Anxiety Disorders - al'Absi

Question 1

What is the definition of anxiety?

Answer 1

• Feeling of apprehension and fear
• Source of feeling can be concrete or imagined

Question 2

How does the Yerkes-Dodson Curve show that anxiety is useful?

Answer 2

Anxiety is a continuum → some anxiety is good and increases performance, however too much will then decrease performance.

Question 3

What are the three categories of Anxiety-Related Disorders in DSM-5?

Answer 3

• Anxiety
  
  • GAD, Panic Disorder, Agoraphobia, Social Phobia
• Obsessive-Compulsive and Related Disorders
  
  • Hoarding, Trichotillomania
• Trauma and Stressor-Related
  
  • PTSD, Adjustment, Reactive Attachment

Question 4

What is a panic attack?

Answer 4

• 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

Question 5

Are panic attacks more prevalent in women or men?

Answer 5

4x more prevalent in women than men

Question 6

What is agoraphobia?

Answer 6

Marked anxiety/distress when leaving home, being in public places, or feared situations.

Question 7

What condition is agoraphobia typically comorbid with?

Answer 7

Panic disorder

Question 8

What is the life prevalence rate for panic disorder?

Answer 8

1.5%

Question 9

What is the life prevalence rate for agoraphobia?

Answer 9

2.7%-5.8%

Question 10

When is the typical age of onset of panic disorder/agoraphobia?

Answer 10

late teens - early thirties

Question 11

What is the prevalence of anxiety disorders in the general population? Primary care? Cardiology?

Answer 11

General pop’n = 3.5%

_{Primary care = 6-10%}

_{Cardiology = 30-50%}

Question 12

What is social phobia?

Answer 12

Intense fear of being humiliated socially, specifically embarrassing yourself.

Question 13

What is the lifetime prevalence of social phobia?

Answer 13

3% - 13%

Question 14

When is the typical onset of social phobia?

Answer 14

during childhood ~16 yoa

Question 15

What is specific phobia?

Answer 15

• 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

Question 16

What is the prevalence of specific phobias? Is it greater in men or women?

Answer 16

• Prevalence rate = 5-12%
• More prevalent in women than in men

Question 17

What are obsessions?

Answer 17

unwanted, recurrent, disturbing thoughts, impulses, or images that cannot be suppressed and can cause overwhelming anxiety

Question 18

What are compulsions?

Answer 18

repetitive, ritualized behaviors that person feels compelled to perform to alleviate the anxiety of obsessions

Question 19

What is the diagnostic criteria for Obsessive Compulsive Disorder?

Answer 19

• 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

Question 20

What is the prevalence of Obsessive Compulsive Disorder?

Answer 20

2-3%

(comorbidity with depression and panic disorders)

Question 21

How does the Two-Factor Learning Theory explain the etiology of anxiety disorders?

Answer 21

• Fear provoking event + neutral stimulus → avoidance/fear
• This leads to avoidance and fear of a neutral stimulus

Question 22

What behavioral factors contribute to the etiology of anxiety disorders?

Answer 22

• 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

Question 23

What is the genetic/familial factor prevalence in OCD?

Answer 23

• Concordance is 75% in monozygotic twins
• Concordance is 32% in dizygotic twins
• 5x as high in relatives of OCD patients

Question 24

What neurotransmitters/hormones are important to recognize in anxiety disorders?

Answer 24

• 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

Question 25

What regions of the brain show high activity in panic disorder and can be viewed in Positron-emission tomography (PET)?

Answer 25

• Temporal cortex
• Hippocampus
• Amygdala

Question 26

What regions of the brain show increased metabolic activity in OCD?

Answer 26

Caudate nucleus and orbital gyrus

(Serotonin & Dopamine)

Question 27

What are the three majory treatment options for Anxiety Disorders?

Answer 27

• 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