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M2 Psych > 10/11 Anxiety Disorders - Tamburello > Flashcards

10/11 Anxiety Disorders - Tamburello Flashcards

1
Q

anxiety

pathological anxiety

A

sense of uneasiness of distress about future uncertainties

UNIVERSAL EXPERIENCE

unpleasant, but might be essential for adaptive functioning

pathological when it is…

  • excessive or illogical
  • maladaptive
  • causing inappropriate avoidance
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2
Q

mind-body connection : anxiety

A

psychic anxiety (mental)

somatic anxiety (physical)

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3
Q

parts of brain involved in fear response

A

fear circuit involves…

  • sensory afferents
  • hippocampus
  • amygdala
  • prefrontal cortex
  • hypothalamus
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4
Q

neurotransmitters assoc with anxiety

A
  • GABA (inhibitory, dampens anx)
  • NE (increases anx)
  • DA (increases anx)
  • serotonin (early on, can increase anxiety; both high and low levels associated with anxiety)
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5
Q

substances associated with anxiety

A

stimulants/caffeine

decongestants

asthma medications (ex. albuterol)

SSRIs (ex. fluoxetine/Prozac)

marijuana

corticosteroids

sodium lactate (in panic disorder)

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6
Q

substance use/withdrawal and anxiety

A

opiates

cocaine

alcohol

benzodiazepines

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7
Q

behavioral theory of anxiety

A

anxiety can be learned

  • classical conditioning
  • operant conditioning

behavioral tx is aimed at extinguishing avoidance behaviors

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8
Q

cognitive theory of anxiety

A

anxiety may be related to cognitive distortions

examples:

  • jumping to conclusions
  • overstimating severity of an event
  • underestimating your coping ability
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9
Q

generalized anxiety disorder

A

persistent, excessive anxiety over ‘everyday stressors’

aka “free-floating” anxiety

DSM5: excessive anx and worry occuring more days than not for at least 6 mos about number of events/activities

prevalence: 4-7%, more in women

  • typical onset: early 20s, but can occur any time in life

may present with somatic sx

overlap with MDD (80% comorbid)

strongly tied to levels of stress

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10
Q

panic attack

A

abrupt surge of intense fear/discomfort that peaks within minutes with 4 or more physical/mental symptoms:

  • palpitations, pounding heart, accel HR
  • sweating
  • trembling, shaking
  • SOB or smothering feeling
  • feeling of choking
  • chest pain/discomfort
  • nausea, abd distress
  • dizzy, unsteady, lightheaded, faint
  • chills/hot flashes

potential mental sx

  • derealization or depersonalization
  • fear of losing control, going crazy
  • fear of dying
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11
Q

diff between generalized anxiety and panic attack

A

gen vs panic

  • long timeframe vs shorter timeframe
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12
Q

panic attacks vs panic disorder

A

panic attacks are COMMON (30% will have one in a given year)

  • may be a specifier to any other mental disorder

panick attacks within a panic disorder? spontaneous! unprovoked

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13
Q

panic disorder

A

recurrent unexpected panic attacks

  • worry about addtl attacks or enact behavior changes to avoid future attacks
  • NOT due to physiological effects of substance or another medical condition/mental disorder

prevalence: 2-5%, 2x common in women, typical onset in early 20s

comorbidities:

  • MDD and other mood disorders
  • other anx disorders
  • substance abuse disorders
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14
Q

agoraphobia

A

fear or avoidance of being helpless in a place where escape may be difficult or embarassing

ex. public transport, open/closed spaces (bridges/theaters), standing in line, being in a crowd, being outside the house alone

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15
Q

phobia

types

A

specific, unreasonable fears of object/situations

types:

  • animal type (spiders, dogs)
  • natural environment (heights, water)
  • blood-injection-injury (needles) → closely linked to vasovagal response! (often faint!)
  • situational (airplanes, elevators, enclosed spaces)
  • other
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16
Q

phobia features

A

common (11% lifetime prevalence)

onset usually in childhood, F>M, genetic component (75% have relative with a phobia)

often see anxious/avoidant personality traits

often don’t seek tx unless affecting work/activities

17
Q

social anxiety disorder

(social phobia)

A

marked or persistent fear of social situations with risk of scrutiny by others

  • not the same as “shy” → only 12% of shy meet criteria for SAD

prevalence: 13%, similar for men/women, usually starting in adolescence

18
Q

performance anxiety

A

specifier for social phobia!

limited to specific perfomance situations

  • beta-blockers may be helpful!
19
Q

separation anxiety disorder

A

more common inchildren (4%) but can also occur as new-onset illness in adults (2%)

may present as…

  • school phobia/refusal
  • nightmares of separation
  • somatic symptoms

over 4wk in kids, 6mo in adults

attachment figure is usually parent for kids, spouse/friend for adults

20
Q

obsessive-compulsive and related disorders

A

OCD

body dysmorphic disorder

hoarding disorder

trichotillomania (hair-pulling)

excoriation disorder (skin picking)

21
Q

obsessions

A

recurrent and persistent throughts, impulses, or images that are experienced as intrusive and unwanted

→ provoke anxiety

examples:

  • contamination
  • self-doubt
  • aggressive/sexual thoughts
  • order/symmetry
22
Q

compulsions

A

repetitive behaviors (or mental rituals) that are engaged in with the goal of reducing teh anxiety assoc with obsessions

  • checking
  • counting
  • washing
  • arranging
23
Q

OCD: obsessive-compulsive disorder

specifiers

A

chronic obsessions and compulsions that cause significant distress, interfere with fx, or are excessively time-consuming (> 1hr per day)

12 month prevalence: 1%, F a little higher than M, onset typicaly in adolescence/young adulthood (younger in males)

specifiers:

  • tic-related (can be comorbid with Tourette’s)
  • insight (good, fair, absent/delusional)
24
Q

OCD and neurosurgery

A

last resort tx: cigulotomy

25
Q

hoarding disorder

A

before DSM5, hoarding was listed as an OCD “compulsion”

ex. animal hoarding

onset is in childhood, but impairment is progressive

26
Q

body dysmorphic disorder

A

preoccupation with imagined/exaggerated body defect

NOT EATING DISORDER

onset usually in early teens

27
Q

PTSD

dx

risk factors

comorbidities

A

traumatic stress: psych sx following severe traumA

  • 50% of people suffering acute trauma → acute stress sx
    • 50% of these have sx for 1mo+

ex. combat stress

diagnosis:

  • severe trauma
  • re-experiencing of the trauma
  • avoidance of reminders
  • negative changes in thinking/mood
  • hyperarousal (easily startled)
  • chronicity (1month+)

risk factors:

  • severity/nature of trauma
  • feeling of ‘powerlessness’
  • genetic/personality factors
  • early traumatic exp
  • less supportive environment

comorbidities:

  • MDD, other mood disorders
  • phobic, other anxiety disorders
  • substance use disorders
28
Q

what kinds of trauma lead to PTSD?

A

exposure to actual or threatened death, serious injury, or sexual violence:

  • directly experienced
  • witnessed
  • second-hand knowledge of trauma to close family member, close friend
  • repeated or extreme exposure to details of traumatic events
29
Q

PTSD treatment

A

psychotherapy

  • cognitive behavior therapy
  • group therapy (survivors group)
  • *single-session “debriefing can be harmful!

EMDR: eye movement desensitization and reprocessing

30
Q

acute stress disorder

A

like PTSD, but for less than a month

  • can develop into PTSD!
31
Q

adjustment disorder

A

clinically significant sx in response to an identifiable stressor

  • not another mental disorder
  • not “normal bereavement”

once stressor is over, sx stop within 6mo

specify: depressed mood, anxiety, disturbance of conduct, mixed

M2 Psych (24 decks)

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