What is the phenotype of anxiety?
Have fear aspect – panic, phobia. Fear is amygdala-centred, quick to respond. And have worry aspect – anxious misery, apprehensive expectation, obsessions. This involves cortio-striato-thalamo-cortical circuits. Hippocampus – we remember where we were when we had fearful response. Increases cortisol levels, makes our heart beat fast etc. – can lead to health problems if chronic. Amygdala communicates and has to do with autonomic nervous system – can increase heart rate which can lead to problems e.g. heart disease, hypertension, arrhythmia, and sudden death. Respiratory fear response in the Parabrachial Nucleus – leads to Bronchospasm: ‘fast’ breathing. Increase breathing because we may need to run away (flight).
