SM_115b: Anxiety Disorders Flashcards
Anxiety disorders are ____
Anxiety disorders are excessive, persistent, and unfounded feelings of nervousness interfering with normal daily activities and creating distress
(cognitive and somatic symptoms)
Pyschoanalytic theory of anxiety ____, ____, and ____
Pyschoanalytic theory of anxiety
- Anxirty is a signal of danger / conflict in unconscious
- Incomplete repression
- Does not differentiate between normal and pathological
Behavioral perspectives of anxiety indicate ____
Behavioral perspectives of anxiety indicate anxiety results from negative reinforcement (operant conditioning)
(also classical conditioning)
Cognitive theory of anxiety states anxiety results from ____, including ____ and ____
Cognitive theory of anxiety states anxiety results from inaccurate thinking, including overestimation of threat and underestimation of control
Physiological explanation of anxiety is that anxiety is ____
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
Anxiety response arises from the same nervous circuit as the fear response, in which the ____
Anxiety response arises from the same nervous circuit as the fear response, in which the amygdala plays a large role
In anxiety, GABA may be ____
In anxiety, GABA may be lacking
(GABA is inhibitory)
Describe neurotransmitters involved in anxiety
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
Anxiety disorders include ____, ____, ____, ____, ____, and ____
Anxiety disorders include
- Panic
- Agoraphobia
- Social phobia
- Specific phobia
- OCD
- GAD
Obsessions are ____
Obsessions are recurrent, persistent thoughts, images, or impulses experienced as intrusive and unwanted, usually causing marked distress
Compulsions are ____
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
Describe DSM-5 criteria for OCD
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
Half of people with OCD have ____ obsessions
Half of people with OCD have uncleanliness obsessions
OCD has onset in ____ and recurs in ____
OCD has onset in adolescence and recurs in early adulthood
OCD has a ____ etiological component
OCD has a genetic etiological component
(linked to Tourette Syndrome, occurrence in Syndenham’s chorea and PANDAS)
In OCD, there is increased activity in the ____, ____, and ____
In OCD, there is increased activity in the cingulate cortex, caudate nucleus, and prefrontal cortex
Panic disorder diagnosis requires ____, with ____ and ____
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
Describe DSM-5 criteria for panic disorder
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)
Panic disorder onset is typically ____ and is often comorbid with ____
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
Panic disorder exhibits ____
Panic disorder exhibits familial aggregation (massively elevated risk by genetics)
Describe DSM-5 criteria for agoraphobia
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)
Describe DSM-5 criteria for specific phobia
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
Specific phobia has ____ onset and is more common in ____
Specific phobia has bimodal onset and is more common in women
Describe DSM-5 criteria for social anxiety disorder
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
Describe DSM-5 criteria for generalized anxiety disorder
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
Onset of generalized anxiety disorder is typically ____ with ____
Onset of generalized anxiety disorder is typically early with fluctuating course
(genetic factors overlap substantially with those influencing liability for major depression)
Primary treatment for anxiety disorders is ____
Primary treatment for anxiety disorders is psychotherapy
(antidepressants, other medications, neurosurgery, and TMS may also be used)
___ is used to treat anxiety-related insomnia
CBT is used to treat anxiety-related insomnia
____ is used to treat specific phobia
Desensitization is used to treat specific phobia
____ is used to treat OCD
Response prevention / flooding is used to treat OCD
____ can block panic attacks in anxiety and treat comorbid depression, of which ____ are first line
Antidepressants can block panic attacks in anxiety and treat comorbid depression, of which SSRIs are first line
OCD has a more ____ than dimensional nature and is rare
OCD has a more categorical than dimensional nature and is rare
