Behavioral Science: Anxiety 1 & 2 Flashcards
Symptoms for a dx of anxiety
- persistent (>6 months)
- interfere with normal functioning
- cause significant distress
Neurobiological factors a/w anxiety
Low serotonin, GABA
High Norepi, glutamate
GAD
A. Excessive anxiety/worry most days for at least 6 months, about more than one event/activity
B. Difficult to control worry
C. A/w at least 3 of the following: restlessness, fatigue, difficulty concentrting, irritability, muscle tension, sleep disturbance
D. causes significant impairment
E. no other explanation for symptoms
Features of GAD
Women > Men
May have had anxious parents
Self medicate
Without tx tends to get worse
Treatment of GAD
Therapy, meds, Beta blockers for performance anxiety
Therapy for GAD
CBT, psychodynamic
Meds for GAD
Antidepressants: escitalopram/paroxetine, venlafaxine, duloxetine
Buspirone (5HT1a receptor agonist)
Benzos
Panic disorder
A. Recurrent unexpected panic attacks
B. At least 1 attack followed by at least 1 month of one or both of the following:
- concern about additional panic attacks or consequences
- significant maladaptive change in behavior related to attacks
C. No other explanation for symptoms
Panic attack
An abrupt surge of intense fear or discomfort, peaks within minutes, that is unexpected. Includes at least 4 of the following:
- palpitations, pounding heart, accelerated heart rate
- sweating
- shaking/trembling
- sensation of shortness of breath or smothering
- choking sensation
- chest pain/discomfort
- nausea
- dizziness, lightheadedness or fainting
- chills or heat
- paresthesias
- derealization
- fear of losing control
- fear of dying
Agoraphobia
A. Fear/anxiety of at least 2 of the following:
- using public transport
- being in open spaces
- being in enclosed spaces
- standing in line or in a crowd
- being outside the home alone
B. Fear of not being able to escape situation
C. Situation almost always produces fear/anxiety
D. Avoids situations
E. Fear/anxiety out of proportion to actual danger
F. At least 6 months duration
G. Causes significant impairment
H. No other explanation for symptoms
Tx for agoraphobia
Therapy: CBT (systematic desensitization or flooding), psychodynamic
Meds: emergency–> quick acting benzos, long term: SSRI/SNRI. Can also use intermediate acting benzos long term but it’s not first line tx due to addictive potential
Or a combo
Specific phobia
A. At least 6 months
B. Causes significant impairment
C. Marked fear/anxiety of specific object/situation
D. Object/situation almost always causes fear/anxiety
E. Actively avoids object/situation
F. Fear/anxiety out of proportion to actual danger
G. No other explanation for sx
Social Anxiety Disorder
A. At least 6 months
B. Causes significant impairment
C. Marked/fear anxiety when exposed to social situation with possible scrutiny by others
D. Fear of acting in ways that will be negatively scrutinized
E. Social situations provoke fear
F. Avoids social situations
G. Fear/anxiety out of proportion to actual threat
H. No other explanation for symptoms
Performance anxiety
For of social anxiety where the fear is restricted to public speaking or performing and does not generalize to other aspects of life
Tx for specific phobia
Therapy (1st line): Flooding, systemic desensitization, psychodynamic
Medication: sedatives?
Tx for social anxiety disorder
Therapy: CBT, assertiveness training, group therapy
Meds: SSRI/SNRI (1st line), paroxetine/venlafaxine ER
MAOI: Phenelzine, tranylcypromine
Beta Blockers: propanalol, 1st line for performance anxiety online
OCD
A. Presence of obsessions and compulsions
B. Must be either:
1. Time consuming (>1h/day), or
2. Cause clinically significant distress
{must have 1 or 2}
3. not substance induced
4. not better explained as the sx of another mental or medical disorder
Obsession
Recurrent/persistent thoughts, urges, or images
- intrusive and unwanted
- cause anxiety and distress
- patient tries to ignore/suppress the thoughts OR try and neutralize them with a thought or action
Compulsion
Repetitive behavior or activity that the patient performs in response to an obsession or as a set of rules that must be strictly adhered to
- typically undoes or reduces anxiety
- stopping the compulsion often dramatically increases the anxiety
OCD demographics and prognosis
- Equal in men and women
- often onset is after a stressful event
- onset is earlier in men (19) than women (22)
- long but variable outcome, generally the hardest anxiety to treat
- up to 2/3 of Tourette’s pts have OCD
Tx for OCD
Psychotherapy: CBT is as effective as drugs, with longer lasting effect (exposure and response prevention), ACT: Acceptance and commitment therapy, Supportive psychotherapy/dynamic psychotherapy
Drugs: 1st: SSRIs, higher dose than MDD
2nd: Clomipramine
3rd: Antipsychotics or other antidepressants
- benzos don’t work
Differential dx for OCD
- Tourette’s
- Temporal lobe epilepsy
- Obsessive Compulsive Personality Disorder
- OCD pts typically have insight into their behavior
- OCPD pts do not…rigid, moralistic, list and pattern oriented.
PTSD
A. Exposure to actual or threatened traumatic event.
- Sx must be present at least 1 month
- must cause significant stress/impairment
- not the result of drugs/medical condition
B. Intrusion symptom a/w event
C. Avoidance of stimuli a/w traumatic event
D. Negative changes in cognition and mood a/w event, at least 2 of the following:
- dissociative amnesia or repression
- persistent, exaggerated beliefs of oneself, others, or the world
- distortion of thoughts of the event causing them to blame themselves
- persistently negative emotional state
- decreased interest in activity
- detachment from others
- inability to experience positive emotions
E. Alterations in arousal/reactivity, at least 2 of the following:
- irritable/angry outbursts, verbal/physical aggression
- reckless/self destructive behavior
- hypervigilance
- exaggerated startle response
- problems with concentration
- sleep disturbance
Modes of Exposure in PTSD
- directly witnessing event
- witnessing event happen to others
- learning that family/friend experienced event
- directly experiencing repeated/extreme exposure to horrific details of event
Acute Stress Disorder
Same criteria A-D as PTSD, but must persist for 3 days-1 month post exposure (versus >1 month for PTSD)
- a precursor to PTSD
- best time to treat! can prevent PTSD
Tx of PTSD, ASD
Psychotherapy: Cognitive therapy, behavioral therapy, eye-movement desensitization and reprocessing, psychodynamic therapy, support groups and family therapy
Drugs:
1st: SSRI
2nd: TCAs (amitryptyline and imipramine), atypical antipsychotics
3rd: MAOIs, trazodone, anticonvulsants, clonidine, propanalol
Prazosin (a1 inhibitor) for nightmares
