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Flashcards in Anxiety Deck (35):
1

Fear vs Anxiety

Fear: emotional response to real or perceived threat
Anxiety: anticipation of future threat
anxiety disorders often have both

2

What causes anxiety to become pathological?

1. Autonomy
2. Intensity
3. Duration
4. Behavior-dysfunctional behaviors

3

Amygdala centered circuit:

fear, panic, phobia

4

Cortico-striatal-thalamic-cortical

worry, anxious misery, apprehension, expectation, obsessions

5

What are the neurotransmitters that are indicated in anxiety?

1. Serotonin-raphe nuclei-low=aggression, impulsivity, depression, suicide attempts, self-injury, intrusive thoughts and repetitive behavior

2. Ne-Locus ceruleus
associated with orienting, selective attention, hypervigilance, mood and autonomic arousal

3. GABA-increase gaba-alleviate anxiety

4. glutamate-learning and memory

6

Male vs female anxiety

female

7

Panic Attack

abrupt surge of intense fear that reaches a peak within 10 minutes and 4 or more occur
Palpitations
Paresthesias
Abdominal Distress
Nausea
Intense fear of dying
I-lIghtheadedness
Chest pain
Chills
Chocking
C disConnectedness
Sweating
Shaking
SOB

4 or more four panic attack within 10 minutes

8

Panic Disorder

unexpected panic attacks with no identifiable trigger. at least one attack is followed for 1 month by anticipatory anxiety
-worry about an additional attack or the consequences of an attack
-significant maladaptive change in behavior related to the attack

9

Can panic attacks occur in any generalized anxiety disorder?

yes

10

What is the most common anxiety disorder comorbidity ?

agoraphobia: avoid places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed

2nd most common: GAD

11

What is the most common non-anxiety comorbidity to anxiety?

major depression

Others:
alcohol>other substances
personality disorders-especially cluster C

12

What is the median age of onset of an anxiety disorder?

20-24

13

What are the symptoms of anxiety?

Physical symptoms:..
Affective: edginess to terror and panic; often viewed as irritability or restlessness
Cognitive: worry apprehension, poor concentration, mind blank, tense/jumpy, anticipate the worst
Behavioral: made an effort to diminish or avoid the stress; response can be checking behaviors, rituals, avoidance

--Without treatment: WAXING AND WANING

14

When are panic attacks and disorders risk factors for suicide?

diagnosis in the prior 12 months

15

What is the neurocircuitry model theory of anxiety?

abnormally sensitive fear network, centered in amygdala
GABA, serotonin, norepinephrine, implicated

16

What is first line for treatment of anxiety?

SSRI, SNRI
2nd line: TCAs, MAOI
while waiting for antidepressant effect: also treat with Benzo
Cognitive behavior therapy

17

Agoraphobia

fear or anxiety in at least 2 of the following situations for more than 6 months
1. pubic transport
2. enclosed spaces
3. open spaces
4 standing in line
5. outside of the home alone

-onset late teens; late 20's if no panic attacks/disorder
remission rare unless treated

18

What is the treatment for agoraphobia?

systematic desensitization

19

What is GAD, Specific Phobia, Social anxiety? How long do you have to have symptoms?
Female to male?
Comparison in prevalence
Age of onset?

GAD-excessive anxiety/ worry about many things-adults

Specific phobia-fear/anxiety about a specific situation or object-children

social anxiety-fear/anxiety from social situations where one is exposed to scrutiny/judgement by others; blushing-teens

>6 months
F>M
Comorbidities: other anxiety disorders, depression, substance abuse disorders

Prevalence: specific> social> GAD

20

What are the courses like for GAD, specific phobia, social phobia?

GAD-wax and wanted, tends to persist, full remission low

Specific- wax and wane; if persistent into adulthood, then full remission low

social-60% for years in adulthood=30% lasts

21

How many phobias to specific phobias tend to have? What specific phobia does not have a childhood onset? What phobia is equal in males and females?

average 3
situational-not childhood onset
Males and females= in blood/injection/injury

22

What two anxiety disorders use CBT and systemic desensitization?

agoraphobia and specific phobia

23

What is separation anxiety?

concerning separation from home or attachment figure
M
fairly common
-majority of children-no anxiety disorders in lifetime
-can be seen adults

24

What is selective mutism?

failure to speak in specific social situations

25

What are 3 comorbidities with anxiety?

1. depression-most common
2. substance abuse
3. personality traits/disorders-cluster c

26

Adjustment disorder

emotional or behavior symptoms in response to an identifiable stressor occurring within 3 MONTHS
-out of proportion distress
-significant impairment

-once stressor is terminated symptoms do not persist for more than 6 months

27

Acute stress disorder and PTSD are exposed to what?

exposure to actual or threatened death, injury, or sexual violence
-direct experience, witnessing, learning trauma occurred to close family member or friend, or repeated exposure to aversive details

28

Acute stress disorder

Intrusion symptoms
Negative mood
dissociative symptoms
avoidance symptoms
arousal symptoms
Duration 3days to 1 month

29

PTSD

Intrusion symptoms
Negative alteration in mood and cognition
avoidance symptoms
arousal symtpoms
duration>1 month
-50% recover in 3 months

F>M
Cocomrbi-mood disorders, anxiety disorder, substance abuse disorder (M>F)

Treatment:
antidep, no benzos

30

OCD

Obsessions
-recurrent and persistent thoughts, images or urges
-intrusive and unwanted cuasing anxiety/stress

COmpulsions
-repetitive behavior or mental acts
-usually in response to obsession to reduce distress or prevent feared event

at least > 1 hour/day

F>M

Mean age 19 (males younger)

chronic waxing and waning over lifetime

Comorbid:
1. anxiety disorder (usually anxiety then COD)
2. mood disorder (OCD then Mood)
3. Tic disorder (especially if OCD child)

Treatment: high dose SSRI
exposure therapy

31

Body dysmorphic disorder?

preoccupied with minor or imagined defects in appearance leading to significant emotional distress

32

Hoarding disorder

persistent difficulty parting with possessions, hoarding causes clinically significant distress

33

trichotillomania

hair pulling

34

excoriation disorder

skin picking

35

Exposure therapy

phobias and OCD