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What are four ways in which the anxiety response goes from normal to pathological

Autonomy-pt haves anxiety sx without obvious reasons

Intensity-response out of proportion, causes dysfunction

Duration-stress response lasts longer than expected

Behavior-coping mechs overwhelmed, pt behaves in dysfunctional ways (anger, depression, agitated)


percent of women and men with anxiety

Women (30% lifetime)>> Men (19% lifetime)


Why are SSRI’s started at low dose in pts with panic disorder?

Pts more prone to the early “activation” s/e of SSRI’s where pts feel a little more jittery or anxious or restless. PD pts take this as worsening anxiety.


Common comorbid conditions w/anxiety disorders?

Substance Abuse
Personality disorders (generally Cluster C-avoidant)
Other anxiety disorders (comorbidity is the rule)


What two conditions can be differentiated based upon CO2 inhalation test?

Panic Disorder (will induce panic attack) vs. GAD (will not)


Which condition is known to increase glucose metabolism in the brain and
Is thought to be caused by autoimmune response to streptococcus in kids?

OCD (inc glucose metab), OCD kids=PANDAS (peds autoimmune neuropsych d/o assoc w/Strep)


What are some neurologic conditions that cause secondary anxiety symptoms?

1-Temporal Lobe Epilepsy (multiple daily panic attacks, brief episodes of altered awareness or memory gaps)

2-Parkinson’s Disease (after 60), mimics GAD

3-Post-Concussion Syndrome (dizziness w/o syncope, cognitive defects), mimics GAD, PD

4-Multiple Sclerosis (incidence peaks in young adults and in pts over 40), vague & fluctuating presentation with cerebellar signs, optic neuritis and weakness. Mimics GAD.

5-Meniere’s disease, migraines (mimic PD)


What are some general medical conditions that cause anxiety symptoms?

1-Endocrine, including hypoglycemia and secreting tumors such as pheo/carcinoid/insulinoma
2-Cardiovascular-angina, arrhythmias, palpitations, CHF
3-Pulmonary-PE, COPD, Asthma
4-Irritable Bowel Syndrome
7-Severe Anemia


Likely patient and presentation of PD?

Twenties or earlier, generally a dramatic onset with panic attack pt remembers for rest of life. Pt usually goes to PCP first because of physical symptoms. May try to medicate with drugs, alcohol.


What is the DSM criteria for panic disorder?

Patients need to have all three:
1. Recurrent unexpected panic attacks (reach a peak w/in 10 minutes)
2. Phobic avoidance (they avoid situations assoc w/attacks)
3. Anticipatory anxiety about attacks (very worried about future attacks or implications of future attacks such as MI, ‘going crazy’, losing control, etc)


What risk factors do patients with PD have?

Highest risk of suicide of all anxiety disorders

Increased risk of CV problems & stroke

Comorbidity w/other Axis I is the rule (not exception)

No good way to predict agoraphobics


What is the DSM criteria for GAD?

Frequent, persistent worry & anxiety that is out of proportion for >6 mo + distress

Pts need 3 out of 6:
1-restless or feeling keyed up or on edge
2-being easily fatigued
3-difficulty concentrating or mind goes blank
5-muscle tension
6-sleep disturbances


When do pts present with OCD? When is it worse?

OCD generally presents in early to mid-twenties

Unusual after 50, almost never after 65

Worsen in pregnancy & postpartum period


What is the DSM definition of OCD?

Either Obsessions or Compulsions (may be both)

Pts think these behaviors are unreasonable or excessive--> distress & impair functioning

If another d/o is involved, OC are not limited to it
-not only obsessed w/food if pt also has eating d/o


What things predict a poorer treatment response in OCD?

Sexual/religious obsessions, poor insight into illness, hoarding, comorbid depression/PD or social anxiety


What is the DSM criteria for PTSD?

Pts need to have symptoms in each of three broad categories
-Re-experiencing of events
-Avoidance of Stimuli
-Increased arousal (need 2)

sleep issues, irritable/angry, can’t concentrate, hypervigilance, exaggerated startle response.


How is Acute Stress Disorder timeframe different than PTSD?

ASD=occurs w/in 1 month and lasts at least two days with remission within 1 month.
Pts have PTSD symptoms in 3 categories PLUS sense of numbing, detachment, depersonalization.


What are the time-frames for Acute, Chronic and Delayed PTSD?

Acute-onset w/in 3 months, Duration less than 6 mo

Chronic-onset w/in 3 months, Duration more than 6 mo

Delayed onset-occurs more than 6 mo after trauma


What are some risk factors for PTSD?

Female, Assaultive Violence (rape, physical assault), Prolonged or repeated exposure, Childhood trauma or separation from parents during childhood.


The presence of psychological symptoms after a stressful but non-life threatening event suggests what disorder?

Adjustment Disorder (not an anxiety disorder)

-maladaptive behavior or emotional sx after stressful life event such as divorce, death of loved one, loss of a job.

-symptoms cannot be from bereavement

-symptoms begin w/in 3 mo and end w/in 6 mo


What is the DSM definition of social phobia
-social anxiety disorder?

Persistent fear of 1+ social situations where pt is exposed to new people or is under scrutiny
-pt fears that they will be humiliated or embarrassed
-pt recognizes fear is unreasonable (unless it’s a kid)
-onset generally in adolescence, sometimes resolves by age 25.


What is the order in life in which specific phobias develop?

Animal Type (animals or insects)—childhood
Environmental Type (water, storms)---childhood
Blood-Injury-Injection Type-childhood to adolescents
*highly familial, strong vasovagal response
Situational Type (tunnels, airplanes, bridges)-adulthood