Anxiety Disorders - al'Absi Flashcards
What is the definition of anxiety?
- Feeling of apprehension and fear
- Source of feeling can be concrete or imagined
How does the Yerkes-Dodson Curve show that anxiety is useful?
Anxiety is a continuum → some anxiety is good and increases performance, however too much will then decrease performance.
What are the three categories of Anxiety-Related Disorders in DSM-5?
- Anxiety
- GAD, Panic Disorder, Agoraphobia, Social Phobia
- Obsessive-Compulsive and Related Disorders
- Hoarding, Trichotillomania
- Trauma and Stressor-Related
- PTSD, Adjustment, Reactive Attachment
What is a panic attack?
- Hallmark of panic disorder
- Intense fear
- Physical symptoms → heart palpitations, dizziness, difficulty breathing, terror
- Occur unexpectedly
- no actual threat; unexplained
- Fight or flight is INAPPROPRIATELY aroused
- Pt feels like they are losing control, overwhelming feeling of stuff crashing in
Are panic attacks more prevalent in women or men?
4x more prevalent in women than men
What is agoraphobia?
Marked anxiety/distress when leaving home, being in public places, or feared situations.
What condition is agoraphobia typically comorbid with?
Panic disorder
What is the life prevalence rate for panic disorder?
1.5%
What is the life prevalence rate for agoraphobia?
2.7%-5.8%
When is the typical age of onset of panic disorder/agoraphobia?
late teens - early thirties
What is the prevalence of anxiety disorders in the general population? Primary care? Cardiology?
General pop’n = 3.5%
Primary care = 6-10%
Cardiology = 30-50%
What is social phobia?
Intense fear of being humiliated socially, specifically embarrassing yourself.
What is the lifetime prevalence of social phobia?
3% - 13%
When is the typical onset of social phobia?
during childhood ~16 yoa
What is specific phobia?
- Excessive fear is presence or anticipation of an object or situations
- Exposure to stimulus provokes immediate anxiety response, often in the form of panic attacks
- Patient recognizes the the fear is excessive
What is the prevalence of specific phobias? Is it greater in men or women?
- Prevalence rate = 5-12%
- More prevalent in women than in men
What are obsessions?
unwanted, recurrent, disturbing thoughts, impulses, or images that cannot be suppressed and can cause overwhelming anxiety
What are compulsions?
repetitive, ritualized behaviors that person feels compelled to perform to alleviate the anxiety of obsessions
What is the diagnostic criteria for Obsessive Compulsive Disorder?
-
Recurrent obsessions or compulsions that are time consuming (more than 1 hour per day) or cause significant distress/impairment
- Patient recognizes the obsessions/compulsions as being excessive or unreasonable
What is the prevalence of Obsessive Compulsive Disorder?
2-3%
(comorbidity with depression and panic disorders)
How does the Two-Factor Learning Theory explain the etiology of anxiety disorders?
- Fear provoking event + neutral stimulus → avoidance/fear
- This leads to avoidance and fear of a neutral stimulus
What behavioral factors contribute to the etiology of anxiety disorders?
- Avoidance behavior is reinforced by the reduction of anxiety
- Information processing problems
- Lack of social skills
- Hypersensitivity to criticism or rejection
- Early unpleasant social performance experiences
What is the genetic/familial factor prevalence in OCD?
- Concordance is 75% in monozygotic twins
- Concordance is 32% in dizygotic twins
- 5x as high in relatives of OCD patients
What neurotransmitters/hormones are important to recognize in anxiety disorders?
- GABA → most inhibitory, dysfunction leads to anxiety
- 5-HT
- NE → alpha or beta-nergic activation can produce panic attack
- CRH
- Adenosine
- Neuropeptides (substance Y, endogenous opiods)
- Glucose metabolism byproducts
What regions of the brain show high activity in panic disorder and can be viewed in Positron-emission tomography (PET)?
- Temporal cortex
- Hippocampus
- Amygdala
What regions of the brain show increased metabolic activity in OCD?
Caudate nucleus and orbital gyrus
(Serotonin & Dopamine)
What are the three majory treatment options for Anxiety Disorders?
- Behavioral Therapy
- Response prevention, exposure to anxiety-provoking stimuli, stress inoculation training
- Cognitive Therapy
- identify triggers, educate, intrusive images, stopping safety behaviors
- Pharmacological Therapy
- Tricyclic antidepressants (Imipramine)
- SSRIs (Fluoxetine/Prozac)
- Benzos (Alprazolam/Xanax
