Anxiety Disorders: Pathophysiology, Clinical Presentation and Treatment Flashcards
Explain current understanding of the biological basis of anxiety and anxiety disorders and important neuroanatomy.
altered prefrontal cortical and amygdala interaction also dysregulated brainstem and amygdala responses
Explain current understanding of the biological basis of anxiety and anxiety disorders regarding important neurotransmitters.
decreased GABA inhibitory tone along with noradrenergic and serotonergic systems involved in stress response
Explain current understanding of the biological basis of anxiety and anxiety disorders including detail about the HPA axis.
chronic stress can lead to abnormal activation of the HPA axis leading to depression anxiety, hypertension, DM, osteoporosis, suppressed immunity and memory impairment; CRF receptors found in many regions of brain (regulates ANS)
Explain current understanding of the biological basis of anxiety and anxiety disorders and their connection to anxious temperament.
Anxious temperament is behavioral inhibition (freezing) in response to novel situations, used to predict future anxiety disorder, depression and drug abuse
List the diagnostic criteria and specific mechanisms for generalized anxiety disorder.
Worry excessively daily about ordinary things for at least 6mo
Worries are difficult to control and associated with at least 3 of:
• Restlessness
• Easily fatigued
• Difficulty concentrating
• Irritability
• Muscle tension
• Sleep disturbance
Producing impairment and attributable to substance or better explained by another mental disorder
mechanism largely unknown, due to NE, GABA, 5-HT disturbances in frontal lobe and limbic system; environment is important in its development
List the diagnostic criteria and specific mechanisms for panic attack.
Recurrent, unexpected panic attacks with at least 1mo of worry about future attacks/ behavior change
Panic attacks can occur in many mental illnesses:
• Palpitations, sweating
• Trembling, chills/heat
• Feeling dizzy or faint
• SOB, sensation of choking or chest pain/discomfort
• GI distress
• Parasthesias
• Derealization, fear of loosing control or dying
Agoraphobia may be co-morbid
theories on etiologies include • Increased catecholamines • Abnormal locus ceruleus • CO2 hypersensitivty • Disturbance in lactate metabolism • Abnormal GABA neurotransmitter syst
List the diagnostic criteria for obsessive compulsive disorder.
Obsessions: recurrent, persistent ideas, thoughts, impulses or images as intrusive and inappropriate (create anxiety)
Compulsions: repetitive and intentional behaviors performed in response to obsessions or according to certain mental rules (relieves anxiety)
Symptoms are often ego-dystonic
Mechanisms: focus on serotonergic systems
Recognize substance and medication induced as well as other medical etiologies of anxiety.
substance or medication: Caffeine, excessive stimulants, alcohol withdrawal, sedative-hypnotic withdrawal; Albuterol, steroids, thyroid meds, bupropion, methylphenidate, decongestants
medical etiologies: hyperthyroidism, hyperparathyroidism, pheochromocytoma, hypoglycemia, cardiac arrhythmias, mitral valve prolapse, MI and pulmonary emoblus
Describe the epidemiology and risk factors for anxiety disorder
average age of onset is early adulthood, prevalence higher in higher SES, GAD is more common in women
Describe the epidemiology and risk factors for panic disorder.
average age of onset is early adulthood, prevalence higher in higher SES
Give a d/dx for anxiety disorder.
Tourette’s Tic disorders Temporal lobe epilepsy Schizophrenia Obsessive compulsive personality disorder Phobia Depressive disorders hypochondriasis
depressive disorder somatic symptom disorder phobias PTSD depersonalization
Compare the prognosis for GAD, panic disorder and OCD.
about a ⅓ move past symptoms about a ⅓ learn to cope with their symptoms and about ⅓ continue to have difficulty with their symptoms
List the medication treatments available for anxiety disorders.
Panic disorder: SSRIs are 1st line; SNRIs, older TCA and MOAI are not tolerated as well
GAD: SSRIs 1st line, SNRIs and benzos (danger of withdrawal)
OCD: SSRIs 1st line, clomipramine for resistent cases (high adverse effects)
List the psychotherapy treatment options available for anxiety disorders.
cognitive behavioral therapy, deep breathing, progressive muscle relaxation, imagery, exposure therapy (panic disorder), exposure and response prevention and family therapy
Recognize the clinical presentations of social phobia and specific phobias.
Agoraphobia may be co-morbid with panic disorder: intense anxiety about public transport, being in open spaces, being in enclosed spaces, standing in line or in a crowd or being outside of home alone (2 or more)
phobias can often present like generalized anxiety disorder, that are trigger by
