Neuroscience Week 8: Anxiety disorders Flashcards
Anxiety objectives

What is anxiety?

Normal vs Pathological Anxiety

Why is Anxiety important?

Helpful vs crippling anxiety

DSM 5 Anxiety Disorders

Anxiety Disorders: Onset
usually, begin in childhood (phobias) or adolescence
Anxiety Disorders: risk factors
4 listed
- more common in females (generally)
- Rates higher with lower SES and education
- Genetics - Serotonin transporter gene?
- Temperament & personality: behavioral inhibition & anxiety sensitivity/resiliency
Anxiety Development

Neurobiology of Anxiety

Epidemiology of Anxiety

Stressor definition

Adjustment disorders - anxious, depressed or conduct
where it doesn’t meet the criteria of anxiety disorders, depressive disorders or conduct disorders

Trauma definition and types

Anxiety Precipitants
6 listed

most common anxiety disorder
simple phobia
Types of anxiety
3 listed
- generalized worries
- Panic
- Obsessional

Anxiety: Common Reactions
8 listed

Specific phobia definition
Marked fear or anxiety about object/situation
Common specific phobias
7 listed
- flying
- enclosed spaces
- heights
- storms
- animals
- injection
- blood
Specific phobia provokes? and criteria
- immediate anxiety or fear
- avoid at all costs
- 6 months or more/happens each time/out of proportion to actual threat
Panic Disorder description
- Recurrent & unexpected panic attacks with 4 of the following symptoms
- and 1 or both of worrying about more attacks or their consequences AND/OR change in behavior due to attacks

Generalized anxiety disorder description
- excessive worry/anxiety about events/activities for more than 6 months
- cannot control worry

Generalized anxiety disorder criteria
worry associated with at least 3:
- Restlessness/keyed up/on edge
- Easily fatigued
- Concentration problems
- Irritability
- Muscle tension
- Sleep disturbance

Social Anxiety description
Marked fear or anxiety of 1 or more social/performance situations exposed to scrutiny by others
Social Anxiety common stressors
- public speaking
- eating
- drinking
- initiating/maintaining conversations
Social Anxiety presentation
- Fears humiliation by manifesting anxiety - such as blushing/sweating/shaking
- Avoid these situations or endured with significant anxiety
- 6 months or more/happens each time/out of proportion to actual threat
Obsessive-compulsive disorder description
presence of obsessions, compulsions or both
Obsessions definition
recurrent & persistent thoughts/images/urges which are intrusive and cause anxiety or stress
Common obsessions
4 listed
- contamination
- pathological doubt
- impulses
- sexual images
Compulsions definition
repetitive behaviors or mental acts person feels driven to perform and with goal of decreasing anxiety/distress or preventing dreaded event or situation
Common compulsions
6 listed
- washing
- ordering
- checking
- praying
- counting
- repeating words
Obsessive-compulsive disorder pathology
time consuming or causes distress or dysfunction
Posttraumatic Stress Disorder description
- typically caused by trauma
- and intrusion of memories, thoughts, dreams, dissociation, distress, marked physical reactions
- avoidance
- negative/flattened alterations in cognition and mood
- Arousal:” hypervigilance, reckless, irritable, decreased sleep, anger, concentration, increased startle

Posttraumatic Stress Disorder criteria
- must last greater than 1 month
- Intrusion: flashback, thoughts, dreams etc
- Avoidance
- Negative/flattened alterations in cognitions and mood
- Arousal

Pharmacology of Anxiety
SSRIs

SSRIs anxiety treatment considerations
4 listed
- Start LOW, go SLOW, aim HIGH
- SSRIs cause anxiety transiently at the initiation of treatment
- Consider Benzo BRIDGE
- Aim very high in dosage range to treat OCD or Panic Disorder
Benzo BRIDGE
using benzodiazepines in the initiation phase to ease the frequency and intensity of symptoms and to avoid initial side effects
SNRIs in the treatment of Anxiety

Anxiety SNRI treatment mechanism
NE is an important input and output neurotransmitter of the amygdala
Excessive NE output from the Amygdala can result in?
4 listed
- Nightmares
- hyperarousal states
- flashbacks
- panic attacks
Activity of SNRIs can be decreased by?
centrally acting Beta-blockers (propranolol or alpha-blockers (Prazosin)
Prazosin use for anxiety
nightmares in PTSD
SNRIs, TCADs and MAOIs may desensitize
Postsynaptic α and β receptors over time
GABA anxiety treatment
3 listed
- key neurotransmitter implicated in anxiety disorders
- reduces amygdala activity
- Drugs which bind GABA receptor are anxiolytic
(benzodiazepines/alcohol)
Cognitive-Behavioral Therapy treatment for anxiety
- most evidence-based therapy
- Focuses on exposure and response prevention
Cognitive-Behavioral Therapy treatment for anxiety Types
- Flooding (rapid exposure)
- Systematic desensitization
CBT panic disorder

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