SM_115b: Anxiety Disorders

Question 1

Anxiety disorders are ____

Answer 1

Anxiety disorders are excessive, persistent, and unfounded feelings of nervousness interfering with normal daily activities and creating distress

(cognitive and somatic symptoms)

Question 2

Pyschoanalytic theory of anxiety ____, ____, and ____

Answer 2

Pyschoanalytic theory of anxiety

• Anxirty is a signal of danger / conflict in unconscious
• Incomplete repression
• Does not differentiate between normal and pathological

Question 3

Behavioral perspectives of anxiety indicate ____

Answer 3

Behavioral perspectives of anxiety indicate anxiety results from negative reinforcement (operant conditioning)

(also classical conditioning)

Question 4

Cognitive theory of anxiety states anxiety results from ____, including ____ and ____

Answer 4

Cognitive theory of anxiety states anxiety results from inaccurate thinking, including overestimation of threat and underestimation of control

Question 5

Physiological explanation of anxiety is that anxiety is ____

Answer 5

Physiological explanation of anxiety is that anxiety is a response to a peripheral phenomenon

• Physiologic signs associated with release of epinephrine
• Increased sympathetic tone, adapt more slowly to repeated stimuli, respond excessively to moderate stimuli

Question 6

Anxiety response arises from the same nervous circuit as the fear response, in which the ____

Answer 6

Anxiety response arises from the same nervous circuit as the fear response, in which the amygdala plays a large role

Question 7

In anxiety, GABA may be ____

Answer 7

In anxiety, GABA may be lacking

(GABA is inhibitory)

Question 8

Describe neurotransmitters involved in anxiety

Answer 8

Neurotransmitters involved in anxiety

• GABA: high concentrations in CNS, major inhibitory
• Serotonin: cell bodies in raphe nuclei, may attenuate activity of the locus coeruleus
• NE: poorly regulated system with bursts of activity, majority of noradrenergic neurons in the CNS

Question 9

Anxiety disorders include ____, ____, ____, ____, ____, and ____

Answer 9

Anxiety disorders include

• Panic
• Agoraphobia
• Social phobia
• Specific phobia
• OCD
• GAD

Question 10

Obsessions are ____

Answer 10

Obsessions are recurrent, persistent thoughts, images, or impulses experienced as intrusive and unwanted, usually causing marked distress

Question 11

Compulsions are ____

Answer 11

Compulsions are repetitive behaviors or mental acts which a person feels driven to perform in response to obsession or rigid rules to reduce their anxiety

Question 12

Describe DSM-5 criteria for OCD

Answer 12

OCD DSM-5 criteria

• Presence of obsessions, compulsions, or both
• At some point in the illness, individual has relealized obsessions or compulsions are excessive / unreasonable
• Symptoms are time-consuming (> 1 hr/day) or cause significant distress or impairment

Question 13

Half of people with OCD have ____ obsessions

Answer 13

Half of people with OCD have uncleanliness obsessions

Question 14

OCD has onset in ____ and recurs in ____

Answer 14

OCD has onset in adolescence and recurs in early adulthood

Question 15

OCD has a ____ etiological component

Answer 15

OCD has a genetic etiological component

(linked to Tourette Syndrome, occurrence in Syndenham’s chorea and PANDAS)

Question 16

In OCD, there is increased activity in the ____, ____, and ____

Answer 16

In OCD, there is increased activity in the cingulate cortex, caudate nucleus, and prefrontal cortex

Question 17

Panic disorder diagnosis requires ____, with ____ and ____

Answer 17

Panic disorder diagnosis requires a discrete period of intense fear / discomfort, with at least 4 of the following developing abruptly and peaking within 10 minutes

Question 18

Describe DSM-5 criteria for panic disorder

Answer 18

Panic disorder DSM-5 criteria

• Recurrent, unexpected panic attacks
• ≥ 1 of the attacks has been followed by ≥ 1 month of either: persistent concern about additional attacks or their consequences (heart attack, going crazy), maladaptive change in behavior related to attacks (avoidance)

Question 19

Panic disorder onset is typically ____ and is often comorbid with ____

Answer 19

Panic disorder onset is typically in adolescence to 30s and is often comorbid with major depression / other anxiety disorderr / somatization disorder / psychoactive substance use disorders

Question 20

Panic disorder exhibits ____

Answer 20

Panic disorder exhibits familial aggregation (massively elevated risk by genetics)

Question 21

Describe DSM-5 criteria for agoraphobia

Answer 21

Agoraphobia DSM-5 criteria

• Marked fear / anxiety about ≥ 2: using public transportation, being in open spaces, being in enclosed spaces, standing in line or being in a crowd, being outside of the home alone
• Situations are feared / avoided because escape is difficult, help is not available if panic symptoms develop, ir fear of other incapacitating / embarrasing symptoms
• Situation almost always provokes fear / anxiety
• Fear / anxiety out of proportion
• Fear / anxiety is persistent (≥ 6 months)

Question 22

Describe DSM-5 criteria for specific phobia

Answer 22

Specific phobia DSM-5 criteria

• Marked fear / anxiety about a specific object / situation
• Object / situation almost always provokes immediate fear / anxiety
• Object / situation is actively avoided or endured with intense fear or anxiety
• Fear / anxiety is persistent (typically > 6 months)
• Fear, anxiety, or avoidance cause distress or impairment

Question 23

Specific phobia has ____ onset and is more common in ____

Answer 23

Specific phobia has bimodal onset and is more common in women

Question 24

Describe DSM-5 criteria for social anxiety disorder

Answer 24

Social anxiety disorder DSM-5

• Makred fear / anxiety about one or more social situations in which individual is exposed to possible scrutiny of others
• Individual fears he/she will show anxiety symptoms and be negativwly evaluated
• Social situations almost always provoke anxiety
• Social situations are avoided or endured with intense fear / anxiety
• Fear / anxiety is out of proportion
• Fear / anxiety / avoidance is persistent (> 6 months)
• Fear / anxiety / avoidance causes clinically significant distress or impairment

Question 25

Describe DSM-5 criteria for generalized anxiety disorder

Answer 25

Generalized anxiety disorder DSM-5 criteria

• Excessive anxiety and worry, more days than not, for ≥ 6 months, ahout several events / activities
• Difficult to control worry
• ≥ 3 symptoms: restlessness / feeling on edge, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance
• Symptoms cause clinically significant distress or impairment
• Not due to substance / general medical condition

Question 26

Onset of generalized anxiety disorder is typically ____ with ____

Answer 26

Onset of generalized anxiety disorder is typically early with fluctuating course

(genetic factors overlap substantially with those influencing liability for major depression)

Question 27

Primary treatment for anxiety disorders is ____

Answer 27

Primary treatment for anxiety disorders is psychotherapy

(antidepressants, other medications, neurosurgery, and TMS may also be used)

Question 28

___ is used to treat anxiety-related insomnia

Answer 28

CBT is used to treat anxiety-related insomnia

Question 29

____ is used to treat specific phobia

Answer 29

Desensitization is used to treat specific phobia

Question 30

____ is used to treat OCD

Answer 30

Response prevention / flooding is used to treat OCD

Question 31

____ can block panic attacks in anxiety and treat comorbid depression, of which ____ are first line

Answer 31

Antidepressants can block panic attacks in anxiety and treat comorbid depression, of which SSRIs are first line

Question 32

OCD has a more ____ than dimensional nature and is rare

Answer 32

OCD has a more categorical than dimensional nature and is rare