Anxiety related disorders- exam 2 Flashcards
What is fear
response to a present and immediate danger
what is anxiety
the anticipation of danger (worry)
how are fear and anxiety different
fear is immediate anxiety is anticipatory
what division of the autonomic nervous system is involved in fear and anxiety
Sympathetic nervous system (also adrenal cortical system)
Activation of fight or flight response
what brain structures are involved in fear and anxiety
Amygdala, hypothalamus
What body organs are involved in fear and anxiety
Adrenal cortical system –> pituitary gland —> adrenal glands
- dilated pupils
- salivary glands
- lunchs
- heart
- release of glucose by liver
- secreations by the adrenal glands
- inhibits pancreatic acitvity
- inhibits stomach activity
- relaxes bladder
what hormones are released in response to anxiety
adrenocorticotropic hormone (ACTH)- bodies major stress hormone (cortisol)
what physiology (somatic response) accompanies fight or flight
- tense muscles
- increased heart rate
- changes in respiration
- dilated pupils
- increased perspiration
- adrenaline secretion
- inhibited stomach acid
- decreased salivation
- bladder relaxation
what emotional response accompanies fight or flight
- sense of dread
- terror
- restlessness
- irritability
what cognitive response accompanies fight or flight
- anticipation of harm
- exaggeration of danger
- problems in concentrating
- hypervigilance
- worried, ruminative thinking
- fear of losing control
- fear of dying
- sense of unreality
what behavioral response accompanies fight or flight
- escape
- avoidance
- aggression
- freezing
What things are comorbid with anxiety
- depression
- lots
what is the DSM-5 criteria for Panic Disorder
A. recurrent panic attacks and during which time four (or more) of the following symptoms occur
1. palpitations, pounding heart, or accelerated heart rate
2. sweating
3. trembling or shaking
4. sensations of shortness of breath or smothering
5. feelings of choking
6. chest pain or discomfort
7. nausea or abdominal distress
8. feeling dizzy, unsteady, light-headed, or faint
9. chills or heat sensations
10. paresthesias (numbeness or tingling sensations)
11. derealization or depersonalization
12. fear of losing control or ‘going crazy’
13. fear of dying
B. at least of the attacks has been followed by a month (or more) of one or both of the following
1. persistent concern or worry about additional panic attacks or their consequences
2. a significant maladaptive change in behavior related to the attacks
C. the disturbance is not attributable to a substance
D. not explained by some other mental disorder
What is the DSM-5 criteria for seperation anxiety disorder
A. developmentally inappropriate and excessive fear or anxiety concering separation from those to whom the individual is attached
B. the fear, anxiety, or avoidance is persistent lasting at least 4 weeks in children and adolescents and typically 6 months or more in adults
C. the disturbance causes clinically significant distress or impairment in social, academic, occupational, or other important areas of functioning
D. the disturbance is not better explained by another mental disorder
What is DSM-5 criteria for generalized anxiety disorder
A. excessive anxiety and worry, occuring more days than not for at least 6 months, about a number of events or activities
B. The individual finds it difficult to control the worry
C. The anxiety and worry are associated with 3 (or more) of the following 6 symptoms (with at least some being present for more than 6 months)
1. restlessness of feeling on edge
2. being easily fatigued
3. difficulty concentrating or mind going blank
4. irritability
5. muscle tension
6. sleep disturbance
D. the anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
E. not attributable to a substance or other medical condition
F. not better explained by some other mental disorder
What is the DSM-5 criteria for social anxiety disorder
A. marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others
B. the individual fears they will act in a way or show anxiety symptoms that will be negatively evaluated
C. social situations almost always provoke fear or anxiety
D. social situations are avoided or endured with intense fear or anxiety
E. fear of anxiety is out of proportion to the actual threat posed by the situation in sociocultural context
F. fear or anxiety is persistent lasting more than 6 months
G. causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
H. not attributable to a substance or other medical condition
I. no bettter explained by symptoms of another mental disorder
J. if another medical condition is present fear/anxiety is unrelated or excessive
Specify if its only related to public performance
what is the DSM-5 criteria for specific phobia
A. marked fear or anxiety about a specific object or situation
B. phobic object or situation almost always provokes immediate fear or anxiety
C. phobic object or situation is actively avoided or endured with intense fear or anxiety
D. fear/anxiety is out of proportion to the actual threat being caused
E. fear/anxiety or avoidence is persistent and lasts 6 months or more
F. causes clinically significant distress or impairment in social, occupational, or other areas of functioning
G. not better explained by some other mental disorder
What is the DSM-5 criteria for OCD
A. presence of obsessions, compulsions, or both:
- obsessions are defined by (1) and (2)
1. recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress
2. the individual attempts ot ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thoughts or actions (compulsions)
- compulsions are defined by (1) and (2)
1. Repetitive behaviors or mental acts that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly
2. the behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however they are not connected in a realistic way with what they are aimed to prevent
B. obsessions or compulsions are time consuming and cause impairment to functioning
C. not attiributable to a substance or other medical condition
D. not better explained by some other mental disorder
What is the DSM-5 criteria for hoarding disorder
A. persistent difficulty discarding or pating with possessions regardless of their actual value
B. difficulty due to a perceived need to save the items and distress associated with discarding them
C. difficulty discarding possessions results in the accumulation of things that clutter active living areas and substantially compromises the intended use
D. hoarding causes clinically significant distress or impairment in social, occupational, or other impairment areas of functioning
E. not attributable to another medical condition
F. not better explained by another mental disorder
What is the DSM-5 criteria for PTSD
A. exposure to actual or threatened death, serious injury, or sexual violence
B. presence of intrusion symptoms associated with the traumatic event, beginning after the traumatic event occured
C. persistent avoidance of stimuli associated with the traumatic event, beginning after the traumatic event occured
D. negative alterations in cognitions and mood associated with the traumatic event, beginning or worsening after the traumatic event occured
E. marked alterations in arousal and reactivity associated with the traumatic event, beginning or worsening after it occured
F. duration of disturbance is longer than one month
G. causes clinically significant distress or impairment of functioning
H. not attributable to a substance
What is generalized anxiety disorder (and GAD free floating)
- anxiety is free floating
- 5% of population, begins in teens; symptoms for at least 6 months
- persistently worried: often about minor things, ruminates- thinks about problem and will not let it go until a solution is decided on
- Uncontrollable worry: difficulty concentrating, tires easily, restlesness and irritability, high muscle tension
what are symptoms of panic attack/disorder
- sudden unexplained hyperarousal of the autonomic (sympathetic) nervous system
- increased respirations, heart rate, sweating, dry mouth, nausea, chest pain, dizziness, etc.
- accompanied by feeling of apprehension, terror and impending doom
- depersonalization: being outside your body
- derealization: the world does not seem real
what are biological factors contributing to anxiety
neurotransmitter systems
heritabillity
what are therapies for anxiety and anxiety related disorders
- systematic desensitization
- flooding
- intense exposure therapy
- CBT
- Extinction enhancement
what is agoraphobia
fear of panic attack in ‘public places’ or places where escape is difficult
what are phobias (specific v. focused)
- irrational, out of proportion to danger
- recognized by person as groundless
- causes social or occupational impairment
- focused anxiety
- specific phobias: specific trigger
what are the 5 types of phobias listed in the DSM-5
Animal
Natural/ environment
situational type
Blood injection/injury
other
what is the role of prepared learning in phobias
expose client to phobia and teaches that there is nothing to fear through repeated events where the fear does not happen
what is blood and injection phobia
- panic attack followed by a drop in BP and fainting
- 3% in general population
- 64% have first degree relative with the same disorder
- treatment is to tense up to prevent blood pressure from dropping
what is vaso-vagal response
blood vessels dialate and heart rate decreases which results in not enough blood going to the brain which causes fainting
what is social anxiety disorder/ social phobia
fear of what other people will think of you
avoid situations or have extreme anxiety in situations where they might be evaluated or show anxiety
are there cultural factors that contribute to anxiety
- parenting factors
- anxiety is out of proportion to what is considered culturally appropriate
what is seperation anxiety disorder
developmentally inappropriate and excessive fear concering seperation from attachment figure:
- recurrent distress when anticipating/experiencing seperation
- excessive worry that something bad will happen to attachment figure
- refusal/reluctance to go to school, work, or elsewhere
- nightmares about seperation
- somatic complaints when seperated (headache, stomachache)
what neurotransmitters are involved in anxiety disorders
- GABA: lack of gaba function causes increase anxiety and neuronal excitability
- serotonin
- norepinepherine
- dopamine
what is depersonalization and derealization
Depersonalization: being detached from ones self
Derealization: feelings of unreality
what are some proposed casues of anxiety disorders
how does the amygdala contribute to anxiety disorders
- amygdala is responsible for responding to stressful situations —> tells the hypothalamus to begin fight or flight response
what different therapies are used for different anxiety disorders
Panic disorder:
- CBT
OCD:
- Exposure and response prevention
Body dismorphia
- CBT
what is systematic desensitization
gradually expose the client to situations they fear most while helping them maintain control over their symptoms
what is flooding
exposing a client to their fear/phobia all at one time. Just as effective as systematic desensitilization but works more quickly
what is modeling
Learning to not fear something based on seeing it continously not cause the feared consequence
what is CBT
Cognitive Behavioral Therapy
modeling, flooding, etc.
challenging catastophizing thoughts
learning healthy coping skills
what is interoceptive exposure
Heightened awareness of bodily cues that may signal a coming panic attack.
What are examples of SSRIs used to treat anxiety and how do they work
Selective Serotonin Reuptake Inhibitors
- prevents reuptake of serotonin
- it is an inhibitor so it is an agonist the system
- examples include: Paxil, Prozac, Zoloft, Celexa, and Lexapro
What are examples of SNRIs, what are they used to treat, and how do they work
Serotonin and Norepinepherine reuptake inhibitors:
- prevents reuptake of serotonin and norepinepherine
- examples include: Effexor and Cymbalta
What are examples of TCAs, what do they treat, and how do they work
Tricyclic antidepressents
treat panic disorder, agorophobia, and depression (first anti depressent)
- prevents reuptake
What are anti-seizure meds used to treat and how do they work
used to treat PTSD and Bipolar disorder
blocks sodium channels OR slows the intracellular process down
examples: Tegretol, Depakote, Lamictal, Dilantin
what are examples of benzodiazpine, what is it used to treat and how does it work
Treat panic disorder and agorophobia
- GABA antogonist: bind directly to GABA neurotransmitter receptor
- examples include: Valium, Xanax, and Klonapin
what are beta-blockers used to treat, what are examples, and how do they work
treat social anxiety and performance related anxieties
- antagonist for beta, norepinepherine, and epinepherine. Andrenelgic receptors, slows heart rate
- Inderal
What are examples of minor tranquilizers
(anxiolytics): benzodiazepines (Valium/diazepam, Lorazepam/ativan, Xanax/alprazolam),
what are the psychoanalytic, behavioral, cognitive, and biological perspectives on anxiety disorders?
What is OCD
Obsessive compulsive disorder
- recurrent and intrusive obsessions and compulsions
- time consuming (> 1 hour a day)
- distress/impairment
What famous person does the book mention to have OCD
David Beckham
what is the difference between obsessions and compulsions
Obsessions: recurrent thoughts
Compulsion: acts/behaviors (rituals)
What are some compulsions displayed by the teenage girl in the video we watched in class
what are some types of compulsions
- cleaning (handwashing, bathing, grooming)
- checking
- counting
- sameness
what is the cause of OCD and how is it treated
- biochemical model: low level of NT serotonin
what brain areas are involved in OCD
- high genetic predisposition
- dysfunction in the circuit which links specific areas of the pre frontal cortex to areas of the basical ganglia (striatum), thalamus, anterior cingulate cortex
- alterations in activity level and function of those areas
- cerebellum
- orbital frontal cortex
what are some common comorbities of OCD
what are drug and behavioral treatments for OCD
- exposure and response prevention
- anafranil: tricyclic
- raise serotonin with SSRIs
What is ERP
Exposure and Response Prevention
- victor Meyer-England (1966)
- a form of flooding
- expose to situations that normally elicit compulsions
- prevent the rituals
- an extinction paradigm
What is body dysmorphic disorder? (also, what famous person is given as an example)
- preoccupation with imagined or exaggerated defect
- visual processing focuses on details
- connect self worth almost exclusively with appearance
What is hoarding disorder and what are common parts of the disorder
- acquiring an excessive number of objects
- inability to part with those objects regardless of what their potential value may be
- possessions/clutter compromise use of living space
- comorbid with GAD, depression, and social phobia
what is trichotillomania and excoriation
Trichotillomania: compulsive hair pulling
Excoriation: compulsion to touch, rub, scratch, pick, or dig into skin to remove small perceived imperfections
also related to excessive cheek biting and nail biting
What are the symptoms of PTSD
- reexperiencing traumatic event
- avoidance
- negative changes in though or mood
- hypervigilance or chronic arousal
What are symptoms of intrusion (PTSD)
- recurrent, involuntary, and intrusive distressing memories of the traumatic event
- recurrent distressing dreams in which the content and or affect of the dream are related to the traumatic event
- dissociative reactions
- intense of prolonged psychiatric distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
what are symptoms of avoidence symptoms (PTSD)
- avoidance or or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event
- avoidance of or efforts to avoid external reminders of that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event
what are negative cognitions and mood and alterations in arousal examples (PTSD)
- inability to remeber certain aspects of the event due to dissociative amnesia
- persistent and exaggerated negative beliefs or expectations about oneself, others, or the world
- persistent, distorted cognitions about the cause or consquences of event that lead individual to blame themself or others
- persistent negative emotional state
- markedly diminished interest or participation in significant activities
- feelings of detachment or estrangement from others
- persistent inability to experience positive emotions
What sort of events trigger PTSD
- natural disaster
- combat, imprisonment in POW camp, terrorist attack, mugging
- rape, childhood SA
- violent assault or deaths
- diagnosis of life threatening disease
How is PTSD different from acute stress disorder
Acute stress disorder is less than 1 month. PTSD is more than 1 month
what percentage of those exposed to a traumatic event develop PTSD
10-20%
how does the severity of the incident relate to PTSD development
severity of event is not a predictor for PTSD development
are there possible personal characteristics that create a ‘diathesis’
diathesis stress model:
Biological:
- genetics, poorly regulated autonomic nervous system, chronic anxiety or depression
Psychological:
- catastrophizing, absolutist thinking, hypervigiliance for threat
Social:
- past experience of trauma, upbringing that enhanced anxiety
Personal Risk factors:
- dissociation, introversion, neurotocism, external locus of control, history of psychiatric disorder (personal or familial)
what are some protective factors
- high IQ
- social support
what is dissociation
a process in whihc different facets of ones self, memories, or conciousness become disconnected from one another
what 3 brain structures/areas are possibly involved in the development of PTSD
amygdala, hippocampus, and prefrontal cortex
what factors are upsetting to medical professionals who routinely work with trauma/critical patients
what are treatments for PTSD
Therapies:
- deal with guilt and rage
- systematic desensitization (exposure with support)
- relaxation techniques
- STOP therapy
- redirect maladptive coping strategies
- drug catharsis
Medications:
- Benzos, SSRIs, Buspar, Antidepressents, Antiseizure
