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OS6- Psychiatry > Anxiety Disorders: Biophyschosocial Aspects and Clinical Manifestations > Flashcards

Anxiety Disorders: Biophyschosocial Aspects and Clinical Manifestations Flashcards

1
Q

Major mediators of the sx of anxiety disorders

A
  • Locus coeruleus-norepinephrine system
  • serotonin
  • dopamine
  • GABA-benzodiazepine receptor complex
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2
Q

Serotonin deficiency seen in ________. Serotonin overactivity seen in _______ states

A

depression; anxiety

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3
Q

•Locus Coeruleus central to modulating _____

A

•vigilance, attention and anxiety or fear

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4
Q

The amygdala receives what type of input?

A

excitatory glutamatergic thalamic and cortical input

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5
Q

The amygdala sends caudal projections to…

A
  • NA neurons of LC
  • DA neurons of VTA
  • 5HT neurons of raphe nuclei
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6
Q

Amygdala connections

A
  • Cortical areas – fear, cognitive misappraisal
  • PAG – escape and freezing
  • Parabrachial nucleus – Hyperventilation
  • Lateral hypothalamus – Sympathetic activation
  • PVN of hypothalamus – Endocrine activation
  • DMN of the vagus – GI distress
  • Nucleus Caudalis pontis - ↑ startle
  • Striatum – Motor activation
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7
Q

•Panicogenic agents

A
  • Sodium Lactate in 2/3 of those with PD
  • 5% Carbon dioxide inhalation- CO2 hypersensitivity
  • Sodium bicarbonate
  • Isoproterenol (Isuprel)
  • Doxapram (adrenergic agonist/carotid chemoreceptor)
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8
Q

•H-P-A activating anxiogens

A
  • Yohimbine- alpha 2 antagonist
  • M-chlorophenylpiperazine (mCPP)
  • Fenfluramine
  • Beta- carboline
  • CCK-cholecystokinin agonists
  • ↑firing in LC, + HPA axis, interacts with GABA
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9
Q

Respiratory panic inducing substaNCES CAUSE RESPIRATORY STIMULATION AND A SHIFT IN THE _________.

A

ACID BASE BALANCe; INCLUDING CARBON DIOXIDE 5% TO 35% SOD LACTATE BICARBONATE.

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10
Q

Panic disorder PET scan

A
  • ↑flow R parahippocampal
  • ↓serotonin type 1A receptor binding in anterior & posterior cingulate/raphe
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11
Q

Panic disorder MRI scan

A

•↓temporal lobe volume despite normal hippocampal volume

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12
Q

Panic disorder CSF

A

•↑ orexin, aka hypocretin, which is thought to play an important role in the pathogenesis of panic in rat models

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13
Q

Cognitive theory of panic

A

that pts. have a ↑ sensitivity to internal autonomic cues (eg, tachycardia)

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14
Q

•Anxiety is neutralized by _________ or _________.

A

avoidance or compulsions

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15
Q

Freud: Panic disoders

A
  • A signal of threat to the ego
  • Symbolic or current events are similar to threatening developmental events (traumatic anxiety)
  • Repression was the primary defense against anxiety
  • When repression fails- hysteria, phobias and obsession-compulsions erupt
  • Superego anxiety, castration anxiety, separation anxiety and impulse anxiety
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16
Q

Separation anxiety disorder

A

Developmentally inappropriate, XS fear or ANXIETY/WORRY ABOUT SOMETHING HAPPENING TO THE MAJOR ATTACHMENT FIGURE (MAF)

17
Q

SAD Symptoms

A

at least 4 WEEKS in children/adolescent; 6 months or more in adults

18
Q

SAD- at least 3 of 8 symptoms/signs

A
  • Distress or reluctance
  • anticipating/experiencing SEPARATION from home or major attachment figures (MAF)
  • about losing MAF
  • About experiencing an UNTOWARD EVENT (e.g., getting lost, kidnapped, becoming ill) separation from the MAF
  • to go out
  • about BEING ALONE
  • To SLEEP AWAY FROM HOME or to go to sleep w/o MAF
  • Repeated NIGHTMARES @ SEPARATION
  • Repeated complaints of PHYSICAL SX WHEN SEPARATED
19
Q

Risk and prognostic factors: SAD

A
  • Often develops after LIFE STRESS esp. a loss
  • DEATH of a relative or pet
  • ILLNESS in patient or relative
  • CHANGE of schools
  • Parental DIVORCE
  • MOVE to a new neighborhood
  • IMMIGRATION
  • DISASTER THAT INVOLVED SEPARATION from major attachment figures
  • Heritability 73% in a community sample of 6 yr twins; ↑ F
20
Q

Selective mutism

A

}FAILURE TO SPEAK in spec. social situations

}Interferes w/ educational, occup. or social comm.

}DURATION IS AT LEAST 1 MONTH

}Failure to speak is not attributable to a lack of knowledge of or comfort with the spoken language required in the social situation

}Not better explained by a COMMUNICATION DISORDER (e.g., childhood onset fluency d/o)

21
Q

Panic disorder

A
  • Persistent worry about ANOTHER ATTACK
  • Change in behavior because of the attacks
  • Peak in 10 min
  • Associated with at least 4 other symptoms
22
Q

Panic disorder comorbidities

A
  • Persistent worry about ANOTHER ATTACK
  • Change in behavior because of the attacks
  • Peak in 10 min
  • Associated with at least 4 other symptoms
23
Q

Agoraphobia

A
  • Fear and avoidance in being in a situation that escape may be difficulty or they may not be able to get help
  • May not leave home or may need a companion
  • Can occur with and without panic disorder
24
Q

Social Phobia

A

Persistent, irrational fear of social situations

  • Marked avoidance of situations (humiliation or embarrassment)
  • Or marked anxiety under these situations
  • Recognized as not reasonable
25
Q

Comorbidity for social phobia

A
  • Comorbid with depression
  • Alcohol and drug use
  • Chronic but fluctuates
  • Worsened during stress
26
Q

•Acrophobia

A

•Fear of heights

27
Q

•Agoraphobia

A

•Fear of open places

28
Q

•Ailurophobia

A

•Fear of cats

29
Q

•Cynophobia

A

•Fear of dogs

30
Q

•Mysophobia

A

•Fear of dirt and germs

31
Q

•pyrophobia

A

•Fear of fire

32
Q

Comorbidity for GAD

A

•Comorbidity – affective disorder, panic disorder and agoraphobia – most common

33
Q

DSM-IV-TR criteria for GAD

A

•Anxiety or worry w/ 3 or more of 6 sx in adults; only 1 item needed in children

  1. Restlessness or “feeling keyed up” or “ on edge”
  2. Being easily fatigued
  3. Difficulty concentrating or mind going blank
  4. Irritability
  5. Muscle tension
  6. Sleep disturbance
34
Q

Panic disorder treatment

A
  • First line:
  • SSRIs

•Second line:

  • Nefazodone
  • Venlafaxine XR
  • Mirtazapine
  • reboxetine
35
Q

Social phobia treatment

A
  • Five SSRI
  • Paroxetine, fluvoxamine, fluxoetine,sertraline, citalopram
  • SNRI, nefazodone
  • Second or third line: MAOIs
  • bzd
  • Beta blockers
36
Q

Wrokup for panic disorder

A
  • Complete blood cell count
  • Chemistry profile
  • Thyroid function tests
  • Urinalysis
  • Urine drug screen
37
Q

Treatment for Acute anxiety

A
  • ED tx: short course fast acting bzd
  • Psychiatric consult- if danger present
  • Provide a calm environment
  • social support from family, friends, and the emergency staff are ideal.
38
Q

Chronic Anxiety Treatment

A
  • requires a comprehensive approach
  • the best pharmaco tx varies for each
  • outpt f/u with a psychiatrist is recommended.
  • discharged on a short course of bzd until they see a psychiatrist.
  • S/HI -emergent psychiatric eval in the ED.

OS6- Psychiatry (27 decks)

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