Anxiety Disorders Flashcards
(92 cards)
1
Q
List anxiety disorders we have studied
A
Specific phobia, Social Anxiety disorder (social phobia), Panic disorder, Agoraphobia, Generalized anxiety disorder
2
Q
DSM 5 criteria for Generalized anxiety Disorder
A
Excessive anxiety “more days than not” for 6 months or more, about several events or activities which the person finds it difficult to control the worry.
3
Q
What are motor tension symptoms in GAD
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Trembling, shaking, Muscle aches, soreness
4
Q
Autonomic Hyperactivity Symptoms in GAD
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Tachycardia (raoid heart rate), sweating, dizziness,Nausea, GI complaints
5
Q
Scanning and vigilance symptoms in GAD
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Exaggerated startle response
6
Q
Annual prevalence of GAD in U.S
A
3%
7
Q
Lifetime prevalence of GAD in U.S
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5-6%
8
Q
Lifetime prevalence of GAD world-wide
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2-11%
9
Q
what percent of people with GAD are female
A
65%
10
Q
What percent of those with GAD are concurrent for another disorder
A
67%
11
Q
DSM-5 Criteria: Panic Disorder (PD)
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-Recurring, unexpected panic attacks involving an sudden surge of intense fear or discomfort
12
Q
Annual prevalence, U.S. for PD
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3%
13
Q
Lifetime prevalence, U.S for PD
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2-5%
14
Q
Lifetime prevalence, world for PD
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1.5-3%
15
Q
Average age of onset for PD
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late 20s
16
Q
How many with PD are female
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65-75%
17
Q
What percent recover completely with no treatment from PD
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30-35%
18
Q
What percent of people with PD have mild or occasional symptoms
A
50%
19
Q
what percent have moderate to severe symptoms and require continuous treatment
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15-20%
20
Q
What is Agoraphobia
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Anxiety re places where escape difficult or embarrassing, or help not available in event of panic attack Situations avoided, tolerated with anxiety, or companion required
21
Q
DSM 5 criteria for agoraphobia
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-Individual’s fear based on concern that escape difficult, or help unavailable, in case of panic, or other embarrassing, incapacitating symptoms. -Agoraphobic situation almost always produces fear or anxiety -Agoraphobic situation avoided, requires companion, or endured with intense anxiety. -Fear, anxiety disproportionate to danger posed by situation, “and to the sociocultural context.”
22
Q
Annual and lifetime prevalence for agoraphobia in the U.S
A
0.8% annual, 1.4% lifetime prevalence in U.S
23
Q
Gender bias and age of onset for agoraphobia
A
More common in women; usual onset in 20s or 30s.
24
Q
HIgh levels of what are found in PD
A
Catecholamines and MAO
25
Over stimulation of what in PD
Beta-adrenergic nervous system
26
Tendency to hyperventilate is associated with what disorder
PD
27
Concordance rate among 1st degree relatives in PD?
10-25% - only 1-3% in controls
28
70% of sufferers of PD show what \_\_\_\_\_\_infused in their blood. Why?
- Sodium(Na) lactate - They produce a large NE increase in susceptibles
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2 differences b/w PET data from lactate positive infusers and normals
- higher levels of brain metabolism - higher activity in non-dominant hippocampal area
30
List four differences b/w PD patients and normals
-Increased sympathetic tone -Slower adaptation to repeated stimuli -Strong ANS responses to moderate stimuli -50% have mitral valve prolapse (thought to be genetic)
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Mital valve prolapse can Can produce some symptoms of PD in non-PD individuals including
Heat rate increase respiration increase
32
Psychodynamic approach to etiology of PD
Reoccurrence of separation anxiety
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% of PD w/ Agoraphobia had symptoms of separation anxiety as children?
20-50%
34
What is Imipramine
-imipramine blocks distress of separation in dogs and monkeys -effective on PD -treats school phobia this supports the psychodynamic theory of PD
35
What is Social phobia (SAD)
Fear of embarrassment or humiliation in social/performance situations
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annual and lifetime prevalence of SAD
7% annual, 11% lifetime prevalence in U.S
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What's the most prevalent anxiety disorder
SAD
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typical onset of SAD?
teens
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what is Specific Phobia
Excessive or unreasonable fear of specific objects or situations. Situations avoided, or tolerated with anxiety,
40
Specific phobia subtypes?
Animals, Environment (storms), Blood-injection-injury, situational (bridges), other (lycanthrophobia)
41
Prevalence of specific phobia
9% annual, 13% lifetime prevalence in U.S.
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typical onset of specific phobia
young adulthood
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male;female ratio of specific phobia
1:2
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Psychodynamic view of Specific phobia?
Phobic objects = symbols of inner conflict (Anxiety-producing unconscious desire) two defense mechanisms:
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Behavioural view for Specific phobia
Phobic objects = CS for learned fear Generalization to similar stimuli limited range of phobic objects? =Evolutionary/genetic predisposition means Faster GSR conditioning, slower extinction to ‘prepared’ CSs (snakes, spiders)
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what is flooding
A behavioural treatment for phobias - Based on extinction via CS-alone presentations (no negative repercussions) fear diminshes gradually -Involves arousal of intense anxiety
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what is Systematic Desensitization Therapy:
A behavioural treatment for phobias based on counterconditioning, generalization - escalating list of feared situations, trained to relax during each - then do it for real and relax -involves low levels of anxiety
48
What are obsessions and complusions
Obsessions: Persistent disturbing or disruptive thoughts or impulses. Compulsions: Repetitive, ritualistic behaviors individual compelled to perform \*must take more than 1hr a day
49
Prevalence of OCD
1% annual, 1.5% lifetime prevalence in U.S.
50
Onset time for OCD
Usually starts in adolescence, early adulthood (can begin in childhood)
51
Male to female ratios in OCD?
For adult OCD, males = females For childhood OCD, male:female ratio 3:1
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Psychodynamic view of OCD
Symptom has symbolic link to underlying conflict Conflict often localized to anal period due to concerns with order, cleanliness
53
Serotonin and OCD
Higher serotonin inhibitory activity in OCD (too much serotonin) Reduced OCD coincides with reduced blood level of serotonin metabolites Serotonin agonist increases OCD obsessions
54
Differences in brains of OCD patients?
1) Damage to basal ganglia 2) OCD symptoms in Sydenham’s chorea 3) PET shows more metabolic activity in caudate 4) CAT scans show caudate 25% smaller
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Judith Rapaport's evolutionary view of OCD?
-Compulsions = left-over ‘programs’ from evolutionary past i.e. Acral lick in dogs = animal model of OCD (Responds to clomipramine, Problem located in basal ganglia)
56
behaviour vs. cognitive symptoms in OCD
behavioural - complusions cognitive - obsessions
57
behavioural view of OCD
Fear conditioned to environmental event Anxiety-reducing behaviors reinforced - BUT behaviourists ignore cognition (i.e. obsessions)
58
Cognitive view of OCD
Difficulty dismissing mildly obsessive thought causes anxiety which causes more difficulty and Compulsive rituals relieve this anxiety (starts with obsession and leads to compulsions)
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Pharmalogical Treatments for OCD
- Antidepressants (higher doses for OCD than for depression) Antipsychotic medications Only used as adjuncts to SSRI therapy; not effective on their own) - clomipramine
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Psychological treatment for OCD
-flooding -response prevention -modelling -cognitive therapy
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Behavioural view of PD
Unconscious internal stimuli precede anxiety/panic = CSs for fear and anxiety Conditioning of fear to unconscious memories
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Catastrophic Appraisal Model (Clark, 1986) of PD
-Catastrophic interpretation of body sensations - conscious or unconscious (hyperventilation, Na lactate, mitral valve prolapse) -Attentional bias towards threat in PD, GAD, SAD -overestimate risk of negative events
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Personality and anxiety - Eysenck’s Introversion & Neuroticism:
-Introverts = higher arousal, faster learning -Neurotics = higher ANS reactivity, emotionality -Combination = more learned fear
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Higher levels of ________ in children of parents with PD and agoraphobia
introversion
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What is cardiac Vagal Tone and heart rate variability
The vagus nerve controls heart rate via parasympathetic nervous system and indicates temperamental reactivity and behavioural regulation measured as heart rate variability (HRV)
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What does HRV indicate?
High HRV =is good: indicates adaptive emotional responding Low HRV bad: indicates poor discrimination re environmental cues
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HRV in GAD?
- adults with high trait anxiety had Low HRV - Lower HRV in generalized anxiety disorder (GAD) -Low HRV associated with behavioural inhibition in children
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3 structures associated with anxiety
- amygdala - Frontal cortex - Temporal Cortex
69
What is the HPA Axis
Hypothalamic-Pituitary-Adrenal axis 1) stress stimulates hypothalamus to produce CRH (corticotropin releasing hormone) 2) CRH stimulates pituitary gland to release ACTH (adrenocoricotropin) 3) ACTH stimulates adrenal gland to release glucocorticoid stress hormones (like cortisol)
70
HPA and anxiety
-HPA overactive in anxiety (and depression) -Antidepressants suppress HPA activity -Early experiences in animals shape HPA reactivity, passed on epigenetically
71
What happened to the Young stressed macaques?
show anxiety-, depression-like symptoms as adults, plus changes in HPA
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How do the CRH-R1 gene and CRH-R2 gene relate to anxiety?
mice w/o CRH-R1 showed reduced anxiety (CRH-R1 triggers release of hormones that are linked to stress and anxiety) mice w/o CRH-R2 showed increased anxiety
73
what neurotransmitters are associated with anxiety disorders?
1) Monoamines: increased serotonin and norepinephrine 2) reduced inhibitory GABA 3) Social phobia also shows dysfunction in serotonin, dopamine systems
74
What are the genetic factors in anxiety?
- Parents with anxiety = children 3-5 times more likely to have anxiety - 41% MZ concordance rate for anxiety reaction; 4% in DZ - No one gene responsible for more than 5% of variability in anxiety - 5 – 15 loci involved
75
What are the 2 candidate genes in Anxiety? What are their functions?
- 5-HT1A receptor gene (serotonin) that decreases blood pressure and heart rate via the vagus nerve - 5-HTT : serotonin transporter protein responsible for the reuptake of serotonin
76
What did studies involving 5-HT1A receptor gene show us about anxiety?
-Mice lacking 5-HT1A show increased anxiety \*only if 5-HT1A receptor is deprived for the first 4 weeks will adults mice have anxiety/depression \*after 4 weeks, deprivation of 5-HT1A has no effect on anxiety
77
What did studies involving 5-HTT transporter protein gene show us about anxiety?
- Mice lacking 5-HTT genes show anxiety-related behaviours - mice treated with fluoxetine (inhibits HTT) at an early age showed anxiety as adults
78
What does the (s)short allele of 5-HTT confer? When you have 2?
Single copy of (s) allele (Found in 50% of Caucasians) show higher risk of stress-induced (reactive) depression 2 short alleles: more amygdala activity to stress and uncoupled amygdala-cingulate feedback circuit
79
Pharmacological treatments for anxiety
Anti-anxiety drugs (anxiolytics):Benzodiazepines – increase GABA activity Antidepressants: SNRI, SSRI and tricyclic MAO inhibitors
80
Psychological treatments for anxiety
Systematic desensitization, modeling, flooding/implosive therapy, cognitive therapy
81
-At least one panic attack has been followed by 1 month or more of both to be diagnosed by the DSM:
1) Persistent concern about another panic attack/concequences 2)Significant maladaptive change in behaviour related to attacks
82
TO qualify in the DSM Anxiety must be Accompanied by at least 3 of the following 6 symptoms, more days than not for last 6 months:
-Restlessness; feeling on edge “keyed up” -Easily fatigued -Difficulty concentrating; mind going blank -Irritability -Muscle tension -Difficulty falling or staying asleep, or restless sleep
83
What are the two defence mechanisms at play in specific phobia
1) displacement: moving target to something else (penis to snake) 2) Reaction formation: opposite emotion (lust becomes fear)
84
what is clomipramine (tricyclic antidepressant) blocks serotonin reuptake, helps OCD
(tricyclic antidepressant) blocks serotonin reuptake, helps OCD - effective in reducing areal lick in dogs
85
interoceptive conditioning model
internal bodily functions serve as triggers for panic attacks i.e rapid heart rate
86
Which condition is most commonly comorbid with OCD
Depression (10X more common in OCD than regular population) 30% of OCD patients have MDD and 20% lifetime comorbidity
87
Syendham's chorea involves damage to what brain structure
Caudate nucleus (in the basal ganglia)
88
What is the % heritability in OCD
50% in the population
89
which anxiety disorder shows Sodium(Na) lactate infusion in their blood?
Panic Disorder
90
Mitral valve prolapse has been linked to what anxiety disorder
Panic Disorder
91
agoraphobics must fear two of the following to qualify in the DSM
public transport, open spaces, enclosed spaces, in line or in crowd, outside home alone
92
what does clomipramine do
Blocks serotonin reuptake
