Anxiety Disorders Flashcards
(38 cards)
List the components of the current understanding of the biological basis of anxiety and anxiety disorders
Neuroanatomy: hippocampus, amygdala, PFC
NT’s
Hypothalamic-Pituitary-Adrenal Axis (HPA)
Anxious temperament
Explain the current understanding of the biological basis of anxiety and anxiety disorders based on neuroanatomy
Hippocampus • In temporal lobe • Involved in memory and learning • Sensors for cortisol • May become dysregulated in anxiety and depression
Amygdala
• Processes sensory info
• Role in negative emotions = fear and learning new fear associations
• Activation → activates HPA → autonomic and behavioral responses
• Responses = innate (evolutionarily conserved); selective (genetically determined)
PFC
• Inhibits amygdala → regulates expression of fear
• Helps “unlearn” fear associations
Explain the current understanding of the biological basis of anxiety and anxiety disorders based on neurotransmitters
o Glutamate = excitatory; GAGA = inhibitory
o Noradrenergic and serotonergic systems likely involved in anxiety disorders
Explain the current understanding of the biological basis of anxiety and anxiety disorders based on the HPA axis
o Normal stress response = activates HPA:
• Result: metabolic mobilization; increased HR, BP and respiration; redistribution of blood flow; suppression of immune, inflammatory, and digestive systems
o Chronic stress = abnormal HPA activation
• Result: HT, obesity, diabetes, osteoporosis, suppressed immune function, memory impairment, changes in brain structure, depression, anxiety
• Adrenal cortex hypertrophy
• Hippocampus neuronal atrophy and volume reduction
Explain the current understanding of the biological basis of anxiety and anxiety disorders based on temperament
Genetically determined = 40% heritable
• Hippocampus = heritable determinants
• Amygdala = not heritable
o Have extreme behavioral inhibition (freezing) in response to new situations or strangers
o Can be identified early in life (2 years old)
o Predicts development of anxiety, depression, co-morbid substance use
Describe agoraphobia
- Intense anxiety about 2 or more of: using public transportation, being in open spaces, being in enclosed spaces, standing in line or being in a crowd, being outside of home alone
- May be co-morbid with panic disorder, social phobia, GAD, MDD, PTSD, alcohol use disorder
Recognize the substance and medication induced and other medical etiologies of anxiety.
Medical conditions o Hyperthyroidism o Hyperparathyroidism o Pheochromocytoma o Hypoglycemia o Cardiac arrhythmias o Mitral valve prolapse o Pulmonary embolus o Myocardial infarction
Substance-induced o Caffeine intoxication o Stimulant abuse o Alcohol withdrawal o Sedative-hypnotic withdrawal
Medications o Asthma drugs (albuterol) o Steroids (prednisone) o Thyroid drugs o Some antidepressants (bupropion) o Stimulants (methylphenidate) o Decongestants (pseudoephedrine) o Caffeine-containing drugs (No-Doz)
Panic disorder: epidemiology
Lifetime prevalence: 2-3% females; 0.5-15% males
Panic disorder: pathophysiology
Biological disturbances: • Increased catecholamines in CNS • Abnormal locus ceruleus (area in brainstem regulating alertness and procuces NE) • CO2 hypersensitivity • Lactate metabolism disturbances • Abnormal GABA NT system
Abnormal brain structure:
• Temporal lobe (hypothalamus)
• Cerebral vasoconstriction
Hereditary
• Risk = 20% in 1st-degress relatives
Panic disorder: common comorbidities
Higher rates peptic ulcer disease, HT, death
Increased risk of other psychiatric conditions
o Depression
o Alcohol abuse
Higher rates suicide
Other types anxiety disorders
GAD: epidemiology
Lifetime prevalence: 4-7%
More common in women
GAD: pathophysiology
- Unknown underlying cause
- Environmental factors > hereditary role
- Frontal lobe and limbic system disturbances in NE, GABA, and serotonin may be factors
GAD: common comorbidities
- Often exists with other psychiatric disorder
* Increased risk depression and substance abuse
OCD: epidemiology
Lifetime prevalence: 2-3%
Equally prevalent in males and females
OCD: pathophysiology
- Serotonin dysfunction
- Associated neurological disorders: TBI, epilepsy, Huntington’s
- Genetically linked to Tourette’s
Other findings:
• Abnormal electroencephalographic findings
• Abnormal auditory evoked potentials
• Growth delays
• Abnormal neuropsychological test results
PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections)
• Strong heritable component
ODC: common comorbidities
- Recurrent major depression episodes (70-80%)
- History of tics (20-30%)
- Tourette’s (5-7%)
OCD: prognosis
Poor prognostic indicators: • Yielding to compulsions • Childhood onset • Bizarre compulsions • Need for hospitalization • Coexisting major depression or personality disorder
Favorable indicators:
• Good social and occupational adjustment
• Presence of precipitating event
• Episodic symptom course
Recognize the clinical presentations of social phobia and specific phobias.
- Social phobia: strong persisting fear of situations in which embarrassment can occur
- Specific phobia: strong persisting fear of an object or situation
- Both result in avoidance, anxious anticipation, or distress
Somatization disorder
o Presence of distressing and impairing somatic symptoms that can’t be explained on basis of physical and lab exam
o Ex: pain, GI symptoms, sexual symptoms, neurological symptoms
o Lifetime prevalence = 0.2-2%; 5:1 female to male ratio
o Begins before age 30
o Course can be chronic and debilitating
o Episodes typically last 6-9 months, may be separated periods of 9-12 months
o Genetic component; otherwise etiology is unclear
o Must rule out other medical disorders: MS, myasthenia gravis, SLE, HIV/AIDS, acute intermittent porphyria, hyperthyroidism, hyperparathyroidism and chronic systemic infections
Conversion disorder
Presents with one or more neurological symptoms without identifiable neurological cause; caused by psychological factors
GAD: treatment
o Combo of medication and psychotherapy
o 1st line = SSRIs
o Also effective = SNRIs
o May use SSRI and benzodiazepine, then taper benzodiazepine once SSRI has taken effect
o CBT: restructure patient’s distortion about environment
o Other behavioral interventions: deep breathing, progressive muscle relaxation, imagery
Panic disorder: treatment
o Combo of medication and psychotherapy
o 1st line = SSRIs
o Also effective = SNRIs; may use older tricyclic and MAOI antidepressants but not as safe or tolerable
o Benzodiazepines to prevent attacks
o CBT: education to help make more appropriate attributions to somatic symptoms
o Exposure therapy: expose to feared stimulus to desensitize themselves
OCD: treatment
o Combo of medication and psychotherapy
o 1st line = SSRIs
o Clomipramine = gold standard but lots side effects so try SSRIs first
o Refractory OCD: antidepressants + antipsychotics; psychosurgery (cingulotomy)
o CBT: Exposure and response prevention; family therapy to prevent reinforcement of compulsions
List the benzodiazepines
Alprazolam Clonazepam Diazepam Lorazepam Midazolam Oxazepam
