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Neuron, Brain, and Behavior (III) > Anxiety Disorders (Tamburello) - 10/11/16 > Flashcards

Anxiety Disorders (Tamburello) - 10/11/16 Flashcards

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1
Q

Anxiety

A
  • Sense of uneasiness or distress about future uncertainties
  • Universal experience; not a mental disorder per se
  • While unpleasant, can be essential for adaptive functioning
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2
Q

Describe the anxiety-performance curve.

A
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3
Q

What are the two manifestations of anxiety?

A
  1. Psychic anxiety (mental)
  2. Somatic anxiety (physical)
  • Fluttering in chest
  • Butterflies in stomach
  • Jitters
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4
Q

List the components of the fear circuit

A

Sensory afferents

Hippocampus

Amygdala

Prefrontal Cortex

Hypothalamus

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5
Q

List the neurotransmitters associated with anxiety and their affect on anxiety.

A
  1. GABA (decrease)
  2. NE (increase)
  3. DA (increase)
  4. Serotonin (decrease/increase)
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6
Q

List substances associated with anxiety. (7)

A
  1. Stimulants/Caffeine
  2. Decongestants
  3. Asthma medications (i.e. albuterol)
  4. SSRIs (i.e., Fluoxetine/Prozac)
  5. Marijuana
  6. Corticosteroids
  7. Sodium lactate (in panic disorder)
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7
Q

Substance Use/Withdrawal and Anxiety (4)

A
  1. Opiates
  2. Cocaine
  3. Alcohol
  4. Benzodiazepines

*Alcohol and benzodiazepines potentiate GABA so when users are in withdrawal, can become anxious

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8
Q

Behavioral Theory vs. Cognitive Theory for anxiety

A

Behavioral Theory:

  • Anxiety may be learned
    • Classical conditioning
    • Operant conditioning (avoidance behaviors in abusive situations)
  • Treatment - aimed at extinguishing avoidance behaviors

Cognitive Theory:

  • Anxiety related to cognitive distortions
    • ​Examples:
      • Jumping to conclusions (i.e. “I’m going to fail this test”)
      • Overestimating severity of the event (i.e. “This is the end of my life”)
      • Underestimating coping abilities
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9
Q

Generalized Anxiety Disorder (GAD) description and features

A

Description

  • DSM-5: “Excessive anxiety and worry occurring more days than not for at least 6 months, about more than one event or activity”
    • Persistent, excessive anxiety for “everyday stressors”
    • “Free-floating” anxiety
  • Focus of anxiety not confied to the features of another mental disorder (such as fear of having a panic attack)
  • Not due to direct physiological effects of a substance or another medical condition (if you get anxious when you use cocaine, that is not GAD)

Features

  • Lifetime prevalence: 4-7%
  • More common in women
  • Usual onset: early 20s
  • May present with somatic symptoms
  • Overlap with MDD (80% co-morbidity)
    • Strongly tied to general levels of stress
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10
Q

Panic Attacks

A

Abrupt surge of intense fear or discomfort that peaks within minutes with four or more of teh following symptoms:

Physical symptoms

Palpitations

Sweating

Trembling or shaking

Shortness of breath (smothering sensation)

Feelings of choking

Chest pain or discomfort

Nausea or abdominal distress

Feeling dizzy, unsteady, lightheaded, or faint

Chills or hot flashes

Mental symptoms

Derealization or depersonalization (i.e. whatever is happening is not happening)

Fear of losing control or going crazy

Fear of dying

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11
Q

Generalized vs. Panic Anxiety (graph)

A
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12
Q

Pain Attacks vs. Panic Disorder

A

Panic attacks in panic disorder are spontaneous.

  • Recurrent, unexpected panic attacks
  • Not due to physiological effects of a substance or medical condition
  • Lifetime prevalence: 2-5%
  • Women > Men
  • Onset: early 20s
  • Co-morbidities
    • MDD (50-65%) and other mood disorders
    • Other anxiety disoders (Patient can have both GAD and Panic Disorder if they meet the criteria for both)
    • Substance abuse disorders
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13
Q

Agoraphobia

A

“Fear of the marketplace”

Fear or avoidance of being helpless in a place where escape may be difficult or embarrassing (i.e. public transportation, crowds, theaters)

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14
Q

Phobia

A

A specific, unreasonable fear for an object or situation

Usual onset in childhood, F > M

Genetic component: 75% of persons witha phobia have a relative with a phobia

Anxious/avoidant personality traits common

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15
Q

Social Anxiety Disorder (Social Phobia)

A
  • Marked or persistent fear of social situations with risk of scrutiny by others
  • Only 12% of “shy” individuals meet criteria
  • Lifetime prevalence: 13%
  • Similar rates in men and women
  • Usually starts in adolescence
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16
Q

Performance Anxiety

A
  • Specifier for social phobia in DSM-5
  • Limited to specific performance situations (i.e. stage fright)
  • Beta-blockers (e.g., propranolol) may be helpful
17
Q

Separation Anxiety Disorder

A
  • More common in children (~4%) but may also occur as new-onset illness in adults (~2%)
  • Attachment figure:
    • Usually a parent in children
    • Usually spouse or friend in adults
  • Duration needed to diagnose:
    • 4 weeks of symptoms in children
    • 6 months of symptoms in adults
18
Q

Obsessive-Compulsive and Related Disorders (5)

A
  • Obsessive-Compulsive Disorder (OCD)
  • Body dysmorphic disorder
  • Hoarding disorder
  • Trichotillomania (hair-pulling)
  • Excoriation disorder (skin-picking)
19
Q

Obsession vs. Compulsion

A

Obsession: recurrent and persistent thoughts, impulses, or images that are experienced as intrusive and unwanted, and provoke anxiety

  • Contamination (germs are everywhere)
  • Self-doubt
  • Agressive or sexual thoughts
  • Order or symmetry (things have to be a particular way)

Compulsion: repetitive behaviors (or mental rituals) one engages in with the goal of reducing the anxiety associated with obsessions

  • Checking
  • Counting
  • Washing
  • Arranging (in response to obsession of symmetry)

Compulsion is a behavior that is usually done in response to an obsession. Obsession inc. anxiety while compulsion dec. anxiety.

20
Q

Obsessive-Compulsive Disorder (OCD)

A

Chronic obsessions and compulsions that cause significant distress, interfere with functioning, or are excessively time consuming

“Time consuming” = greater than 1 hour per day

  • Only psychatric disorder than can be corrected with surgery (e.g. cingulotomy)
  • Not the same as OCPD (no true obsessions or compulsions, more personality driven for following rules, morality)
21
Q

Hoarding Disorder

A
  • Before DSM-5, hoarding listed as an OCD “compulsion”
  • Animal hoarding = well-known subtype (but not in DSM)
  • Onset of hoarding behavior in childhood but impairment is progressive
22
Q

Body Dysmorphic Disorder

A
  • Preoccupation with an imagined or exaggerated body defect (not an eating disorder)
    • Example: feet are too big or freckle too big (distress is exaggerated)
  • “Delusional” level of belief
  • Onset: early teens
23
Q

Traumatic Stress

A
  • Psychological symptoms following a severe trauama (e.g. atrocities, rape, combat)
  • Symptoms happen so often that they cannot be dismissed as personal weakness
    • 50% have acute stress symptoms after a serious trauma
    • 50% have symptoms that persist beyond one month (a lot of stress traumas go away after one month)
24
Q

PTSD

  1. Diagnostic Elements
  2. Risk Factors
  3. Comorbidities
  4. Treatment
A
  1. Diagnostic Elements
    1. Severe trauma
    2. Re-experiencing the trauma
    3. Avoidance of reminders
    4. Negative changes in thinking/mood
    5. Hyperarousal (easy arousal)
    6. Chronicity (>1 month)
  2. Risk Factors
    1. Severity and nature of trauma
    2. Feeling of “powerlessness”
    3. Genetic/personality factors
    4. Early traumatic experiences
    5. Less supportive environments
  3. Comorbidities
    1. MDD and other mood disorders
    2. Phobic and other anxiety disorders
    3. Substance abuse disorders
  4. Treatment
    1. CBT
    2. Group therapy (survivors)
      1. Single-session “debriefing” may be harmful
    3. Eye Movement Desensitization and Reprocessing (EMDR)

Neuron, Brain, and Behavior (III) (23 decks)

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