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BMS150 Midterm 2 > Intro to Psychiatry - Anxiety and Anxiety-Related Disorders > Flashcards

Intro to Psychiatry - Anxiety and Anxiety-Related Disorders Flashcards

1
Q

When is fear pathologic?

A
  • When its out of proportion to risk/severity of threat
  • Response lasts beyond threat duration
  • Response becomes generalized to other situations
  • Social/occupational functioning impairment
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2
Q

“True” Anxiety disorders

A
  • Panic Disorder
  • Agoraphobia
  • Specific phobia
  • Generalized Anxiety Disorder
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3
Q

“Anxiety-like” disorders

A
  • OCD
  • PTSD
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4
Q

Type of anxiety disorder characterized by recurrent panic attacks?

A

Panic disorder

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5
Q

Criteria for panic disorder diagnosis?

A
  • need to have periods in between attacks where patient fears another attack OR does maladaptive things to avoid another one
  • Panic can’t be due to a phobia or other disorder
  • Must have at least 4 panic symptoms not due to an underlying medical disorder
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6
Q

Generalized worry that occurs more days than not that is disproportionate to the severity of the event that is feared

A

Generalized Anxiety Disorder

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7
Q

Diagnostic criteria for GAD?

A
  • Excessive anxiety more days than not for 6 months
  • Difficulty controlling the anxiety
  • Accompanied by at least 3 of the diagnostic symptoms
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8
Q

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

A

Agoraphobia

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9
Q

How long does the fear or anxiety need to be present for agoraphobia to be diagnosed?

A

6 months

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10
Q

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

A

Specific phobias

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11
Q

Diagnostic criteria for specific phobias? (6)

A
  • exposure to phobia results in immediate fear/anxiety
  • phobia actively avoided
  • fear is out of proportion
  • person recognizes it as excessive
  • significantly impacts daily functioning
  • Must be present for > 6 months
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12
Q

Persistent (> 6mo.) fear of social or performance situations?

A

Social anxiety

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13
Q

When does PTSD happen?

A
  • Exposure to actual death, threatened by death, physical or sexual violence, serious injury
  • Frequently associated with combat in men
  • Frequently associated with abuse in women
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14
Q

Intrusion symptoms of PTSD?

A

Intrusive, distressing memories, flashbacks, dreams

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15
Q

Avoidance behaviour of PTSD?

A
  • Avoiding situations or events that are associated with the trauma
  • Can also involve avoiding people, places, or conversations
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16
Q

Cognitive and mood symptoms of PTSD?

A
  • memory deficits, negative emotions, guilt, shame
  • detachment from others, loss of interest in people or activities
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17
Q

Arousal and reactivity symptoms of PTSD?

A
  • Difficulty sleeping, exaggerated startle response
  • Anger, irritability, increased risk-seeking behaviour
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18
Q

Definition of an obsession?

A

intrusive and unwanted repetitive thoughts, urges, or impulses that lead to a marked increase in anxiety or distress

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19
Q

Definition of a compulsion?

A

repeated behaviours or mental acts that are done in response to obsessions, or in rigid-rule bound ways

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20
Q

Obsessions and compulsions in OCD must take up ________/day or cause what?

A

1 hour/day; cause significant distress or impairment in social, occupational, or other areas of function

21
Q

What is it called when patients are aware that their obsessions and compulsions are illogical and not based on fact?

A

Insight

22
Q

Other disorders that share a similar neurobiology to OCD?

A
  • hoarding disorder
  • skin-picking disorder or trichitomania
  • Body dysmorphic disorder
23
Q

Fear response initial steps?

A

Activation of locus coeruleus (LC) that releases norepinephrine (NE)

24
Q

Result of LC activation and increase release of NE?

A
  • Activation of amygdala = emotional fear response
  • Activation of hypothalamus = SNS and cortisol release
  • Activation of reticular activating system = increased arousal
25
Q

When the hippocampus is involved/activated, what is its role?

A

Learning about the cause of the fear and how it can be avoided

26
Q

Important pathways that can “cross-talk” to each other in the brain

A

Noradrenergic, serotonergic, and dopaminergic

27
Q

Normal anxiety and fear response?

A

Locus coeruleus and amygdala activated => SNS and temporary release of cortisol to help us deal with threats

28
Q

Areas activated or inactivated in abnormal anxiety and fear response?

A

Stria terminalis (near amygdala), dorsal raphe nucleus, and LC

29
Q

What are the results of abnormal anxiety and fear response?

A
  • poorer regulation of mood, worry/fear by PFC
  • Excessive cortisol release and SNS activation
30
Q

OCD pathogenesis likely involves circuits that involve what?

A

Basal ganglia

31
Q

Input nuclei? Functions?

A
  • putamen (limb/trunk movement)
  • caudate (cognition and eye movement)
  • nucleus accumbens (emotional reg)
32
Q

Associated nuclei? Function?

A
  • Globus pallidue externa
  • Substantia nigra pars compacta
  • Subthalamic nucleus
    all limb/trunk, eye movement; and emotional reg
33
Q

Output nuclei? Functions?

A
  • Globus pallidus interna (putamen function)
  • Substantia nigra pars reticulata (caudate function)
34
Q

Epidemiology of eating disorders

A

F>M (10:1)

35
Q

Higher risk individuals for an eating disorder?

A
  • “perfectionist” traits
  • Hx of sexual abuse
  • feelings of lack of control in other dimensions of life
  • Expectations regarding weight
36
Q

Anorexia diagnostic criteria?

A
  • intake and weight: energy intake < requirement = low body weight
  • fear or behaviour: fear of gaining weight/avoiding gaining weight
  • perception: body dysmorphia
37
Q

Bulimia diagnostic criteria?

A
  • recurrent episodes of binge eating
  • recurrent inappropriate compensatory behaviour to prevent weight gain
  • binge/compensation = at least 1 time wky for 3 mo
  • self-evaluation based on body shape and weight
38
Q

Benzodiazepines act as _____ and _______. Examples of each?

A
  • Anxiolytics (Diazepam)
  • Hypnotics (Triazolam)
39
Q

Benzo mechanism of action?

A

Facilitate binding of GABA to GABA-R

40
Q

Hangover effect?

A
  • wake up feeling groggy
  • more common with long half-life agents
41
Q

Early morning rebound effect?

A
  • wake up too early
  • more common with short half-life agents
  • can lead to taking second pill => tolerance development
42
Q

Tolerance?

A

Usual dose of a drug no longer sufficient to get therapeutic effect

43
Q

What may cause tolerance of a benzo?

A

Down-regulation of GABA-R

44
Q

Dependance?

A

Brain requires the drug to generate normal amounts of GABA activity - leading to more severe withdrawal sx

45
Q

Mild benzo withdrawal sx?

A
  • extra-sensory awareness
  • muscle twitching and tremor
  • rebound excitation
46
Q

Severe benzo withdrawal sx?

A
  • increased BP, HR, temp
  • rage
  • hallucinations and paranoia
  • seizures
47
Q

Competitive inhibitor of benzos?

A

Flumazenil

48
Q

Why use Flumazenil?

A
  • remove effects of benzo once therapeutic effects no longer needed
  • treatment of benzo OD

BMS150 Midterm 2 (14 decks)

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