Lecture 13-Anxiety 1 Flashcards
Name the physical manifestations of anxiety
Sympathetic NS: diaphoresis, mydriasis, tachycardia, tremor
Hyperventilation → dizziness and syncope, parasthesia
Name the psychological manifestations of anxiety
Restlessness, Irritability, Trouble concentrating, worry
Norepi & _____ = anxiety
cortisol
Anxiety symptoms must be present for _____ months
≥6
Traumatic events or extreme stressors (PTSD, Panic attack) may help _____ the anxiety disorder
create
Can anxiety be learned?
YES (GAD)
Gender bias in anxiety (disorder dependent) in that women ______ men are affected (Except OCD men _____ women)
> ; =
In anxiety:
____ Serotonin(5-HT) and ____ GABA activity
____ NorEpi and ____ Glutamate activity
↓,↓; ↑, ↑
Norepi & glutamate increased activity; and serotonin and GABA are decreased in anxiety
A 35 year old female comes to your office asking for help. She claims that she and her husband have been arguing a lot more lately. She says he can’t take her constant worrying. She worries about his job and whether he is making enough money, if the mail will be delivered on time, and about how well she is raising her kids in such a sad and cruel world. She says she has worried about things as long as she can remember. She doesn’t like that she doesn’t sleeps well at night. What is her most likely diagnosis?
Panic disorder
Generalized Anxiety Disorder
Acute Stress Disorder
Obsessive Disorder
Generalized Anxiety Disorder
General anxiety disorder:
Excessive anxiety/worry, occurring more days than not for ≥ ____ months, about ≥ ____ event/activity
Associated with ≥ \_\_\_\_ of the following symptoms: Restlessness Easily fatigued Difficulty concentrating Irritability Muscle tension Sleep disturbance
6; 1; 3
People with anxiety self medicate with what?
alcohol–increases GABA tone
Axiety prognosis?
Without treatment tends to worsen over time. (especially during stressful times)
What type of cognitive therapy do you give for anxiety?
CBT
What type of medical therapy do you give for anxiety?
SSRI or SNRI–Increases SR or NE or both, downregulates or desensitizes receptors (increases in NE desensitizes receptors)
Buspirone (a 5HT1a receptor agonist)–Initially lowers SR activity as these autoreceptors are stimulates but eventually renders them inactive allowing increases in SR output
Benzodiazepines: (GABA-A receptor positive allosteric modulator allows more Cl- channels to open
Beta Blockers. For symptomatic relief of performance anxiety, not GAD!!!
A 35 year old, Caucasian female, presents to your office with complaints of heart palpitations starting a year ago. She doesn’t consider herself a person that worries too much. They are not constant and she hasn’t noticed that they are related to any particular event. She also reports diaphoresis along with the palpitations. She denies any headache, vision change, nausea, vomiting, radiating chest pain, or change in her bowel habits. She denies any past traumatic events.. Her physical exam is normal. What is her diagnosis?
General Anxiety Disorder Atrial fibrillation Panic Disorder Social Anxiety Hyperthyroidism
Panic Disorder
What is a panic attack?
An abrupt surge of intense fear or discomfort, peaks within minutes, that is unexpected with ≥ 4 of the following:
Palpitations, pounding heart, or accelerated heart rate Sweating Shaking/trembling Sensation of shortness of breath or smothering Choking feeling Chest pain/discomfort Nausea Dizziness, lightheadedness or fainting Chills or heat Paresthesias Derealization (slow motion) Fear of Losing of control Fear of dying
In panic disorder there are
Recurrent unexpected panic attacks
≥ __ attack followed by ≥ __ month of ≥ __ of the following:
Concern about _____ panic attacks or consequences
Significant ______ change in behavior related to attacks (stay away from locations where one has had a panic attack)
1; 1; 1;
additional; maladaptive
What is agoraphobia?
Agoraphobia (panic disorder)
Fear/Anxiety about ≥ 2 of the following situation:
Using public transportation Being in open spaces Being in enclosed spaces Standing in line or in a crowd Being outside the home alone
Fear of not being able to escape situation
Situation almost always produces fear/anxiety
Avoids situations
Fear/anxiety out of proportion to actual danger
≥ 6 months
Psychotherapy for panic disorder?
Emergency treatment: fast-acting benzodiazepines (alprazolam)
Long Term 1st line: SSRI/SNRI
Intermediate or long acting benzos (not 1st line 2nd to addiction potential…)
A 29 year old asks that you help her with her problems and reveals that for the past 7 months she has had to push her self to go work. During her last office presentation, she stumbled and fell off stage. Since then she has worried that something will happen during her next presentation, which is in 2 weeks. She can’t concentrate on anything as she is consumed with her fear of being embarrassed in front of her coworkers again. She now takes the service elevator and leaves work early to avoid seeing her coworkers. She has no other areas in her social life where she is not doing well and actually did a successful presentation at a parent teacher organization meeting yesterday. What is the most likely diagnoses?
Panic disorder Social Anxiety Performance Anxiety Generalized Anxiety PTSD
Performance Anxiety
What is a specific phobia?
Specific phobia Diagnostic criteria (DSM-V):
≥ 6 months
Causes significant impairment
Marked fear/anxiety about a specific object/situation
Object/situation almost always provokes fear/anxiety
Actively avoids object/situation
Fear/anxiety out of proportion to actual danger
No other explanation for symptoms
What is social anxiety disorder?
≥ 6 months
Causes significant impairment
Marked fear/anxiety when exposed to social situation with possible scrutiny by others
Fear of acting in ways that will be negatively scrutinized
Social situation provokes fear
Avoids social situations
Fear/anxiety out of proportion to actual threat
No other explanation for symptoms
What is performance anxiety?
Performance anxiety only – Fear is restricted to public speaking or performing and does not generalize to other social aspects of life
What type of therapy do we do for specific phobia?
Therapy (1st line): Flooding, systemic desensitization (CBT)
What do we give for performance anxiety?
Beta Blockers (propranolol) – 1st line for performance only variant
What do we give for Social Anxiety Disorder?
SSRI/ SNRI
sometimes we give MAOI’s
