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Behavioral Medicine > Anxiety > Flashcards

Anxiety Flashcards

1
Q

Describe the anxiety circuitry

(hint: 2 reaction types)

A
  • Fast reaction: thalamus → amygdala → response
  • Slow reaction: thalamus → prefrontal cortex determines level of threat → decide if you’re in danger
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2
Q

What is normal anxiety?

A
  • fear resulting from the perception of danger
  • May arise from internal impulses that threaten a person’s well-being (cramming for a test)

(anxiety is a learning problem→ you must unlearn the process to remove anxiety)

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3
Q

What is pathological anxiety?

A
  • Ineffective adaptation to normally occurring threat
  • Pathological when functioning is disrupted
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4
Q

What are the two types of symptoms that caused disruption in adaptation leading to pathological anxiety?

A
  1. Psychological: worried, demoralization
  2. Physical symptoms: cardiac, respiratory, GI or neurological
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5
Q

Patients w/ panic or phobias have greater cardiac and respiratory reactivity during _____. Sodium lactate infusions and breathing CO2 may induce ______, which elicit panic attacks.

A
  • sleep
  • respiratory alkalosis and exaggerated elevations of brain lactate
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6
Q

Anatomic relations to anxiety (3)

A
  1. ​​ Locus coeruleus: relay center for bodies alarm system
  2. Dopamine receptors in the prefrontal cortex: avoidance conditioning
  3. Dysegulation of serotonin system (panic disorder)
    4.
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7
Q

PET studies: look at which structures in anxiety?

A
  1. Amygdala
  2. Hypothalamus
  3. Prefrontal cortex
  4. Fear network
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8
Q

Describe the hypothalamic-pituitary-adrenal axis reaction to anxiety

A

Acute stress → CRF from the paraventricular nucleus (hypothalamus) ⇒ ACTH + cortisol levels → activation of the sympathetic and parasympathetic nervous systems

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9
Q

Endocrine disorders that can cause anxiety (4)

A
  1. Pheochromocytoma
  2. Thyroid dysfunction
  3. Pituitary dysfunction
  4. Adrenal disorder
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10
Q

Neurological causes of anxiety (4)

A
  1. Head trauma
  2. Neurosyphilis
  3. Seizure disorder
  4. CNS neoplasm
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11
Q

Toxic and metabolic causes of anxiety (8)

A
  1. Alcohol or sedative withdrawal
  2. Stimulant intoxication
  3. Sympathomimetic agents
  4. Cannabis
  5. B12 deficiency
  6. Hypoxia
  7. Ischemia
  8. Anemia
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12
Q

Autoimmune disorders that may cause anxiety (3)

A
  1. Systemic lupus erythematosis
  2. Temporal arteritis
  3. Polyarteritis nodosa
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13
Q

Men with panic disorder have twice the risk of _____

A

death (cardio & suicide)

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14
Q

Anxiety disorders increase the overall rate of _______

A

Alcoholism

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15
Q

Social phobias decrease educational attainment and increase the rate of _______ (2).

A
  1. Teenage pregnancy
  2. Marital violence
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16
Q

Define classical conditioning

A

Person learns to associate a neutral object or situation with something that naturally results in a fear response.

(Ex: Watson taught a child to be afraid of a rat by presenting it immediately before a loud and startling noise)

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17
Q

Define operant conditioning

A

Reward vs. punishment influences the response

18
Q

Define negative reinforcement

A

Person is influenced to escape a situation→ tendency to avoid situation rainforest

(this is not the same thing as punishment!!)

19
Q

Define positive reinforcement

A

Positive stimulus influences → increases desired behavior

(giving children at Goldstar)

20
Q

Define repression

A

Unacceptable thoughts, impulses or desires kept out of conscious reach

(trauma: did or didn’t do something → reppress → can’t remember)

21
Q

Interviewing guidelines for anxiety (5)

A
  1. Anxiety symptoms
  2. Associated symptoms
  3. Life history
  4. Medical history
  5. Cultural understanding

(and of course, be calm and reassuring, avoid irritation or impatience with them)

22
Q

What is included in a history of anxiety symptoms (6)?

A
  1. Psych & Physical symptoms
  2. Onset
  3. Duration
  4. Distribution
  5. Quality
  6. Intensity
23
Q

Which associated symptoms are particularly important with anxiety disorder?

A
  1. Depression
  2. Suicidal ideation
24
Q

When taking a life history for a patient with anxiety what two things would you want to know?

A
  1. Psychosocial triggers
  2. Context of anxiety
25
Q

Anxiety disorders have a tremendous overlap with _____ (disease).

A

MDD

(it is possible to have MDD, GAD & SAD simultaneously)

26
Q

What is the first rule of panic attacks?

A

A single panic attack does not mean they have panic disorder

27
Q

Criteria for panic attack: A discrete period of intense fear or discomfort, w/four (or more) of the following developed abruptly and reached a peak within 10 minutes:

A
  1. Palpitations
  2. Sweating
  3. Trembling
  4. Sensation of SOB
  5. Feeling of choking
  6. Chest pain
  7. Nausea
  8. Dizzy, unsteady, lightheaded, or faint
  9. Derealization or depersonalization
  10. Fear of losing control or going crazy
  11. Fear of dying
  12. Paresthesias
  13. Chills of hot flashes
28
Q

Agoraphobia: anxiety about places (2 or more of the following) for at least 6 months:

A
  1. Use public transport
  2. Being in open spaces
  3. Being in closed spaces
  4. Standing in line or in a crowd
  5. Being outside of home alone
29
Q

Agoraphobia anxiety last _____.

A

at least 6 months

(not better accounted for by another psychiatric disorder)

30
Q

Agoraphobia: Situations are avoided or feared because ________ (2).

A
  • Escape might be difficult
  • Help might not be available in the event of a panic attack

(Fear or anxiety is out of proportion to the actual danger posed)

31
Q

Criteria for panic disorder: Recurrent unexpected panic attacks that happen to be followed by at least one month of one of the following:

A
  1. Panic about having a panic attack
  2. Worry about the implications of another attack
  3. Maladaptive change in behavior-related to the attacks (can happen in your sleep)
32
Q

Panic disorder occurrence is highly variable and may occur either _____ or _____ (time frames).

A

several per day or 2/xs a year

33
Q

Panic disorder are often comorbid with ______ (5).

A
  1. MDD
  2. Social phobia
  3. GAD
  4. OCD
  5. PTSD

(in order from most to least common)

34
Q

Physical findings of panic disorder (2).

A
  1. Transient tachycardia
  2. Moderate elevation of systolic blood pressure
35
Q

General medical conditions comorbid with panic disorder (5)

A
  1. Arrhythmias
  2. Asthma
  3. Hyperthyroidism
  4. COPD
  5. IBS
36
Q

Panic disorder: genetics

A
  • Prevalence in first degree relatives 20%
  • 45% concordance in identical twins; 15% in non-identical twins
37
Q

Prevalence of panic disorder: lifetime? one-year? femal:male

A
  • Lifetime 1-3.5%
  • One-year: 0.5-1.5%
  • Female:male 2:1

(Agoraphobia present 1/3 to ½ patients with PD)

38
Q

Panic disorder age of onset & course

A
  • Late adolescence - mid-thirties
  • Chronic: waxing and waning
39
Q

Panic disorder: primary treatment (4)

A
  1. Relaxation training
  2. CBT
  3. SSRI
  4. SNRI
40
Q

Panic disorder secondary treatment (2)

A
  1. TCA
  2. Benzos

(tertiary: MAOI’s, anticonvulsant. Adjuncts: buspirone, beta blocker)

41
Q

Relaxation exercises for panic disorder

A
  1. Visual Imagery
  2. Diaphragmatic Breathing
  3. Autogenic training
  4. Progressive Muscle Relaxation
  5. Yoga
  6. Meditation

(be familiar)

Behavioral Medicine (35 decks)

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