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Flashcards in Anxiety Deck (20):

DD for anxiety?

1. Think organic (med) causes: caffeine, substance abuse (stimulants), withdrawal, hyperthyroidism, arrythmia, vit B12 deficiency, hypoglycemia, pheochromocytoma
2. usually seen in ED setting (acute MI, PE, COPD, asthma); take a HISTORY about med and psych components, do physical, and send labs to rule out med causes if needed
3. Psych disorder associated with anxiety: depression, schizo, eating disorders, personality disorders, substance dependence


To diagnose anxiety, symptoms must

1. be persistent (usually at least 6 months, but shorter for kids)
2. Interfere with normal functioning (work, job, marriage, etc.)
3. Cause significant distress


Etiology of anxiety: biopsychosocial associations

1. Psychosocial factors: traumatic events or extreme stressors (PTSD, panic attack); maladaptive coping skills/personality traits can make people vulnerable to increased stress levels; learned?
2. Biologic factors: greater prevalence in populations of family members with anxiety disorders (genetics possibly, less so than bipolar, ADHD, schizo); also gender bias with women>men except OCD
3. Neurobiological factors (less serotonin, GABA; more NE and glutamate)



1. Excessive anxiety/worry, occurring more days than not for > or = 6 months, about > or = 1 event/activity
2. Difficult to control worry
3. Associated with at least 3 of these symptoms: restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance
4. Causes significant impairment
5. No other explanation for symptoms


Occurrence for GAD:

1. 3-5% of general pop
2. Women > men
3. About 50% begin prior to adulthood
4. May have had generally anxious parents
5. Self-med (booze);
prgonosis: without treatment, tends to worsen over time!! Think especially STRESSFUL times


Treat GAD?

1. Therapy (CBT or psychodynamic)
2. Meds (antidepressants that increase SR or NE or both, downregulate or desens receptors; use 5HT1a receptor agonist like buspirone; benzos, but second line because of risk of addiction, falls, apnea; beta blockers, more for symp relief of performance anxiety, NOT GAD!!!!!!)


For panic disorder, look out for

panic attack: abrupt surge of intense fear or discomfort, peaking within minutes that is UNEXPECTED, with at least four of the symptoms in the slide


Panic disorder: how to diagnose

1. Recurrent unexpected PANIC ATTACKS
2. At least one attack followed by at least 1 month of at least one of the following: concern about additional panic attacks or consequences; significant maladaptive change in behavior related to attacks
3. No other explanation for symptoms


For panic disorder with agoraphobia, what is needed to diagnose?

1. Fear/anxiety about at least 2 of the in the slide
2. Fear of not being able to escape situation
3. Situation almost always causes fear/anxiety
4. Avoids situations
5. Fear/anxiety out of proportion to actual danger
6. At least 6 months
7. Causes significant impairment
8. No other explanation for symptoms


Occurrence, prognosis, treatment of panic disorder

Occurrence: 1.5-3.5%, F>M;
Prognosis: chronic, recurring, increased risk of depression and suicide
Treatment: therapy is CBT with SYSTEMATIC DESENS preferred or flooding, or psychodynamic therapy; meds are fast-acting benzos like alprazolam, SSRI/SNRI (long term first-line), intermediate or long-acting benzos (2nd line because of addiction potential); COMBO treatments


For specific phobia, how to diagnose?

At least
1. 6 months or more
2. Cause significant impairment
3. Marked fear/anxiety about a specific object/situation
4. Object/situation almost always provokes fear/anxiety
5. Actively avoid object/situation
6. Fear/anxiety out of proportion to actual danger
7. No other explanation for symptoms


For social anxiety phobia, how different than specific?

Change object/situation to social situation specifically; also fear of acting in ways that will be negatively scrutinized;
if PERFORMANCE only, then fear is restricted to public speaking or performing and won't generalize to other social aspects of life


Occurrence, comorbidities, treatment of phobias?

O: 5% men, 10% women (usually women > men)
C: other anxiety disorders and depression
T: specific phobia: think therapy first with flooding, systematic desens (CBT!!!!); meds likes sedatives?
for social phobia: do therapy with CBT, assertiveness training, group therapy; meds include SSRI/SNRI (first-line), MAOI's (after you've given SSRI's and benzos), then beta blockers (best for PERFORMANCE ONLY variant)


Physical and Psychological manifestations of anxiety?

Physical: 1. symp NS (diaphoresis, mydriasis, tachy, and TREMOR) 2. GI/GU symptoms (diarrhea, increased urinary freq) 3. Hyperventilation (dizziness, syncope, PARESTHESIA) 4. Numbness and tingling in extremities and around mouth

Psychological: Restlessness, irritability, trouble concentrating, worry


Fear of clowns



Fear of snakes




fear of airplanes



fear of snakes on a plane


Fear of bald people




fear of going to doctor or of doctors