Childhood Anxiety Disorders - Lachish

Question 1

What anatomical structures are related to anxiety?

Answer 1

Locus coeruleus

• Important in vigilance, attention and anxiety or fear
• Stimulation: ↑ panic attacks
• Blockade: ↓panic attacks

Amygdala
-Major mediator of stress response (fear/anxiety: fight, flight and freezing)

Question 2

What are the criteria for separation anxiety?

Answer 2

The duration of the disturbance is at least 4 weeks
Onset is before age 18 (only in children)
Disturbance causes clinically significant distress or impairment in social, academic or other areas of functioning.
Disturbance does not occur exclusively during the course of a PDD, Schizophrenia or other psychotic disorder
Early onset if before age 6 years (must be extreme)

Criteria:
Intense anxiety when separated from parent and fear that the absent parent my be hurt or die duration of greater than 4 weeks
Often the focus is on somatic complaints
Genetics: 83% of affected children had mothers diagnosed with anxiety disorder
Prognosis: better if younger and with mild symptoms up to 50% may continue with chronic anxiety problems

School refusal is most common form of diagnosis

Question 3

What are Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS)?

Answer 3

OCD or tics resulting from a possibly reversible lesion of the basal ganglia

Possibly caused by an autoimmune response after group A beta-hemolytic strep infection.

Question 4

What are the possible manifestations of post-traumatic stress disorder?

Answer 4

Depends on nature of trauma, degree of exposure and the child’s coping and support structure

CHILDREN
nightmares,daydreams or repetitive and potentially dangerous reenactments in symbolic play
continue to act out trauma
sleep disturbances
somatic complaints
Irritability
Behavioral Problems
Biological Differences

Question 5

What are the types of anxiety disorders present in children?

Answer 5

Panic disorder- PD
Agoraphobia- AG
Social phobia- SoP
Specific phobias- SP
Generalized Anxiety Disorder- GAD or GD
Posttraumatic Stress Disorder- PTSD or PTD
Acute Stress Disorder-ASD
Obsessive Compulsive Disorder-OCD
Separation Anxiety Disorder*-SAD
*children only