Anxiety (wk 6) Flashcards

1
Q

“true” anxiety disorders vs “anxiety like” disorders

A

“True” anxiety disorders: * Panic disorder
* Agoraphobia
* Specific phobia
* Generalized anxiety disorder

“Anxiety-like” disorders (no longer strictly considered
as part of the anxiety disorder spectrum)
* Obsessive-compulsive disorder
* Post-traumatic stress disorder

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2
Q

how many people have had an anxiety disorder

A

17%

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3
Q

panic disorder criteria

A

need to have periods in between attacks where patient a) fears another attack or b) does maladaptive things to avoid another attack

  • Need at least 1 month history of avoidance or fear of another panic attack
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4
Q

panic attacks need how many symptoms and give examples

A

4 of;

▪ Palpitations, pounding heart, or accelerated heart rate
▪ Sweating
▪ Trembling or shaking
▪ Sensations of shortness of breath or smothering
▪ Feelings of choking
▪ Chest pain or discomfort
▪ Nausea or abdominal distress
▪ Feeling dizzy, unsteady, light-headed, or faint
▪ Chills or heat sensations
▪ Paresthesias (numbness or tingling sensations)
▪ Derealization (feelings of unreality) or depersonalization (being detached from oneself)
▪ Fear of losing control or “going crazy.”
▪ Fear of dying

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5
Q

GAD diagnostic criteria

A

▪ Excessive anxiety for more days than not for 6 months
▪ Individual has difficulty controlling the anxiety

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6
Q

how many symptoms for GAD

A

3-6 of

▪ Restlessness or feeling “keyed up” or on edge
▪ Being easily fatigued
▪ Difficulty concentrating or mind going blank
▪ Irritability
▪ Muscle tension
▪ Sleep disturbance

  • As with all psychiatric diagnoses, the anxiety, worry, or physical symptoms must:
    ▪ Cause clinically significant distress OR
    ▪ Impairment in social, occupational, or other important areas of function
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7
Q

agoraphobia

A

fear of being out-of-doors or being in a crowd or being in a place where they can’t escape from or may suffer embarrassment

i.e. public stransport

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8
Q

how long for agorphobia

A

The fear or anxiety needs to be present for > 6 months and needs to cause significant distress or impairment in social or occupational functions

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9
Q

specific phobias

A

i.e. spider, blood, clown

fears of specific objects or situations that go beyond the true threat of the stimulus and cause avoidance and functional impairment

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10
Q

how long does specific phobia need to be present for

A

> 6 months

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11
Q

social anxiety disorder

A

▪ One is exposed to unfamiliar people or to possible scrutiny by others
▪ One is afraid that fearing he/she will act in a way that maybe humiliating or embarrassing
* e.g. public speaking, initiating or maintaining conversation, dating eating in public
▪ Out-of-proportion fear that they will be harshly judged by their interpersonal interactions

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12
Q

post traumatic stress disorder

men and women common causes

A

exposure to actual death, threatened death, physical or
sexual violence, serious injury

men- combat
women- abuse

First responders, healthcare personnel, law enforcement are a growing demographic affected by this disorder

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13
Q

symptom categories of PTSD

A
  1. intrusion symptoms
  2. avoidance behaviour
  3. cognitive and mood symptoms
  4. arousal and reactivity symptoms

▪ Intrusion symptoms
* Intrusive, distressing memories, flashbacks, dreams ▪ Avoidance behaviour
* Avoidance of situations or events that are associated with the inciting trauma
* Can also involve avoiding people, places, or conversations that arouse memories or feelings associated with the event
▪ Cognitive and mood symptoms
* Memory deficits, negative emotions, guilt, shame
* Detachment from others, loss of interest in people or activities
▪ Arousal and reactivity symptoms
* Difficulty sleeping, exaggerated startle responses
* Anger, irritability, increased risk-seeking behaviour

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14
Q

intrusion symptoms of PTSD

A

i.e. falshbacks

▪ Recurrent, involuntary distressing memories or dreams of a
traumatic event (they “intrude” on the sufferer’s mind)
▪ Dissociative reactions where the individual feels as if the event was occurring
* Known as a flashback – different than a memory
▪ Marked physiological reactions or distress at exposure to cues
that resemble the traumatic event

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15
Q

PTSD alterations in arousdal and reactivity examples

A

▪ Irritable behaviour or angry outbursts with little or no provocation
▪ Hypervigilance or exaggerated startle responses to everyday stimuli
▪ Sleep disturbances or difficulty concentrating
▪ Reckless or self-destructive behaviour

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16
Q

PTSD negative alterations in cognitions or mood

A

▪ Inability to remember important aspects of the traumatic
event
▪ Negative beliefs about oneself or the world in general
* These could be linked to or independent from self-blame about the traumatic incident
▪ Persistent inability to experience positive emotions
▪ Diminished interest or participation in general day-to-day,
essential activities
▪ Detachment or estrangement from other people

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17
Q

how long must PTSD symptoms be present

A

> 1 month

impair life.

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18
Q

obsession and compulsion definition

A
  • Obsession: intrusive and unwanted repetitive thoughts, urges, or impulses that lead to a marked increase in anxiety or distress
  • Compulsion: repeated behaviors or mental acts that are done in response to obsessions, or in a rigid rule-bound way (i.e. ritual)
    ▪ Act may attempt to “suppress” the obsession
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19
Q

obsession examples

A

Fear of contamination

Pathological doubt (i.e. something was missed leading to catastrophic consequences)

Fear of causing harm to others

Need for symmetry or exactness

Superstitious obsessions (can include religious obsessions)

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20
Q

compulsion examples

A

Cleaning or washing rituals

Repetitive checking

Ordering, rearranging objects

Superstitious rituals (i.e. repeating things a certain number of times)

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21
Q

how long must OCD take place in a day

A

▪ Obsessions and compulsions must take > 1 hour/day or cause significant distress or impairment in social, occupational, or other areas of functiona

22
Q

True or false

OCD people are aware that their obsessions and compulsions are illogical and not based in fact

A

TRUE

▪ This is known as insight
▪ Most patients with delusions and hallucinations have poor
insight (i.e. schizo)

23
Q

what other disorders share similar neurobiology to OCD

A

▪ Hoarding disorder
▪ Skin-picking or trichitomania (hair-pulling/plucking) disorders
▪ Body dysmorphic disorder

24
Q

neurobiology of anxiety disorders

A
25
Q

what part of the brain does the fear response activate and which neuortransmitter does it release

A

locus coerulus (a midbrain nucleus)

norepinephrine

26
Q

how does the amygdala get activated in a fear response

A

from the locus coeurluls and norepinephrine release

27
Q

in a fear response what gets activated after the amygdala

A

hypothalamus and reticular activating system

▪ Activation of the hypothalamus – activation of the sympathetic nervous system and cortisol release

▪ Activation of the reticular activating system in the brainstem – increased arousal

28
Q

which neurotransmitters in which part of the brain can have a modulatory effect on mood, memory and fear and stress

A

The serotonin-releasing nucleus in the brainstem (the raphe nucleus)

29
Q

what 3 pathways are effected in anxiety disorders

A

Noradrenergic, Dopaminergic, Serotonergic Pathways →Brainstem Nuclei

30
Q

what is a normal anxiety response

A

“Normal” – areas activated include the locus coeruleus, amygdala→activation of the sympathetic nervous system and temporary increased release of cortisol
* Helps us deal with threats – the prefrontal cortex is able to regulate mood, negative cognition, and general worry

31
Q

what is abnormal anxiety response

A

▪ “Abnormal” – areas activated OR inactivated include an area close to the amygdala (stria terminalis) and other midbrain nuclei like the dorsal raphe nucleus as well as the locus coeruleus
* Poorer regulation of mood, fear/worry by the prefrontal cortex
* Excessive long-term activation of cortisol release by activation of the hypothalamic pituitary axis as well as excessive chronic activation of the sympathetic nervous system

32
Q

what brain part does OCD involve mainly

A

basal ganglia
–> direct and indirect pathways via extrapyramidal motor system

33
Q

which pathway is over active in OCD

A

direct pathway in basal ganglia

over-activation of the direct pathway and poor activation of the indirect pathway as they modulate activity of the orbitofrontal cortex

  • Inhibitory dopaminergic transmission transmission (D2 receptors) may be implicated
34
Q

treatment for OCD

A

high dose SSRIs

35
Q

eating disorder in femalee vs male

A

10:1

36
Q

who is at high risk for ED

A

▪ display “perfectionist” traits
▪ Have a past history of sexual abuse
▪ feel that they lack control in other dimensions of their lives
▪ Expectations (i.e. athletic) regarding weight * Gymnasts, dancers
* Wrestlers

37
Q

anorexia diagnostic crieria

A
  1. low energy intake and low weight
  2. fear or behaviour of becoming fat
  3. perception; doesn’t think is underweight

intake and weight: restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
▪ Significantly low weight → a weight that is less than minimally normal
fear or behaviour: intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain, even though at a significantly low weight
perception: disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight

38
Q

bulimia diagnostic criteria

A
  1. binge eating episode
  2. compensatory behaviour to prevent weight gain (vomit, laxative, fast, exercise)
  3. at least 1x/ week for 3 months

A. recurrent episodes of binge-eating; an episode of binge-eating is characterized by both of the following:
▪ eating, in a single period of time, an amount of food that is larger than what most individuals would eat during a similar period of time and under similar circumstances
▪ a sense of lack of control over eating during the episode
B. recurrent inappropriate compensatory behaviour in order to prevent weight
gain such as:
▪ self-induced vomiting
▪ misuse of laxatives, diuretics, enemas, or other medications ▪ Fasting
▪ excessive exercise
C. the binge-eating and inappropriate compensatory behaviours both occur, on average, at least once a week for 3 mo
D. self-evaluation is unduly influenced by body shape and weight
E. the disturbance does not occur exclusively during episodes of AN

39
Q

dangers of starvation/ calorie restriction

A
  • Hypotension, bradycardia
  • Dysrhythmias, congestive heart
    failure
  • Vitamin deficiencies
  • Constipation, delayed gastric
    emptying
  • Decreases thyroid hormone,
    amenorrhea, osteoporosis
  • Increased risk of seizure due to
    electrolyte abnormalities
  • Severe restriction can cause renal
    failure and edema
40
Q

dangers of bingin+ purging

A
  • Gastric dilation or rupture
  • Esophageal damage/tearing
  • Pancreatitis
  • Dysrhythmias (due to K+ loss from
    vomiting or use of laxatives) * Damage to teeth (purging)
  • Aspiration pneumonia
  • Gastric contents cause pneumonia when they are accidentally “breathed in”w
41
Q

2 ways that benzodiazepines act

A
  1. anxiolytics
  2. hypnotics

▪ Anxiolytic example: Diazepam (Valium®) * Also used for certain types of seizures
▪ Hypnotic example: Triazolam (Halcion®)

42
Q

mechanism of action of benzodiazepenes

A

binds GABA to GABA-R

43
Q

adverse effects of benzos

A

–>most common w hypnotics
* Hangover effects
▪ Wake up feeling groggy
▪ More common with long half-life agents
* Early morning rebound insomnia
▪ Wake up too early
▪ More common with short half-life agents
▪ Can lead to taking a second pill during the same sleep cycle, which makes tolerance more likely to develop

44
Q

what might cause tolerance to benzos

A

down regulation of GABA receptor

45
Q

dependence of benzos?

A

▪ Brain requires the drug to generate normal
amounts of GABA activity
▪ Leads to more severe withdrawal symptoms when drug is discontinued

46
Q

withdrawal symptoms of benzos

A

▪ Mild symptoms can occur after short-term use and/or
low-doses, including:
* Extra-sensory awareness
▪ Ex acute hearing
* Muscle twitching or tremors * Rebound excitation
▪ Patients should be counselled to expect a few nights bad sleep at the end of a course of BDZ
* During this time, a new prescription should not be given

  • Use of BDZ’s more than 14-21 nights in a row makes tolerance/dependence/several withdrawal symptoms more likely
47
Q

severe withdrawal of benzos

A

▪ Severe symptoms usually occur on abrupt discontinuation after long-term use and/or high doses, and include:
* Increased blood pressure, temperature and pulse
* Rage
* Hallucinations and paranoia * Seizures

withdrawal symptoms can also occur during the chronic drug use bc they aren’t getting the impact of the drugs anymore bc the gaba receptors are downregualted

48
Q

warms of hypnotics for insomnia (benzos)

A

Abnormal thinking and behavioral changes
* Visual and auditory hallucinations, “sleep-X” events
▪ The need to evaluate for an underlying primary psychiatric and/or medical illness for the insomnia
* Hypnotic use coupled with an underlying primary disorder can cause:
▪ Worsening of insomnia, worsening of depression (including suicidal thoughts), etc

49
Q

what is the benzodiazepine antagonist

and via what mechanism

A

flumazenil

competitive inhibition of benzodiazepines

ie for drug overdose or to get off meds

50
Q

typically how long must someone have the mental health disorder persistently for to be diagnosed

A

> 6 months

except i.e. PTSD is >1 month

mania is 1 week