Lec 76 Anxiety Disorders Flashcards
What is the most common group of mental disorders?
anxiety disorders
Are anxiety disorders more common in women or men?
women
What are the most common types of anxiety disorders?
- specific phobia
- social anxiety disorder
- generalized anxiety disorder
- panic disorder with/without agoraphobia
What is prevalence of anxiety disorders?
29%
What are common symptoms of all anxiety disorders?
subjective: apprehension, worry, anticipation, fear, hyper-vigilance, restlessness, impaired conc, depression
physiologic: neuromuscular [tension, fatigue], GI [dry mouth, difficulty swallowing], resp [hyperventilation], cardio [palpitations]
What are criteria for panic disorder?
- recurrent unexpected panic attacks
- anticipatory anxiety: > 1 mo concern about having additional attacks, worry about implications of attacks
- not attributable to other substance/med condition
- +/- agoraphobia
What are the elements of a panic attack?
- abrupt surge of intense fear that builds to crescendo pattern
- sudden onset, peak w/in min
- lasts 5-30 min
- often out of the blue
- physical symptoms
- emotional: fear of dying/losing control
- can occur in non-psychiatrically ill people
- can occur in disorders besides panic disorder
What are the physical symptoms of panic attack?
- palpitations
- sweating
- trembling or shaking
- feelings of choking
- chest pain or discomfort
- nausea
- parasthesias
- chills or hot flashes
- derealization or depersonalization
- dizzy/unsteady/lightheaded/faint
- dyspnea
What is the cardinal symptom of panic?
hyperventilation
- panic pts are chronic hyperventilators who also acutely hyperventilate during spontaneously and induced panic
What is path of hyperventilation causing dizziness?
hyperventilation –> hypocapnia + alkalosis –> decreased cerebral blood flow –> dizziness, confusion, derealization
What is agoraphobia?
marked fear or anxiety about 2 or more of the following:
- using public transportation
- being in open places
- being in enclosed places
- standing in line or being in a crowd
- being outside of the home alone
the situations provoke fear/anxiety, are avoided or endured with marked distress about having a panic attack out of proportion to the actual danger posed
What is lifetime prevalence of panic disorder?
5%
Are panic disorders more common in women or men?
female > males 2-3:1
What is age of onset of panic disorder?
- young adults - 30s but can be as late as 60s
- women have greater rise in panic disorder during childbearing years
What is the course of panic disorder?
- first attack generally strikes during routine activity
- can have trigger for 1st attack but often continue once triggers resolved
- course = variable: 30-40% symptom free, 50% mild symptoms, 10-20% significant symptoms
- association between panic disorder and suicide
- pharm blockade of panic attacks before phobic avoidance develops can lead to complete remission
What diseases are co-morbidities with panic disorder?
- major depressive disorder
- other anxiety disorder
- alcohol in 20%
What are criteria for generalized anxiety disorder?
- excessive anxiety and worry more days than not for > 6 months unrelated to specific person/situation/event
- difficult to control
- > 3 of the following: restlessness, poor concentration, muscle tension, fatigue, irritability, sleep disturbance
What is lifetime prevalence of generalized anxiety disorder [GAD]? more common females vs males? onset/course?
- lifetime prevalence 5.7%
- females > males
- onset early 20s but can develop any age
- chronic course
- symptoms fluctuate over time
- 1/4 develop panic disorder
What is social phobia?
- fear of 1 or more social or performance situations in which person is exposed to unfamiliar people or to possible scrutiny by others
- exposure to feared situation provokes anxiety
- fear or anxiety out or proportion to actual threat
- avoid situations or endures them with intense anxiety
- functional impairment
- usually lasts > 6 months
What are typical fears in social phobia?
- fear of speaking, meeting people, eating in public, public phone, public bathroom, attending parties
== because fear of being laughed at, criticized, making mistakes, etc
What is epidemiology of social phobia?
- lifetime prevalence 3-12%
- no difference men and women
- typical onset late childhood/early adolescence, may be acute or insidious over mos to yrs without clear precipitant
What are risk factors for social phobia?
lower socioeconomic status, educational level
What is course of social phobia?
- tends to be chronic
- may be asymptomatic unless confronted with phobic situation
- few seek professional help
What is psychodynamic theory of anxiety?
signal of presence of danger in unconscious = result of psychic conflict between unconscious sexual or aggressive
What are cognitive-behavioral theories of anxiety disorders?
learned response from parental behavior, classic conditioning
What are cognitive theories of panic disorder?
somatic sensations –> catastrophic thoughts about their meaning –> autonomic arousal/more thoughts –> panic
palpitations –> “imminent heart attack” –> anxiety/autonomic arousal –> panic
What are proposed circuit abnormalities in anxiety disorders?
- hyperactivity of subcortical emotion-processing areas [amygdala] = targeted by pharmacotherapy
- hypoactivity of PFC causing decreased top-down modulation and disinhibition of subcortical areas = targeted by CBT
How is disordered fear circuitry associated with panic attacks?
similarities between conditioned fear and panic attacks –> panic may originate in abnormally sensitive fear network in which neurocognitive deficit in PFC processing paths lead to inappropriate activation of fear network
What is role of hippocampus in anxiety disorder?
formation contextual memory
important for phobic avoidance –> association of panic attacks with context in which they occurred
What NT abnormalities in panic disorder?
- decreased serotonin binding
- increased NE activity/sensitivity
- decrease GABA-A
What is role of 5HT abnormalities in panic disorder?
- decrease 5HT receptor binding
- 5HT modulates output of entire fear network
What is role of NE abnormalities in panic disorder?
- increased activity and sensitivity of NE closely linked to anxiety
What is role of GABA abnormalities in panic disorder?
- decrease conc of cortical GABA suggests hyposensitivity of GABA transmission
- decreased benzo receptor binding to GABA-A in hippocampus/amgydala
What structural and functional brain changes in anxiety disorders?
limited evidence for most EXCEPT
social phobia = higher activation in amygdala in response to harsh + emotionally neutral faces during fMRI
What are genetic contributions to anxiety disorders?
complex non-mendelian inheritance = probably inherit a susceptibility/vulnerability to panic/anxiety
panic disorder > social anxiety disorder > GAD
What is behavioral inhibition?
reticence when faced with novel situations/people
= linked to risk for social phobia + other anxiety disorders
treatment of anxiety disorders?
- SSRIs, SNRIs
- tricyclic antidepressants, MAOIs
- benzodiazepines
- anticonvulsants
What is cognitive behavioral therapy [CBT]?
- treatment for anxiety disorders = good drurability
- psychoeducation about panic to correct misconceptions regarding panic symptoms
- cognitive restructuring to identify and correct distortions in thinking
- exposure to feared situations/sensations
- operates upstream of amygdala
- strengthens ability of cortical projections to inhibit automatic behaviors and physical responses
