Anxiety Related Disorders Flashcards
1
Q
anxiety definition
A
negative mood state characterized by bodily symptoms of physical tension and apprehension about the future, not a normal response
2
Q
fear
A
emotion of an immediate alarm reaction to present danger or life threatening emergencies, normal response to objective threat, clearly delineated stimulus
3
Q
panic
A
sudden overwhelming fright or terror
4
Q
panic attack
A
abrupt experience of intense fear or discomfort accompanied by several physical symptoms such as dizziness or heart palpations
5
Q
expected panic attack (cued)
A
if you know you are scared of something you might have a panic attack when put into situations with that something, more common in specific phobias or social anxiety disorder
6
Q
unexpected panic attack (uncued)
A
do not have a clue when or where the next panic attack with occur, important in panic disorder
7
Q
panic attacks and genetics
A
tend to run in families, we inherit tendency to be uptight or anxious
8
Q
neurotransmitter system associated with anxiety
A
depleted levels of GABA
9
Q
panic disorder definition
A
recurrent panic attacks
10
Q
agorophobia
A
fear of being in crowds, public places or open spaces
11
Q
social phobia
A
fear of uncomfortable social interactions
12
Q
specific phobias
A
fear of heights, closed spaces, etc
13
Q
generalized anxiety disorder
A
excessive worrying
14
Q
seperation anxiety disorder
A
fear or separation from attachment figures
15
Q
what anxiety disorders were taken out of anxiety category in DSM-5
A
PTSD and OCD
16
Q
12 month prevalence of any anxiety disorder
A
total: 18.1
17
Q
12 month prevalence of any anxiety disorder
A
18.1
18
Q
12 month prevalence of serious anxiety disorder
A
22.8
19
Q
12 month prevalence of moderate anxiety disorder
A
33.7
20
Q
12 month prevalence of mild anxiety disorder
A
43.5
21
Q
12 month prevalence of any mood disorder
A
9.5
22
Q
12 month prevalence of serious mood disorder
A
45
23
Q
12 month prevalence of moderate mood disorder
A
40
24
Q
12 month prevalence of mild mood disorder
A
15
25
in 12 month prevalence, disorder that is most severe but rare (1 total)
OCD
26
most common anxiety disorder in general population
specific phobia
27
most common anxiety disorder among those seeking treatment/clinical help
panic disorder
28
estimate of population 18 and older that is affected by at least one type of anxiety disorder
18%
29
Freud objective anxiety
a natural response to realistic perception of external danger (fear)
30
Freud neurotic anxiety
"free floating" anxiety and when attached to specific object of situation, the product is phobia/angst (anxiety)
31
behavioral symptoms of anxiety
motoric uneasiness, hyper vigilance, screaming and crying, compulsive/escape avoidant behaviors such as shyness or school refusal
32
cognitive symptoms of anxiety
inattentiveness, distractibility, decreased performance in school, impaired memory
33
physiological symptoms of anxiety
increased HR, BP, electrodermal activity, enuresis, abdominal pain, tics
34
phobias- class definition
excessive and unreasonable responses leading to severe avoidance (while fears are considered a normal, adaptive reaction)
35
most common diagnosis given in childhood
phobias
36
specific phobia
persistent, irrational fear or and compelling desire to avoid an object or situation
37
social phobia
persistent, irrational fear of and compelling desire to avoid situations which could be evaluative, humiliating or embarrassing
38
DSM 5 criteria of phobia
-marked fear or anxiety about a specific object or situation typically lasting for 6 mo or more
-the phobic object/situation almost always provokes immediate fear or anxiety and is avoided with intense fear of anxiety
-the fear/anxiety is out of proportion to the actual danger posed by the specific object or situation
-fear, anxiety, avoidance causes clinically significant distress or impairment in social , occupational or other important areas of functioning
-disturbance not better explained by another disorder
39
social phobia tends towards
being more server than specific phobias but less common
40
normal infant fears
height, noise
41
normal 1-2 year old fears
strangers, toileting activities, of being injured, not yet afraid of snakes or dark
42
normal preschool (3-4) year old fears
animals, dark, strangers, being left alone, imaginary creatures (monsters)
43
as kids enter school, their fears
kids mature cognitively and their fears become more specific and realistic
44
normal elementary schools aged fears
small animals, dark, lightning, thunder, physical safety
45
normal middle school aged fears
more based in reality: academic, social, health related fears, bad grades, parental disproval
46
separation anxiety disorder
-excessive anxiety concerning separation from home or from those to whom the person is attached to
-anxiety is beyond what is expected for developmental level
-causes significant distress and impairments in daily functioning
-lasts for at least 4 weeks and begins before age 18
47
separation anxiety disorders tend to be more
severe
48
associated features of separation anxiety disorder
fear of dark, depressed mood, often being demanding, intrusive or needing constant attention, or conscientious, eager to please, and compliant, older kids report physical complaints
49
course of separation anxiety disorder
chronic, periods of exacerbation and remission over several years
50
sex ration of separation anxiety disorder
M=F
51
PTSD: 1918
Freud offers first descriptions of psychic trauma in children
52
PTSD: 1930s-1940s
"alarm period"- lots of researchers studied effects of war on children and adults (holocaust survivors and orphans)
53
PTSD: 1970
studied Vietnam Vets and victims of a school school bus kidnapping
54
PTSD: 1980
PTSD included as a diagnostic category
55
PTSD Key diagnostic features
1. life threatening trauma (rape, combat, accidents)
2. re-experience (nightmares, intrusive memories and flashbacks, physical reactions like nauseas, palpations, sweating, tremor)
3. avoiding reminds (places, sights, senses associated with event, avoid emotional attachment)
4. being on guard (hyperarousal, startle/anger easily, difficulty concentrating)
56
there is no treatment for PTSD so many struggle with
depression, substance abuse, social destructive behavior, social discord
57
PTSD 12 month prevalence trends
3.5 total, serious, moderate, mild tend to be pretty equal but slight swing towards severe
58
% of people who experience a trauma in a lifetime
50%
59
diagnosis of PTSD in US
3-10% (5.2 million), 300 million worldwide
60
PTSD in military
-33% Vietnam veterans
-20% of those returning from Iraq or Afghanistan
-typically presents 3-9 months after returning from tour
61
combat stressors for PTSD
-seeing dead bodied (highest for army)
-being shot at
-being attacked/ambushed
-rocket or mortar fire
-know a KIA or WIA
62
POWs in WWII PTSD
European theater: 54%
Pacific theater: 76%
63
psychological treatments for PTSD
CBT, exposure therapy, desensitization
64
structure that is central to theories of learned fear
amygdala
65
DSM 5 classification of OCD
-got it's own category, also contains related disorders (dysmorphic disorder, hoarding, trichtillomania, excoriation)
66
dysmorphic disorder
thinking you have a physical abnormality that is not there
67
trichotillomania
pulling out hair
68
excoriation
picking at skin until it bleeds or bruises
69
OCD classification
-individuals experience obsessions, compulsions or both
-obsessions/compulsions are time consuming (over 1 hour/day)
-obsessions/compulsions lead to significant distress or impairment
-recognition by the affected person that they are unreasonable or excessive
-may be specifiers such as good/fair insight or poor or delusions
70
obsessions
generate/increase anxiety, internalizing, recurrent or persistent thoughts, urges or images that are experienced as intrusive or unwanted
71
compulsions
relieve anxiety, may be externalizing, repetitive behaviors or mental acts that an individual feels drivel to perform in response to an obsession or according to rules that must be applied rigidly
72
Epidemiology of OCD
-mean age: 19.5 (25% cases begin by 14 years, onset past 35 is unusual)
-incidence of 50-80 per 100,000 in US (not uncommon)
-lifetime prevalence is 1-3% globally
-course is chronic and fluctuating
73
12 month prevalence of OCD
-total: 1
-serious: 50.6
-moderate: 34.8
-mild: 14
tend to be more severe!
74
comorbidities of ODC
VERY COMMON
-depression most common
-high rates of other anxiety disorders
-others like bipolar, psychosis, adhd...
75
biological perspective of ODC
-neuroanatomical hypothesis
-neurochemical hypothesis
76
psychological perspectives of OCD
neuropsychiatric hypothesis
77
neuroanatomical hypothesis
"OCD circuit"--> abnormal anatomy, circuits or connections cause OCD
-basal ganglia
-anterior cingulate cortex
-prefrontal/orbitofrontal cortex
78
normal brain vs. ODC brain study
-found that those with ODC had under activation of the FSCT circuit of brain but more bilateral action
-normal brain had more activity and the activity was more lateral to the right side
79
neurochemical hypotheis
-serotonin: initial basis in pharmacotherapy, basal hyperactivity of 5-HT system
-dopamine: major neurotransmitter in basal ganglia, some patients respond to DA blockers
-glutamate: excitatory, may underlie hyperactivity of "OCD circuit"
80
treatments of ODC
-CBT (#1)
-Pharmacological therapy (SSRIs)
last resort is neurosurgery (lesion cut in circuit or DBS)
81
DBS for OCD
-place electrodes in areas of brain to block abnormal activity
-reduced symptoms in patients with treatment resistant OCD
-fewer adverse effects that neurosurgical options
-approved by FDA
82
corticotropin releasing factor system (CRF)
central to expression of anxiety, group of gene that increase likelihood that system will be turned on, links to hypothalamic pituitary adrenocortical, hippocampus, amygdala, brain stem, prefrontal cortex and linked to dopaminergic neurotransmitter system, GABA, and sertotonergic and noradrenergic neurotransmitter systems
83
area of brain most often associated with anxiety
limbic system
84
behavioral inhibition system (BIS)
-found by Gray
-leads from hippoccampal area to frontal cortex
-brain stem signals danger from unexpected events or descend from the cortec and cause is to experience anxiety
85
circuit involved in panic
CIS
86
fight or flight system (FFS)
-circuit originating in brain stem and travels through midbrain structures (including amygdala, hypothalamus and central gray matter)
-produced alarm and escape response that is panic
-partly activated by deficiencies in serotonin
87
psychological contributions to anxiety
-perception of control, specifically in childhood helps with learning how to cope when adversity comes along
-if not, can lead to anxiety
88
anxiety sensitivity
tendency to respond fearfully to anxiety symptoms, important personality trait that determines who will/will not experience problems with anxiety under stressful situations
89
psychological contribution of panic
-strong response of panic initially occurs under ectreme stress or from dangerous situation creating response to both internal and external cues
-these learned cues then provoke the panic/fear response when nothing is actually happening that is dangerous
90
external cues of panic
places or situations similar to the one where initial panic attack occured
91
internal cues of panic
increase in HR or respiration that were associated with initial panic
92
triple vulnerability theory
1. generalized biological vulnerability (diathesis)
2. generalized psychological vulnerability (based on past experiences/how you were raised)
3. specific psychological vulnerability (learning from specific early childhood experiences or from someone close to you like parent)
93
% of patients who received principle diagnosis of anxiety or depression along eith one additional anxiety or depression related disorder (comorbidity)
55%
94
% of patients with anxiety/depression that met criteria for any other disorder at any time in life
76%
95
% of patients diagnosed with anxiety disorder that was also diagnosed with depression
50%
96
generalized anxiety disorder (GAD)
intense, uncontrollable, unfocused, chronic and continuous worry that is distressing and unproductive, accompanied by physical symptoms of tenseness, irritability and restlessness
97
GAD DSM-5 criteria
-at least 6 months of excessive anxiety and worry
-must be going on for more days than not
-must be difficult to control/turn off
98
GAD physical symptoms
muscle tension, mental agitation, susceptibility to fatigue, some irritability and difficulty sleeping
99
panic physical symptoms
autonomic arousal as a result of sympathetic nervous system surge
100
what different ages of GAD focus on
children: competence related to academic or athletic, social performance or family issues
adults: possible misfortune to children, family health, job responsibility, minor things like chores or being on time
older adults: health (also may have difficulty sleeping)
101
% of population meeting criteria for GAD in year
3.1%
102
% of population meeting criteria for GAD in lifetime
5.7%
103
GAD in males v females
females 2x more likely to have
104
most common group to have GAD
adults 45 and up
105
least common group to have GAD
15-24 years
106
physiological differences in those with GAD
-less responsiveness on physiological measures (HR, BP, respiration, etc)
-low cardiac vagal tone (vagus nerve is parasympathetic nerve innervating the heart and decreases activity)
-autonomic inflexibility (heart less responsive to certain tasks)
-called autonomic restrictors
-chronically tense (muscles)
-intense cognitive processing in frontal lobe (intense worrying)
107
drug most commonly prescribed for GAD
benzodiazepines (short term) and then antidepressants for long term help
108
agoraphobia
anxiety about being in places or situations where escape might be difficult
109
introceptive avoidance
-can occur in those with PD or agoraphobia
-avoidance of internal physical sensations
-remove self from situations that might produce physiological symptoms that resemble a panic attack (such as exercising)
110
1 year period for PD
2.7%
111
lifetime prevalence of PD
4.7%
112
2/3 of PD cases are
women
113
age of onset of PD
mid teens to 40 years old (median age is 20-24)
114
more women are diagnosed with PD and seek treatment while men treat PD by
consuming large amounts of alcohol
115
ataques de nervios
anxiety related syndrome among Hispanic Americans where symptoms are similar to panic attack and manifest as shouting and bursting into tears
116
___% of people with D experience nocturnal attacks
60%
117
most common time for panic attacks to occur
1:30am-3:30 am
118
nocturnal attacks
occur during delta wave of sleep (slow wave) and in deepest stage of sleep, produces feeling of letting go and can induce physical sensations that lead to panic
119
sleep terrors
occur in children where they scream and may get out of bed, occur in later stage (4) of sleep and is associated with sleep walking
120
isolated sleep paralysis
occurs during transitional stage of sleep and wake, unable to move and experience fear that is similar to panic attack, highest among african americans, does not occur in Nigerian blacks
121
panic attacks/PD seem to be mostly related to
biological and psychological factors
122
learned alarms
cues of being somewhere/something that become associated with certain physiological signs of panic
123
cognitive theory related to PD by David Clark
those with psychological vulnerability tend to interpret normal physical sensations in catastrophic ways, emphasizes the cognitive process as most important in panic disorder
124
common medications taken for PD
SSRIs and benzodiazepine (Xanax)
125
pain control treatment
CBT for panic attacks, involves gradual exposure to feared somatic sensations and modification of perceptions and attitudes about them
126
conclusions from studies on treatments of PD
-no substantial advantage to combining medication and CBT
-CBT performs better in long run
127
4 major subtypes of specific phobias
1. blood injection injury type
2. situational type
3. natural environment type
4. animal type
there is also "other category" for those that do not fit major subtypes
128
blood injection injury phobia
-differ in physiological reaction that other phobias
-unreasonable fear/avoidance of exposure to blood, injury or injection
-experience fainting and a drop in BP
-average age of occurrence is 9 years
129
blood inject injury phobia in families
tends to run in families more strongly than any other phobia, probably due to strong vasovagal response
130
situational phobia
-anxiety involving closed spaces or public transportation
-do not experience panic attacks outside of situation
-average age of occurence is mid teens to mid 20s
-30% of first degree relations have same/similar disorder
131
natural environment phobia
-situations occurring in nature (heights, storms, water)
-some fear of these dangerous situations is normal
-peak onset at age 7
132
animal phobia
-fear of animals/insects that is outside of normal fear (some fear is normal)
-peak onset at age 7
133
most common phobia
snakes and heights
134
1 year prevalence of specific phobia
8.7%, but 15.8% in teens
135
sex ratio for specific phobias
4:1 (females way more)
136
hispanic rate of specific phobias
2x more likely to have phobias than whites
137
pa-leng
"frigo phobia"=fear of the cold is chinese concept related to yin and yang where yin is cold, dark windy energy that sapps life so they fear and want to avoid that
138
phobias acquired by direct experience
when person is in situation of real danger or pain results in an alarm response (true alarm)
139
other ways specific phobias can be acquired
-experiencing a false alarm (panic attack) in specific situation
-observing someone else experiencing severe fear (vicarious experience)
-being told about danger (information transmission)
140
treatment for specific phobia
-structured and consistent exposure based exercises
141
% of kids with separation anxiety
4.1%, can extend into adulthood for 35% of cases
142
1 year prevalence of social anxiety disorder
6.8% but is 8.2% in teens
143
sex ratio for SAD
1:1
144
taijin fyofusho
Japanese subcategory of anxiety disorders that is related to fear of some aspect of their personal appearance will appear badly and others will feel embarrassed (focused on offending or embarrassing other rather than embarrassing oneself)
145
we are more likely to learn ___ facial expressions
angry/critical, socially anxious people more quickly recognize these expressions
146
% of adults that have SAD were teased/bullied in childhood
92%
147
parents with SAD are
more likely to pass it down to kids (16%)
148
treatment for SAD
-cognitive program (CBT) had 84% effectiveness
-IPT follows (interpersonal psychotherapy)
-psychological treatment proved to be better than SSRIs
149
D-cycloserine (DCS)
a drug that works in amygdala and fan facilitate extinction of anxiety my by modifying neurotransmitter flow in the glutamate system, may be helpful to use along with exposure therapy in people with SAD
150
selective mutism (SM)
rare childhood disorder characterized by lack of speech in one or more setting than in which speaking is socially expected, driven by social anxiety
151
diagnosis criteria for SM
-lack of speech for a month or more and cannot be limited to the first month of school
152
new DSM criteria for PTSD
-reckless or self destructive behavior as one sign of increased arousal and reactivity
-dissociative subtype who have less arousal than normal and may experience feelings of unreality
153
PTSD with delayed onset
individuals show no or few symptoms immediately or months after trauma but at least 6 months later (even a year) show full blown PTSD
154
PTSD cannot be diagnosed until
1 month after event
155
acute stress disorder
in DSM, similar to PTSD but in the first month after trauma, emphasizes the severe reaction some have
156
% of people with acute distress disorder go on to develop PTSD
50%
157
PSTD prevalence at some point in life in general population
6.8% (3.5% in past year)
158
highest rates of PTSD are associated with
rape, being held captive, tortured or kidnapped, or badly assaulted
159
rates for women PTSD
compared to normal women, those experiencing sexual assault/rape are 2.4-3.5 times higher for PTSD (4.3-8.2 times higher if re-victimized)
160
surprisingly low rates of PTSD in those who
lived through bombings such as WWII as they did not directly experience horror of death/dying or direct attack
161
there is a strong relationship between PTSD and
close/direct exposure to the trauma (rape, combat, 9/11)
162
biological predisposition for PTSD
-if anxiety runs in family
-emotional reactivity
163
predisposing factors that can contribute to PTSD (psychological)
-minimal education
-lower intelligence
-family instability
164
social factors that can contribute to PTSD
-little/no social support after trauma
-negative coping strategies (angry, placing blame)
165
support from loved ones reduces
cortisol secretion and HPA activity
166
neurobiological systems involved in PTSD
-elevated or restricted corticotropin releasing factor (CRF) which has higher activity in HPA (leads to chronic arousal)
-damaged hippocampus (regulates HPA axis)
167
treatment of PTSD: psychoanalytic therapy
-relive emotional trauma to relive emotional suffering (catharsis)
168
imaginal exposure
content of trauma and emotions associated with it are worked through systematically
-most common strategy is prolonged exposure therapy (develop narrative of traumatic experience and expose patients for an extended period of time to image)
169
found a link between effectiveness of exposure therapy and
sleep in those with PTSD
-taking a nap soon after exposure
170
adjustment disorders
anxious or depressive reactions to life stress that are milder than PTSD, emotional and behavioral response to one or more specific stressor
171
attachment disorder
developmentally inappropriate behaviors in which a child is unable or unwilling to form normal attachment relationships with caregiving adults
-often due to inadequate or abusive child rearing practices
172
reactive attachment disorder
child with disturbed behavior neither seeks out a caregiver nor responds to offers of help from one, fearfulness and sadness often present
173
disinhibited social engagement disorder
child shows no inhibitions whatsoever in approaching adults (may follow stranger wherever)
-from inadequate child rearing which may include harsh punishment
174
symmetry obsession
-needing things just right or to be symmetrical/aligned
-compulsion: putting things in certain order, repeating ritual
175
forbidden thoughts or actions obsessions
-agressive, sexual, religion
-fears, urges to harm self or others, fears of offending God
-compulsion: checking rituals, avoidance, repeated requests for reassurance
176
cleaning/contamination obsessions
-germs, fear of germs/contamination
-compulsion: repetitive/excessive washing, using gloves or masks to do daily tasks
177
hoarding obsession
-fear of throwing things away
-compulsion: saving objects that have little or no actual value/sentimental value
178
tic disorders and OCD
have been tied together as a tic may be a compulsion relating to OCD, most always related to symmetry obsessions, can be treated with CBT
179
lifetime prevalence of OCD
1.6-2.3%
180
1 year prevalence of OCD
1%
181
sex ratio of OCD
1:1
182
thought action fusion
when clients with OCD equate thoughts with specific actions or activity represented by the thoughts
183
pharmacological treatment of OCD
drugs that target serotonin re-uptake (clomipramine or SSRIs) benefit 60% of those with OCD
184
most effective psychological approach to OCD
exposure and ritual prevention (ERP)
-rituals are prevented and patient is exposed to feared thoughts or situations
-shows clients that there is no harm that will result
-superior results to medication
185
body dysmorphic disorder (BDD)
preoccupation with some imagined defect in in appearance by someone who actually looks reasonably normal
186
those with BDD primarily focus on
-skin, hair, nose, stomach
187
BDD statistics
-tends to be kept secret
-lifelong course
-70% of college students report some dissatisfaction with their bodies (4-8% meet criteria for BDD)
-equal in men and women
-peak age 16-17
188
treatment of BDD
similar to OCD, medication or CBT/ exposure
189
BDD doctors and plastic surgery
76% seeks medical help to fix disformity, 45% saw dermatologist, 23% had plastic surgery (nose jobs, eyebrow elevation, facelift adn liposuction common)
190
3 characteristics of hoarding
excessive acquisition of things, difficulty discarding anything, living with excessive clutter best described as gross disorganization
191
prevalence of hoarding
2-5% of population
192
treatment of hoarding
CBT
