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Brain And Behavior Exam 4 > Lec 76 Anxiety Disorders > Flashcards

Lec 76 Anxiety Disorders Flashcards

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1
Q

What is the most common group of mental disorders?

A

anxiety disorders

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2
Q

Are anxiety disorders more common in women or men?

A

women

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3
Q

What are the most common types of anxiety disorders?

A
  • specific phobia
  • social anxiety disorder
  • generalized anxiety disorder
  • panic disorder with/without agoraphobia
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4
Q

What is prevalence of anxiety disorders?

A

29%

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5
Q

What are common symptoms of all anxiety disorders?

A

subjective: apprehension, worry, anticipation, fear, hyper-vigilance, restlessness, impaired conc, depression
physiologic: neuromuscular [tension, fatigue], GI [dry mouth, difficulty swallowing], resp [hyperventilation], cardio [palpitations]

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6
Q

What are criteria for panic disorder?

A
  • 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
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7
Q

What are the elements of a panic attack?

A
  • 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
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8
Q

What are the physical symptoms of panic attack?

A
  • 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
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9
Q

What is the cardinal symptom of panic?

A

hyperventilation

- panic pts are chronic hyperventilators who also acutely hyperventilate during spontaneously and induced panic

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10
Q

What is path of hyperventilation causing dizziness?

A

hyperventilation –> hypocapnia + alkalosis –> decreased cerebral blood flow –> dizziness, confusion, derealization

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11
Q

What is agoraphobia?

A

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

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12
Q

What is lifetime prevalence of panic disorder?

A

5%

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13
Q

Are panic disorders more common in women or men?

A

female > males 2-3:1

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14
Q

What is age of onset of panic disorder?

A
  • young adults - 30s but can be as late as 60s

- women have greater rise in panic disorder during childbearing years

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15
Q

What is the course of panic disorder?

A
  • 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
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16
Q

What diseases are co-morbidities with panic disorder?

A
  • major depressive disorder
  • other anxiety disorder
  • alcohol in 20%
17
Q

What are criteria for generalized anxiety disorder?

A
  • 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
18
Q

What is lifetime prevalence of generalized anxiety disorder [GAD]? more common females vs males? onset/course?

A
  • 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
19
Q

What is social phobia?

A
  • 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
20
Q

What are typical fears in social phobia?

A
  • fear of speaking, meeting people, eating in public, public phone, public bathroom, attending parties

== because fear of being laughed at, criticized, making mistakes, etc

21
Q

What is epidemiology of social phobia?

A
  • 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
22
Q

What are risk factors for social phobia?

A

lower socioeconomic status, educational level

23
Q

What is course of social phobia?

A
  • tends to be chronic
  • may be asymptomatic unless confronted with phobic situation
  • few seek professional help
24
Q

What is psychodynamic theory of anxiety?

A

signal of presence of danger in unconscious = result of psychic conflict between unconscious sexual or aggressive

25
Q

What are cognitive-behavioral theories of anxiety disorders?

A

learned response from parental behavior, classic conditioning

26
Q

What are cognitive theories of panic disorder?

A

somatic sensations –> catastrophic thoughts about their meaning –> autonomic arousal/more thoughts –> panic

palpitations –> “imminent heart attack” –> anxiety/autonomic arousal –> panic

27
Q

What are proposed circuit abnormalities in anxiety disorders?

A
  • 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
28
Q

How is disordered fear circuitry associated with panic attacks?

A

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

29
Q

What is role of hippocampus in anxiety disorder?

A

formation contextual memory

important for phobic avoidance –> association of panic attacks with context in which they occurred

30
Q

What NT abnormalities in panic disorder?

A
  • decreased serotonin binding
  • increased NE activity/sensitivity
  • decrease GABA-A
31
Q

What is role of 5HT abnormalities in panic disorder?

A
  • decrease 5HT receptor binding

- 5HT modulates output of entire fear network

32
Q

What is role of NE abnormalities in panic disorder?

A
  • increased activity and sensitivity of NE closely linked to anxiety
33
Q

What is role of GABA abnormalities in panic disorder?

A
  • decrease conc of cortical GABA suggests hyposensitivity of GABA transmission
  • decreased benzo receptor binding to GABA-A in hippocampus/amgydala
34
Q

What structural and functional brain changes in anxiety disorders?

A

limited evidence for most EXCEPT

social phobia = higher activation in amygdala in response to harsh + emotionally neutral faces during fMRI

35
Q

What are genetic contributions to anxiety disorders?

A

complex non-mendelian inheritance = probably inherit a susceptibility/vulnerability to panic/anxiety
panic disorder > social anxiety disorder > GAD

36
Q

What is behavioral inhibition?

A

reticence when faced with novel situations/people

= linked to risk for social phobia + other anxiety disorders

37
Q

treatment of anxiety disorders?

A
  • SSRIs, SNRIs
  • tricyclic antidepressants, MAOIs
  • benzodiazepines
  • anticonvulsants
38
Q

What is cognitive behavioral therapy [CBT]?

A
  • 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

Brain And Behavior Exam 4 (24 decks)

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