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5. Anxiety Disorders > DSM Anxiety Part 2 (Panic Disorder, Panic Attack Specifiers, Agoraphobia, GAD, Sub/Med, Other) > Flashcards

DSM Anxiety Part 2 (Panic Disorder, Panic Attack Specifiers, Agoraphobia, GAD, Sub/Med, Other) Flashcards

1
Q

how many symptoms are there for panic attack

A

13

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2
Q

what are the possible symptoms of a panic attack

A
  1. palpitations, pouding heart, accelerated HR
  2. sweating
  3. trembling or shaking
  4. sensations of SOB or smothering
  5. feelings of choking
  6. chest pain or discomfort
  7. nausea or abdominal distress
  8. feeling dizzy, unsteady, lightheaded or faint
  9. chills or heat sensations
  10. parethesias (numbness/tingling)
  11. derealization (feelings of unreality) or depersonalization (being detached from oneself)
  12. fear of losing control or “going crazy”
  13. fear of dying
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3
Q

how many symptoms of the 13 for panic attack must you have to meet criteria A for panic disorder

A

4

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4
Q

what is a panic attack

A

abrupt surge of intense FEAR or intense DISCOMFORT that reaches a peak within minutes, and during which you have the required symptoms

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5
Q

what is criterion A for panic disorder

A

recurrent UNexpected panic attacks

(that meet criteria with 4/13 symptoms)

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6
Q

criterion B for panic disorder

A

at least one of the panic attacks has been followed by ONE MONTH or more of one or both of the following:

  1. persistent concern or worry about additional panic attacks or their consequences (i.e losing control, going crazy, having a heart attack)
  2. a significant maladaptive change in behaviour related to the attacks (i.e behaviours designed to avoid panic attacks, such as avoidance of exercise or unfamiliar situations)
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7
Q

criteria C and D for panic disorder

A

not attributable to med or substance, to another med condition or to another mental disorder

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8
Q

what is the 12 month prevalence of panic disorder

A

2-3% in adults and teens

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9
Q

what populations have higher rates of panic disorder

A

non-latino whites and american indians (in usa)

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10
Q

what is the gender difference in panic disorder

A

female:male 2:1

gender difference is already observable before age 14 years

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11
Q

can panic disorder occur in children

A

panic attacks occur in children but overall prevalence of panic disorder is low before age 14

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12
Q

what is the median age at onset for panic disorder

A

20-24

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13
Q

what is the usual course of panic disorder if untreated

A

chronic, but waxing and waning

some people have episodic outbreaks with years of remission in between and others may have continuous severe symptomatology

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14
Q

name two temperamental risk factors for panic attacks

A

negative affectivity and anxiety sensitivity (disposition to believing that symptoms of anxiety are harmful)

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15
Q

what early childhood adverse experiences may precipitate panic disorder

A

reports of sexual and physical abuse in childhood more common in panic disorder than in other anxiety disorders

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16
Q

list environmental risk factors for panic disorder

A

childhood physical/sexual abuse

smoking

identifiable stressors in months prior to first panic attack

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17
Q

what medical condition is associated with panic disorder

A

respiratory disturbance such as asthma

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18
Q

there is an association between panic disorder and what gene

A

COMT gene–> in FEMALES only

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19
Q

list some agents than can provoke panic attacks in individuals with panic disorder (at greater rates than in general pop)

A

sodium lactate

caffeine

isoproterenol

yohimbine

CO2

cholecystokinin

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20
Q

how do panic attacks affect suicide risk

A

panic disorder and panic attacks increase risk of suicide even when other risk factors are controlled for

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21
Q

ddx panic disorder

A

other specified anxiety disorder or unspecified anxiety disorder

anxiety due to another medical condition

sub/med induced anxiety disorder

other mental disorders with panic attacks as an assoc. feature

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22
Q

list medical conditions that can cause panic attacks

A

hyperthyroidism

hyperparathyroidism

pherchromocytoma

vestibular dysfunctions

seizure disorders

cardiopulmonary conditions like arrhythmias, SVTs, COPD

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23
Q

what is the usual amount of time to peak intensity of symptoms in panic attacks

A

withi minutes

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24
Q

what is the 12 month prevalence of panic attacks in the USA

A

11.2%

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25
Q

are panic attacks common in kids?

A

not before puberty but then increases

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26
Q

how many “agoraphobia situations” are there

A

5

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27
Q

how many situations must someone fear to meet criterion A for agoraphobia

A

2/5

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28
Q

list the 5 “agoraphobia situations” listed in criterion A for agoraphobia

A
  1. using public transportation
  2. being in open spaces
  3. being in enclosed spaces
  4. standing in line or being in a crowd
  5. being outside of the home alone
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29
Q

what is criterion A for agoraphobia

A

marked fear or anxiety about 2+ of the 5 situations

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30
Q

criterion B agoraphobia

A

individual fears or avoids these situations because of thoughts that ESCAPE might be difficult or fears help might not be available in the event of developing panic-like symptoms
or other incapacitating or embarrassing symptoms

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31
Q

criterion C agoraphobia

A

the agoraphobic situations almost always provoke fear or anxiety

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32
Q

criterion D agoraphobia

A

the agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety

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33
Q

criterion E agoraphobia

A

fear/anxiety is out of proportion to actual danger

34
Q

criterion F agoraphobia

A

persistent–6+ months

35
Q

criteria G-I agoraphobia

A

clinically significant distress/impairment

if another medical condition is present, the fear/anxiety or avoidance is clearly excessive

not better explained by another mental disorder

36
Q

what are considered “panic like symptoms” in agoraphobia

A

any of the 13 symptoms of panic attacks

37
Q

what are considered “other incapacitating or embarrassing symptoms” in agoraphobia

A

vomiting or IBS symptoms

fear of falling

sense of disorientation or getting lost (esp. in kids)

37
Q

what are considered “other incapacitating or embarrassing symptoms” in agoraphobia

A

vomiting or IBS symptoms

fear of falling

sense of disorientation or getting lost (esp. in kids)

38
Q

what is the prevalence of agoraphobia

A

1.7% of teens and adults

39
Q

what is the gender disparity in agoraphobia

A

females 2x as likely to have agoraphobia compared to men

40
Q

when does incidence of agoraphobia peak

A

late adolescence and early adulthood

in 2/3 of people onset is before age 35; second high incidence risk phase after age 40

mean age at onset is 17 years for agoraphobia (25-29 if no preceding panic attacks/disorder)

41
Q

what % of people report panic attacks or panic disorder preceding onset of agoraphobia

A

community–30%

clinical–50%

42
Q

what is the typical course of agoraphobia

A

typically PERSISTENT and CHRONIC

complete remission is rare unless agoraphobia is treated

43
Q

agoraphobia is associated as a risk factor for what other disorders

A

substantially elevated risk of secondary MDD, PDD and SUDs

44
Q

what is the heritability for agoraphobia

A

61%

*of the various phobias, agoraphobia has the STRONGEST and MOST SPECIFIC association with the genetic factor that represents proneness to phobias

45
Q

what is a major determinant of degree of disability associated with agoraphobia

A

agoraphobia severity–> irrespective of the presence of comorbid panic disorder, attacks and other comorbid conditions

46
Q

what proportion of those with agoraphobia are completely homebound and unable to work

A

about 1/3

47
Q

ddx agoraphobia

A

*note that when criteria for agoraphobia and another disorder are both fully met, both diagnoses can be given (unless fear is entirely explained by the other disorder)

specific phobia–situational type

separation anxiety disorder

social anxiety disorder

panic disorder

acute stress and PTSD

MDD

other medical conditions

48
Q

how do you distinguish agoraphobia from specific phobia–situational type

A

in agoraphobia there are MORE situations feared (2+) and the cognition is around fear of panic sx or other incapacitating symptoms/unable to escape

in specific phobia, its just one situation and the cognitions are different i.e fear of plane crashing (cognitions usually around being harmed by the situation directly)

49
Q

what are the most frequent additional diagnoses in those with agoraphobia

A

anxiety disorders–often preceeds agoraphobia

depressive disorders–typically secondary to agoraphobia

PTSD

AUD–typically secondary to agoraphobia

50
Q

criterion A for GAD

A

excessive anxiety and worry (apprehensive expectation), occurring more days than not for AT LEAST 6 MONTHS, about a NUMBER of events or activities (i.e work or school performance)

51
Q

criterion B for GAD

A

the individual finds it difficult to control the worry

52
Q

criterion C for GAD

A

the anxiety and worry are associated with THREE (or more) of the following SIX symptoms (with at least some of the symptoms having been present for more days than not for the past 6 months)

  1. restlessness or feeling keyed up or on edge
  2. being easily fatigued
  3. difficulty concentrating or mind going blank
  4. irritability
  5. muscle tension
  6. sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep)
53
Q

how many symptoms must you have to meet criteria for GAD

A

3/6

54
Q

criteria D-F GAD

A

clinically significant distress/impairment

not attributable to physiological effects of med/substance

not better explained by another mental disorder

55
Q

what types of things do people with GAD worry about

A

everyday, routine life circumstances i.e possible job responsibilities, health and finances, health of family members etc

56
Q

what is the 12 month prevalence of GAD in teens and adults

A

0.9% in teens
2.9% in adults
in the general community in the usa

57
Q

how many criteria are required for diagnosis of GAD in kids (i.e out of the 6 symptoms in addition to worry)

A

1

58
Q

what is the gender disparity in GAD

A

females 2x more likely to have than males

59
Q

when does the prevalence of GAD peak

A

in middle age

declines across later years of lfie

60
Q

what population is more likely to experience GAD

A

those of European descent

61
Q

what is the lifetime morbid risk of GAD

A

9%

62
Q

what is the median age at onset for GAD

A

30–but broad range

63
Q

what is the usual course of GAD

A

chronic

wax and wane across the lifespan

fluctuates between syndromal and subsyndromal level

rates of full remission are very low

64
Q

list 3 temperamental risk factors for GAD

A

behavioural inhibition

negative affectivity

harm avoidance

65
Q

what proportion of the risk of having GAD is genetic

A

about 33%

66
Q

ddx GAD

A

anxiety due to another medical condition

sub/med induced anxiety disorder

social anxiety disorder

OCD

PTSD and adjustment disorders

depressive, bipolar, adjustment disorders

67
Q

what are the criteria for substance/medication induced anxiety disorder

A

basically same as sub/med induced mood disorder–>

anxiety/panic attacks predominate in clinical picture, there is evidence that symptoms started during intox or withdrawal or after exposure to a med, and its not better explained by another anxiety disorder

not during only the course of a delirium

causes clinical impairment/distress

68
Q

once substance or treatment is discontinued, how long does it usually take the symptoms of anxiety/panic to resolve in substance/medication induced anxiety disorder

A

within days to weeks to a month

if lasting longer than a month from sub/med/withdrawal d/c, should consider other dx possibilities

69
Q

list classes of substances that can result in substance/medication induced anxiety disorder due to intoxication

A

alcohol

caffeine

cannabis

phencyclidine

other hallucinogens

inhalants

stimulants

other

70
Q

what classes of medications can cause panic/anxiety in withdrawal states

A

alcohol

opioids

sedatives

hypnotics

anxiolytics

stimulants

71
Q

what classes of drugs can invoke panic/anxiety symptoms

A

anesthetics and analgesics

sympathomimetics or other bronchodilators

anticholinergics

insulin

thyroid preparations

oral contraceptives

antihistamines

antiparkinsonian agents

corticosteroids

antihypertensives

cardiovascular meds

anticonvulsants

lithium

antipsychotics meds

antidepressant meds

*heavy metals and toxins can also do this

72
Q

ddx substance/medication induced anxiety disorder

A

substance intox or withdrawal

anxiety disorder

delirium

anxiety disorder due to another medical condition

73
Q

what are the criteria for anxiety disorder due to another medical condition

A

“Panic attacks or anxiety is predominant in the clinical picture.

There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.

The disturbance is not better explained by another mental disorder.

The disturbance does not occur exclusively during the course of a delirium.

The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.”

74
Q

list diseases known to cause anxiety and a symptomatic presentation

A

endocrine disease–> hyperthyroid, pheochromocytoma, hypoglycemia, hyperadrenocortisolism

cardiovascular disease–> CHF, PE, arrhythmia

respiratory illness–> COPD, asthma, pneumonia

metabolic disturbance–> B12 deficiency, porphyria

neuro illness–> neoplasms, vestibular dysfunction, encephalitis, seizure disorders

75
Q

ddx for anxiety disorder due to another medical condition

A

delirium

mixed presentation of symptoms i.e mood and anxiety

substance or med induced anxiety disorder

primary anxiety disorder

illness anxiety disorder

adjustment disorders

associated feature of another mental disorder (AN, schizophrenia)

76
Q

name two scales that can be used to assess anxiety

A

GAD-7 and Beck Anxiety Inventory (BAI)

77
Q

what brain structures are thought to be implicated in the worry in anxiety disorders

A

the cortico-striatal-thalamic-cortical (CSTC) loop

(also for obsessions in OCD)

78
Q

if anxiety is due to a fear of panicking, dying or losing control, what disorder should you think of?

A

panic disorder

79
Q

if anxiety is due to worry about being trapped or unable to escape, what disorder should you think of?

A

agoraphobia

80
Q

if anxiety is due to being embarrassed in front of, or judged by others, what disorder should you think of?

A

social anxiety

81
Q

if anxiety is due to constant, pervasive worries and they cant stop worrying, what disorder should you think of?

A

GAD

5. Anxiety Disorders (4 decks)

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