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Flashcards in 1: Anxiety Disorders Deck (37)
1

features of anxiety disorders

-characteristic clinical course
-familial pattern
-disrupted brain circuits
-selective drug responses

2

describe the disrupted brain circuits of anxiety disorders

-mediated by prefrontal cortex
-in high levels of anxiety, prefrontal cortex not as good at modulating the limbic system
-major site of action for anti-anxiety drugs

3

3 general ways to decrease limbic activity

1. strengthen prefrontal cortex -> CBT
2. increase serotonin levels in circuits -> SSRI's
3. increase GABA inhibition in the amygdala and hippocampus -> benzodiazepines

4

specific treatment responses - psychological

-cognitive behavioral therapy (CBT)
-mindfulness - acceptance - based therapies (MABT)

5

specific treatment responses - pharmacological

-SSRI's
-SNRI's
-other antidepressants
-benzodiazepines

6

4 examples of SSRI's

-prozac (fluoxetine)
-zoloft (sertraline)
-celexa (citalopram)
-lexapro (escitalopram)

7

2 examples of SNRI's

-effexor (venlafaxine - higher dose)
-cymbalta (duloxetine)

8

which drug increases levels of both dopamine and norepi?

wellbutrin (bupropion)

9

panic attack qualifications

-development of sudden, intense fear/discomfort
-peaks within 10 minutes
-at least 4 Sx for full panic attack
-less than for 'limited Sx attack'

10

potential panic attack Sx

-tachycardia
-SOB
-chest pain
-nausea
-sweating
-shaking
-dizziness
-numbness/tingling
-fear of dying
-fear of losing control
-depersonalization
-choking
-chills or hot flashes

11

panic disorder qualifications

-recurrent, unexpected panic attacks
-attack followed by at least 1 month of:
-concern about further attacks
-worry about consequences
-significant behavioral change
-panic attacks are not due to organic causes
-panic attacks are not better accounted for by another psychiatric disorder

12

what percent of the population is affected by panic disorder? what about panic attacks?

panic disorder 1-2%
panic attacks 5-8%

13

usual onset of panic disorder?

during teenage/early adult period

14

describe a panic disorder diagnosis

-typical Hx
-usually present with a physical focus
-convinced they have a 'medical' illness
-elicit classic pattern of Sx
-lack of physical signs and risk factors for other medical causes

15

Tx for panic disorder

Psychological:
-CBT

Pharmacological:
-SSRI's
-tricyclic antidepressants
-benzodiazepines
-MAOi's

16

describe dosing of SSRI's in panic disorder

-all currently available SSRI's are effective - sertraline and paroxetine
-start at very low dose (5 mg fluoxetine, 25 mg sertraline, 25 mg fluvoxamine or 5 mg paroxetine)
-many respond to lower doses than depression

17

5 comorbidities with panic disorder

-depression
-agoraphobia
-alcohol abuse
-other anxiety disorders
-personality disorders

18

7 criteria for social anxiety disorder (phobia)

1. marked and persistent fear of one or more social situations (possible scrutiny by others)
2. exposure invariably provokes anxiety or fear
3. recognize that the fear is excessive
4. feared situations are avoided or endured
5. persistent for at least 6 months
6. significantly interferes with normal life
7. not due to another condition

19

4 most common fears

1. speaking in groups (57%)
2. meeting strangers (42%)
3. eating in public (25%)
4. writing in public (12%)

20

which gender do most anxiety disorders affect more?

females

21

mean age of onset of social anxiety disorder

11-15 years

22

environmental/socioeconomic factors associated with social phobia

-on welfare
-did not complete high school
-lowest 2 socioeconomic quartiles
-single or divorced

23

4 criteria for generalized anxiety disorder (GAD)

-excessive anxiety or worry about a number of events or activities for 6 months (more days than not)
-person finds it difficult to control the worry
-three of the following: restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance
-Sx cause clinically significant impairment in important areas of functioning

24

GAD onset: early vs. late

early onset:
-before 20
-female > male
-always been anxious
-childhood fears

late onset:
-adult onset
-female = male
-usually precipitated by a stressful event

25

GAD treatments

pharmacotherapy:
-benzodiazepines
-azospirones (buspirone) - but takes 4-6 weeks to start working
-antidepressants (SSRI's)

psychotherapies to strengthen prefrontal cortex

26

OCD: diagnosis

-obsessions and/or compulsions
-cause significant disability/discomfort
-usually occupy 1 hour or more per day

27

psychiatric obsessions

-intrusive/irrational thoughts, ideas, or images
-usually distressing to the subject

28

most common obsessions:

-contamination
-fears of harm to self or others

29

psychiatric compulsions

-repetitive behaviors
-usually done to neutralize the anxiety induced by the obsession
-most patients acknowledge the futility

30

common compulsions:

-cleaning
-checking
-counting

31

OCD epidemiology

-2-3% of population
-earlier onset and severe course in males
-one of the most disabling anxiety disorders

32

how is OCD pathophysiology different from other anxiety disorders?

affects different brain circuits - here the extrapyramidal pathway - basal ganglia pathway is affected (fronto-striato-thalamo-frontal circuit)

33

OCD treatment

-SSRI's most effective first line Tx
-requires higher doses and longer duration
-always combine with behavior therapy

34

definition of trauma

-life-threatening or potentially life-threatening
-inherent subjective nature to severity
-most critical elements appear to be sense of horror and helplessness

35

PTSD criteria (6)

-severe trauma
-followed by at least 1 month of Sx
-re-experiening of the trauma (1 or more) flashbacks
-avoidance of situations/memories (1 or more)
-negative alterations in cognition and mood (2 or more)
-Sx of disturbed arousal (2 or more)

specify: with dissociative Sx or with delayed expression

36

4 risk factors for developing PTSD

-type of trauma
-gender
-age
-genetic vulnerability

37

PTSD pharmacological Tx

-SSRI's improve about 50% of PTSD pts
-some anticonvulsants
-combination of medication + therapy = most effective