Anxiety Disorders

Question 1

Fear VS Anxiety

Answer 1

The object of fear is imminent/certain harm
The object of anxiety is distant/uncertain harm

Question 2

Threat parts of the brain

Answer 2

Anterior cingulate cortex, Ventromedial prefrontal cortex, Amygdala, Insular cortex, Hippocampus

Question 3

Global 12-month prevalence of anxiety

Answer 3

~14%

Question 4

The Vicious Cycle of Anxiety

Answer 4

Anxiety -> Increased scanning for danger -> Avoidance -> Short term relief -> Long term increase in anxiety

Question 5

3 Trajectories of Anxiety

Answer 5

1 - Occurence of subthreshold syndromes
2 - Onset of threshold anxiety disorders
3 - Development of secondary complications

Question 6

Treatment of Anxiety (Mild, Moderate, Severe)

Answer 6

Mild - Watchful-waiting or CBT if worsening
Moderate - CBT or Pharmacotherapy, or both
Severe - CBT + Pharmacotherapy

Question 7

Specific Phobia Diagnostic Criteria

Answer 7

A. Marked fear or anxiety about specific object or situation
B. It almost always causes fear or anxiety
C. Actively Avoided as a result
D. Out of proportion to the actual danger
E. 6 months or more of avoidance
F. Causes distress in important areas of functioning
G. Not better explained by another disorder (agoraphobia, OCD, PTSD, seperation anxiety, social anxiety)

Question 8

Aetiology of Specific Phobias

Answer 8

Classical Conditioning
- Direct or Indirect

Question 9

Types of Exposure Therapy

Answer 9

Imaginal, In vivo, VR

Question 10

Panic Attack Criteria

Answer 10

A discrete period of intense fear in which 4 of the following symptoms abruptly develop and peak within 10 minutes:
- Heart Rate
- Sweating
- Shaking
- Shortness of Breath
- Choking
- Chest Pain
- Chills/Hot Flushes
- Nausea
- Dizziness
- Derealization/Depersonalization
- Fear of Insanity
- Fear of Dying
- Paresthesias (numbness/tingling)
13

Question 11

Panic Disorder Diagnostic Criteria

Answer 11

Recurrent Unexpected Panic Attacks for at least a month:
- Worry of future attacks
- Change in behaviour because of attacks
- Not attributable to smth else

Question 12

Panic Disorder Epidemeology

Answer 12

18-29 Year olds, females, low income more affected
Comorbidity of agoraphobia, depression
25% history of substance dependence

Question 13

Vicious Cycle of Panic

Answer 13

Trigger Causes Palpitations -> Perceived Threat (Something wrong with body) -> Arousal -> Sensations -> Catastrophic Misinterpretation -> Perceived Threat

Question 14

Panic Disorder Treatment

Answer 14

CBT, Pharmalogical, Benzodiazapenes for short term symptoms

Question 15

Agoraphobia Diagnostic Criteria

Answer 15

A. Marked Fear or Anxiety about 2+ Of:
- PTV
- Open Spaces
- Closed Spaces
- Crowds/Queues
- Being Outside Alone
B. Avoids Situations because of inescapability
C. Almost always provoke fear/anxiety
D. Avoided, require companion, or endured with intense anxiety
E. Out of proportion
F. 6+ months
G. Functioning
H. Not another medical condition
I. Not better explained by another disorder

Question 16

Agoraphobia Epidemeology

Answer 16

Chronic without treatment, 90% comorbidity

Question 17

Agoraphobia Aetiology

Answer 17

External Cues -> Somatic Sensations of Anxiety -> Expected Catastrophes -> Increase Anxiety -> Increased Somatic Sensations -> Expected Catastrophes -> Panic/Anxiety

Question 18

Social Anxiety Diagnostic Criteria

Answer 18

A. Marked fear or anxiety about one or more social situations in which exposed to possible scrutiny by others
B. Fear of showing symptoms that will be negatively evaluated
C. The Social situations almost always provoke fear/anxiety
D. Avoided
E. Out of proportion
F. 6+ months
G. Functioning
H. No medical condition
I. Not better explained by other MD
J. If there is a medical condition, social anxiety is unrelated.
Performance-only specifier

Question 19

Social Anxiety Epidemeology

Answer 19

• Development before 20
• Comorbidity with Mood, anxiety, substance use

Question 20

Social Anxiety Aetiology

Answer 20

Genes + Environment -> Proximal Factors (behavioural/cognitive) -> Social Anxiety -> Diagnosis <- Life interference <- Cultural/Personal Factors

Question 21

Social Anxiety Treatment

Answer 21

CBT - Exposure Therapy
Social Skills Training
Cognitive Restructuring

Question 22

Generalised Anxiety Disorder Diagnostic Criteria

Answer 22

A. Excessive Anxiety 6+ Months
B. Difficult to Control
C. Associated with 3+ of:
- Restlessness, Fatigue, Distraction, Irritability, Muscle Tension, Sleep Disturbance
D. Functioning
E. No substance or medical condition
F. Not accounted for by other mental disorder

Question 23

Generalised Anxiety Disorder Epidemeology

Answer 23

Early onset, females more, comorbidity with mood and other anxiety disorders, worse prognosis than panic disorder over 5 years

Question 24

Avoidance Model of Worry

Answer 24

Worry is ineffective attempt at problem solving while avoiding the experience

Question 25

Intolerance of Uncertainty Model

Answer 25

Uncertain or ambiguous situations are stressful. Belief that worry helps cope or avoid events.

Question 26

Contrast Avoidance Model of GAD

Answer 26

Worry does not facilitate avoidance but it does sustain negative emotionality

Question 27

Meta-cognitive model of GAD

Answer 27

Meta-worrying (worrying about worrying). Thought control fails and people feel helpless.

Question 28

GAD Treatment

Answer 28

CBT, 50% respond to meds or CBT. Combined recommended in complex cases.