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abnormal psych test 2 > Anxiety Related Disorders > Flashcards

Anxiety Related Disorders Flashcards

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1
Q

anxiety definition

A

negative mood state characterized by bodily symptoms of physical tension and apprehension about the future, not a normal response

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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

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3
Q

panic

A

sudden overwhelming fright or terror

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4
Q

panic attack

A

abrupt experience of intense fear or discomfort accompanied by several physical symptoms such as dizziness or heart palpations

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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

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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

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7
Q

panic attacks and genetics

A

tend to run in families, we inherit tendency to be uptight or anxious

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8
Q

neurotransmitter system associated with anxiety

A

depleted levels of GABA

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9
Q

panic disorder definition

A

recurrent panic attacks

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10
Q

agorophobia

A

fear of being in crowds, public places or open spaces

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11
Q

social phobia

A

fear of uncomfortable social interactions

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12
Q

specific phobias

A

fear of heights, closed spaces, etc

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13
Q

generalized anxiety disorder

A

excessive worrying

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14
Q

seperation anxiety disorder

A

fear or separation from attachment figures

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15
Q

what anxiety disorders were taken out of anxiety category in DSM-5

A

PTSD and OCD

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16
Q

12 month prevalence of any anxiety disorder

A

total: 18.1

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17
Q

12 month prevalence of any anxiety disorder

A

18.1

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18
Q

12 month prevalence of serious anxiety disorder

A

22.8

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19
Q

12 month prevalence of moderate anxiety disorder

A

33.7

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20
Q

12 month prevalence of mild anxiety disorder

A

43.5

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21
Q

12 month prevalence of any mood disorder

A

9.5

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22
Q

12 month prevalence of serious mood disorder

A

45

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23
Q

12 month prevalence of moderate mood disorder

A

40

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24
Q

12 month prevalence of mild mood disorder

A

15

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25
Q

in 12 month prevalence, disorder that is most severe but rare (1 total)

A

OCD

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26
Q

most common anxiety disorder in general population

A

specific phobia

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27
Q

most common anxiety disorder among those seeking treatment/clinical help

A

panic disorder

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28
Q

estimate of population 18 and older that is affected by at least one type of anxiety disorder

A

18%

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29
Q

Freud objective anxiety

A

a natural response to realistic perception of external danger (fear)

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30
Q

Freud neurotic anxiety

A

“free floating” anxiety and when attached to specific object of situation, the product is phobia/angst (anxiety)

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31
Q

behavioral symptoms of anxiety

A

motoric uneasiness, hyper vigilance, screaming and crying, compulsive/escape avoidant behaviors such as shyness or school refusal

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32
Q

cognitive symptoms of anxiety

A

inattentiveness, distractibility, decreased performance in school, impaired memory

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33
Q

physiological symptoms of anxiety

A

increased HR, BP, electrodermal activity, enuresis, abdominal pain, tics

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34
Q

phobias- class definition

A

excessive and unreasonable responses leading to severe avoidance (while fears are considered a normal, adaptive reaction)

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35
Q

most common diagnosis given in childhood

A

phobias

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36
Q

specific phobia

A

persistent, irrational fear or and compelling desire to avoid an object or situation

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37
Q

social phobia

A

persistent, irrational fear of and compelling desire to avoid situations which could be evaluative, humiliating or embarrassing

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38
Q

DSM 5 criteria of phobia

A

-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

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39
Q

social phobia tends towards

A

being more server than specific phobias but less common

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40
Q

normal infant fears

A

height, noise

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41
Q

normal 1-2 year old fears

A

strangers, toileting activities, of being injured, not yet afraid of snakes or dark

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42
Q

normal preschool (3-4) year old fears

A

animals, dark, strangers, being left alone, imaginary creatures (monsters)

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43
Q

as kids enter school, their fears

A

kids mature cognitively and their fears become more specific and realistic

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44
Q

normal elementary schools aged fears

A

small animals, dark, lightning, thunder, physical safety

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45
Q

normal middle school aged fears

A

more based in reality: academic, social, health related fears, bad grades, parental disproval

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46
Q

separation anxiety disorder

A

-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

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47
Q

separation anxiety disorders tend to be more

A

severe

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48
Q

associated features of separation anxiety disorder

A

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

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49
Q

course of separation anxiety disorder

A

chronic, periods of exacerbation and remission over several years

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50
Q

sex ration of separation anxiety disorder

A

M=F

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51
Q

PTSD: 1918

A

Freud offers first descriptions of psychic trauma in children

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52
Q

PTSD: 1930s-1940s

A

“alarm period”- lots of researchers studied effects of war on children and adults (holocaust survivors and orphans)

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53
Q

PTSD: 1970

A

studied Vietnam Vets and victims of a school school bus kidnapping

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54
Q

PTSD: 1980

A

PTSD included as a diagnostic category

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55
Q

PTSD Key diagnostic features

A
  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)
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56
Q

there is no treatment for PTSD so many struggle with

A

depression, substance abuse, social destructive behavior, social discord

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57
Q

PTSD 12 month prevalence trends

A

3.5 total, serious, moderate, mild tend to be pretty equal but slight swing towards severe

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58
Q

% of people who experience a trauma in a lifetime

A

50%

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59
Q

diagnosis of PTSD in US

A

3-10% (5.2 million), 300 million worldwide

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60
Q

PTSD in military

A

-33% Vietnam veterans
-20% of those returning from Iraq or Afghanistan
-typically presents 3-9 months after returning from tour

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61
Q

combat stressors for PTSD

A

-seeing dead bodied (highest for army)
-being shot at
-being attacked/ambushed
-rocket or mortar fire
-know a KIA or WIA

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62
Q

POWs in WWII PTSD

A

European theater: 54%
Pacific theater: 76%

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63
Q

psychological treatments for PTSD

A

CBT, exposure therapy, desensitization

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64
Q

structure that is central to theories of learned fear

A

amygdala

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65
Q

DSM 5 classification of OCD

A

-got it’s own category, also contains related disorders (dysmorphic disorder, hoarding, trichtillomania, excoriation)

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66
Q

dysmorphic disorder

A

thinking you have a physical abnormality that is not there

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67
Q

trichotillomania

A

pulling out hair

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68
Q

excoriation

A

picking at skin until it bleeds or bruises

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69
Q

OCD classification

A

-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

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70
Q

obsessions

A

generate/increase anxiety, internalizing, recurrent or persistent thoughts, urges or images that are experienced as intrusive or unwanted

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71
Q

compulsions

A

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

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72
Q

Epidemiology of OCD

A

-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

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73
Q

12 month prevalence of OCD

A

-total: 1
-serious: 50.6
-moderate: 34.8
-mild: 14
tend to be more severe!

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74
Q

comorbidities of ODC

A

VERY COMMON
-depression most common
-high rates of other anxiety disorders
-others like bipolar, psychosis, adhd…

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75
Q

biological perspective of ODC

A

-neuroanatomical hypothesis
-neurochemical hypothesis

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76
Q

psychological perspectives of OCD

A

neuropsychiatric hypothesis

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77
Q

neuroanatomical hypothesis

A

“OCD circuit”–> abnormal anatomy, circuits or connections cause OCD
-basal ganglia
-anterior cingulate cortex
-prefrontal/orbitofrontal cortex

78
Q

normal brain vs. ODC brain study

A

-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
Q

neurochemical hypotheis

A

-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
Q

treatments of ODC

A

-CBT (#1)
-Pharmacological therapy (SSRIs)
last resort is neurosurgery (lesion cut in circuit or DBS)

81
Q

DBS for OCD

A

-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
Q

corticotropin releasing factor system (CRF)

A

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
Q

area of brain most often associated with anxiety

A

limbic system

84
Q

behavioral inhibition system (BIS)

A

-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
Q

circuit involved in panic

A

CIS

86
Q

fight or flight system (FFS)

A

-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
Q

psychological contributions to anxiety

A

-perception of control, specifically in childhood helps with learning how to cope when adversity comes along
-if not, can lead to anxiety

88
Q

anxiety sensitivity

A

tendency to respond fearfully to anxiety symptoms, important personality trait that determines who will/will not experience problems with anxiety under stressful situations

89
Q

psychological contribution of panic

A

-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
Q

external cues of panic

A

places or situations similar to the one where initial panic attack occured

91
Q

internal cues of panic

A

increase in HR or respiration that were associated with initial panic

92
Q

triple vulnerability theory

A
  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
Q

% of patients who received principle diagnosis of anxiety or depression along eith one additional anxiety or depression related disorder (comorbidity)

A

55%

94
Q

% of patients with anxiety/depression that met criteria for any other disorder at any time in life

A

76%

95
Q

% of patients diagnosed with anxiety disorder that was also diagnosed with depression

A

50%

96
Q

generalized anxiety disorder (GAD)

A

intense, uncontrollable, unfocused, chronic and continuous worry that is distressing and unproductive, accompanied by physical symptoms of tenseness, irritability and restlessness

97
Q

GAD DSM-5 criteria

A

-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
Q

GAD physical symptoms

A

muscle tension, mental agitation, susceptibility to fatigue, some irritability and difficulty sleeping

99
Q

panic physical symptoms

A

autonomic arousal as a result of sympathetic nervous system surge

100
Q

what different ages of GAD focus on

A

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
Q

% of population meeting criteria for GAD in year

A

3.1%

102
Q

% of population meeting criteria for GAD in lifetime

A

5.7%

103
Q

GAD in males v females

A

females 2x more likely to have

104
Q

most common group to have GAD

A

adults 45 and up

105
Q

least common group to have GAD

A

15-24 years

106
Q

physiological differences in those with GAD

A

-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
Q

drug most commonly prescribed for GAD

A

benzodiazepines (short term) and then antidepressants for long term help

108
Q

agoraphobia

A

anxiety about being in places or situations where escape might be difficult

109
Q

introceptive avoidance

A

-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
Q

1 year period for PD

A

2.7%

111
Q

lifetime prevalence of PD

A

4.7%

112
Q

2/3 of PD cases are

A

women

113
Q

age of onset of PD

A

mid teens to 40 years old (median age is 20-24)

114
Q

more women are diagnosed with PD and seek treatment while men treat PD by

A

consuming large amounts of alcohol

115
Q

ataques de nervios

A

anxiety related syndrome among Hispanic Americans where symptoms are similar to panic attack and manifest as shouting and bursting into tears

116
Q

___% of people with D experience nocturnal attacks

A

60%

117
Q

most common time for panic attacks to occur

A

1:30am-3:30 am

118
Q

nocturnal attacks

A

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
Q

sleep terrors

A

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
Q

isolated sleep paralysis

A

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
Q

panic attacks/PD seem to be mostly related to

A

biological and psychological factors

122
Q

learned alarms

A

cues of being somewhere/something that become associated with certain physiological signs of panic

123
Q

cognitive theory related to PD by David Clark

A

those with psychological vulnerability tend to interpret normal physical sensations in catastrophic ways, emphasizes the cognitive process as most important in panic disorder

124
Q

common medications taken for PD

A

SSRIs and benzodiazepine (Xanax)

125
Q

pain control treatment

A

CBT for panic attacks, involves gradual exposure to feared somatic sensations and modification of perceptions and attitudes about them

126
Q

conclusions from studies on treatments of PD

A

-no substantial advantage to combining medication and CBT
-CBT performs better in long run

127
Q

4 major subtypes of specific phobias

A
  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
Q

blood injection injury phobia

A

-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
Q

blood inject injury phobia in families

A

tends to run in families more strongly than any other phobia, probably due to strong vasovagal response

130
Q

situational phobia

A

-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
Q

natural environment phobia

A

-situations occurring in nature (heights, storms, water)
-some fear of these dangerous situations is normal
-peak onset at age 7

132
Q

animal phobia

A

-fear of animals/insects that is outside of normal fear (some fear is normal)
-peak onset at age 7

133
Q

most common phobia

A

snakes and heights

134
Q

1 year prevalence of specific phobia

A

8.7%, but 15.8% in teens

135
Q

sex ratio for specific phobias

A

4:1 (females way more)

136
Q

hispanic rate of specific phobias

A

2x more likely to have phobias than whites

137
Q

pa-leng

A

“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
Q

phobias acquired by direct experience

A

when person is in situation of real danger or pain results in an alarm response (true alarm)

139
Q

other ways specific phobias can be acquired

A

-experiencing a false alarm (panic attack) in specific situation
-observing someone else experiencing severe fear (vicarious experience)
-being told about danger (information transmission)

140
Q

treatment for specific phobia

A

-structured and consistent exposure based exercises

141
Q

% of kids with separation anxiety

A

4.1%, can extend into adulthood for 35% of cases

142
Q

1 year prevalence of social anxiety disorder

A

6.8% but is 8.2% in teens

143
Q

sex ratio for SAD

A

1:1

144
Q

taijin fyofusho

A

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
Q

we are more likely to learn ___ facial expressions

A

angry/critical, socially anxious people more quickly recognize these expressions

146
Q

% of adults that have SAD were teased/bullied in childhood

A

92%

147
Q

parents with SAD are

A

more likely to pass it down to kids (16%)

148
Q

treatment for SAD

A

-cognitive program (CBT) had 84% effectiveness
-IPT follows (interpersonal psychotherapy)
-psychological treatment proved to be better than SSRIs

149
Q

D-cycloserine (DCS)

A

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
Q

selective mutism (SM)

A

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
Q

diagnosis criteria for SM

A

-lack of speech for a month or more and cannot be limited to the first month of school

152
Q

new DSM criteria for PTSD

A

-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
Q

PTSD with delayed onset

A

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
Q

PTSD cannot be diagnosed until

A

1 month after event

155
Q

acute stress disorder

A

in DSM, similar to PTSD but in the first month after trauma, emphasizes the severe reaction some have

156
Q

% of people with acute distress disorder go on to develop PTSD

A

50%

157
Q

PSTD prevalence at some point in life in general population

A

6.8% (3.5% in past year)

158
Q

highest rates of PTSD are associated with

A

rape, being held captive, tortured or kidnapped, or badly assaulted

159
Q

rates for women PTSD

A

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
Q

surprisingly low rates of PTSD in those who

A

lived through bombings such as WWII as they did not directly experience horror of death/dying or direct attack

161
Q

there is a strong relationship between PTSD and

A

close/direct exposure to the trauma (rape, combat, 9/11)

162
Q

biological predisposition for PTSD

A

-if anxiety runs in family
-emotional reactivity

163
Q

predisposing factors that can contribute to PTSD (psychological)

A

-minimal education
-lower intelligence
-family instability

164
Q

social factors that can contribute to PTSD

A

-little/no social support after trauma
-negative coping strategies (angry, placing blame)

165
Q

support from loved ones reduces

A

cortisol secretion and HPA activity

166
Q

neurobiological systems involved in PTSD

A

-elevated or restricted corticotropin releasing factor (CRF) which has higher activity in HPA (leads to chronic arousal)
-damaged hippocampus (regulates HPA axis)

167
Q

treatment of PTSD: psychoanalytic therapy

A

-relive emotional trauma to relive emotional suffering (catharsis)

168
Q

imaginal exposure

A

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
Q

found a link between effectiveness of exposure therapy and

A

sleep in those with PTSD
-taking a nap soon after exposure

170
Q

adjustment disorders

A

anxious or depressive reactions to life stress that are milder than PTSD, emotional and behavioral response to one or more specific stressor

171
Q

attachment disorder

A

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
Q

reactive attachment disorder

A

child with disturbed behavior neither seeks out a caregiver nor responds to offers of help from one, fearfulness and sadness often present

173
Q

disinhibited social engagement disorder

A

child shows no inhibitions whatsoever in approaching adults (may follow stranger wherever)
-from inadequate child rearing which may include harsh punishment

174
Q

symmetry obsession

A

-needing things just right or to be symmetrical/aligned
-compulsion: putting things in certain order, repeating ritual

175
Q

forbidden thoughts or actions obsessions

A

-agressive, sexual, religion
-fears, urges to harm self or others, fears of offending God
-compulsion: checking rituals, avoidance, repeated requests for reassurance

176
Q

cleaning/contamination obsessions

A

-germs, fear of germs/contamination
-compulsion: repetitive/excessive washing, using gloves or masks to do daily tasks

177
Q

hoarding obsession

A

-fear of throwing things away
-compulsion: saving objects that have little or no actual value/sentimental value

178
Q

tic disorders and OCD

A

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
Q

lifetime prevalence of OCD

A

1.6-2.3%

180
Q

1 year prevalence of OCD

A

1%

181
Q

sex ratio of OCD

A

1:1

182
Q

thought action fusion

A

when clients with OCD equate thoughts with specific actions or activity represented by the thoughts

183
Q

pharmacological treatment of OCD

A

drugs that target serotonin re-uptake (clomipramine or SSRIs) benefit 60% of those with OCD

184
Q

most effective psychological approach to OCD

A

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
Q

body dysmorphic disorder (BDD)

A

preoccupation with some imagined defect in in appearance by someone who actually looks reasonably normal

186
Q

those with BDD primarily focus on

A

-skin, hair, nose, stomach

187
Q

BDD statistics

A

-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
Q

treatment of BDD

A

similar to OCD, medication or CBT/ exposure

189
Q

BDD doctors and plastic surgery

A

76% seeks medical help to fix disformity, 45% saw dermatologist, 23% had plastic surgery (nose jobs, eyebrow elevation, facelift adn liposuction common)

190
Q

3 characteristics of hoarding

A

excessive acquisition of things, difficulty discarding anything, living with excessive clutter best described as gross disorganization

191
Q

prevalence of hoarding

A

2-5% of population

192
Q

treatment of hoarding

A

CBT

abnormal psych test 2 (2 decks)

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