Behav. Sci. Anxiety Flashcards
what are physical manifestations of anxiety?
sympathetic NS: diaphoresis, mydriasis, tachycardia, tremor, GI/GU symptoms (diarrhea, increased urinary frequency), hyperventilation, dizziness, syncope, parasthesia, numbness and tingling in the extremities and around the mouth
what are the psychological manifestations of anxiety?
restlessness, irritability, trouble concentrating, worry
what are the 5 main classifications of anxiety disorder?
generalized anxiety disorder, panic disorder (w and w/o agoraphobia), specific phobia/social anxiety disorder, OCD, ASD/PTSD
DD for anxiety: medical causes
medical causes (caffeine, substance abuse, withdrawal, hyperthyroid, arrhythmia, vit B12 deficiency, hypoglycemia, pheochromocytoma
what are often seen in ED setting presenting as anxiety?
acute MI, pulmonary embolism, COPD, asthma exacerbation
which psychiatric disorders are associated with anxiety?
depression, schizophrenia, eating disorders, personality disorders, substance dependence
diagnosing anxiety
symptoms must:
- be persistent (>6 months) - shorter for children
- interfere with normal functioning
- cause significant distress
etiology psychosocial factors for anxiety
- traumatic events or extreme stressors (PTSD, panic attack) may help create the anxiety disorder
- maladaptive coping skills/personality traits make people vulnerable
etiology biologic factors for anxiety
- greater prevalence in populations of family members with anxiety orders (genetics may play role, environment you grew up in)
- gender bias towards women (except OCD)
neurobiological factors for anxiety
- lowered serotonin and GABA activity
- increased NE and glutamate activity
diagnostic criteria for general anxiety disorder
excessive anxiety/worry occurring more days than not for more than 6 months about more than 1 event/activity - difficult to control this worry
what are the symptoms associated with general anxiety disorder? how many symptoms are needed to diagnose?
more than 3 symptoms
- restlessness
- easily fatigued
- difficulty concentrating
- irritability
- muscle tension
- sleep disturbance
prognosis for general anxiety disorder
without treatment tends to worsen esp during stressful times
treatment for general anxiety disorder
best/most studied: cognitive behavioral therapy
- psychodynamic (childhood trauma, unconscious thoughts)
- antidepressents: SSRIs frontline
- buspirone
- benzodiazepines
what is the mechanism to giving SSRIs in general anxiety disorder
increases SR or NE or both by downregulating or desensitizing receptors (needs to be done slowly)
buspirone in general anxiety disorder mechanism
initially lowers SR activity as autoreceptors are stimulated, but eventually renders them inactive allowing increases in SR output (has less sexual and weight gain side effects)
what is second line pharmacologic treatment for general anxiety disorder? why second line?
benzodiazepines - highly addictive, falls, apnea
when are beta blockers used?
symptomatic relief of PERFORMANCE ANXIETY ONLY
panic disorder
an abrupt surge of intense fear or discomfort, peaks within minutes and is UNEXPECTED - recurrent - more than one attack followed by more than one month of concern about additional panic attacks or consequences and/or significant maladaptive change in behavior related to attacks
what symptoms are associated with panic disorder? how many required to diagnose?
need more than 4
- palpitations
- sweating
- shaking
- sensation of SOB
- choking feeling
- chest pain/discomfort
- nausea
- dizziness, lightheadedness, fainting
- chills/heat
- paresthesias
- derealization
- fear of losing of control
- fear of dying
agoraphobia
fear/anxiety about more than 2 of the following for more than 6 months
- using public transportation
- being in open spaces
- being in enclosed spaces
- standing in line or in a crowd
- being outside the home alone
- fear of not being able to escape situation
treatment for panic disorder
cognitive behavioral therapy (esp systemic desensitization or flooding), benzodiazepine, SSRI, benzos
what is the emergency treatment for panic disorder? long term 1st line?
emergency benzodiazepine
first line long term SSRI
specific phobia diagnostic criteria
- more than 6 months
- causes significant impairment
- marked by fear/anxiety about specific object/situation
- object/situation almost always provokes fear/anxiety
- actively avoids object/situation
- fear/anxiety out of proportion to actual danger
social anxiety disorder diagnostic criteria
- more than 6 months
- significant impairment
- marked fear/anxiety when exposed to social situation with possible scrutiny by others
- fear of acting in ways that will be negatively scrutinized
- social situation provokes fear
- avoids social situations
- fear/anxiety out of proportion to actual threat
-can have PERFORMANCE ONLY - public speaking/performing
treatment for specific phobia
1st line: flooding, systemic desensitization
medications: maybe sedatives?
treatment for social anxiety disorder
CBT, assertiveness training, group therapy
-meds: SSR 1st line, MAOI, beta blocker for performance only**
