What is the difference between Fear and Anxiety?
Fear - sense of apprehension, activation of autonomics, emotional response to perceieved imminent threat
Anxiety - anticipation of a future threat, more associated with muscle tension, vigilance in preparation for future danger and cautious or avoidant behavior
What is generalized Anxiety disorder?
excessive anxiety/worry occuring more days than not for at least 6 months about a number of events/activities
- worried about more than just 1 thing, hard to control the worry
Associated with 3 or more of the following symptoms (1 in kids):
-sleep disturbance - cant fall asleep and can't stay asleep
describe the course of GAD?
Illness is chronic with periodic exacerbations and times when you do better - waxes and wanes
felt anxious or nervous all their lives
Median age onset 30 yo
Earlier in life present with symptoms then the more comorbidity they tend to have and more impairment
What are the Pros and Cons of SSRIs in treating GAD?
Advantages: effective, benign side effect profile, safe, no dependence, 1x/day
Disadvantages: delated onset of action (3-6 weeks), Early anxiogenic effect, Sexual Dysfunction, dose titration required
What are the pros and cons of Benzodiazepine use in GAD?
Advantages: rapid onset, effective, well-tolerated, safe in OD
Disadvantages: Withdrawal reactions, sedation, PRegnancy Class C, mutliple daily dosing, Abuse potential
Long-Acting benzos preferred bc less addicting
What are "obsessions"? What are "Compulsions"?
Obsessions - thoughts: ideas, impulses, images that can be intrusive and senseless
Compulsions - behaviors: repetitive actions often to neutralize the thoughts or response to obsession
What is the difference between OCD and OCPD?
OCPD = Obsessive Compulsive Personality Disorder - NOT characterized by intrisuve throughts, images, urges or repetitive behavior (OCD)s and instead involves an enduring and pervasive maladaptive pattern of excessive perfectionism and rigid control
Panic Attack --> Panic Disorder
Panic Attack happens and then you are so afraid of having another panic attack that you get a panic disorder
"fear of the fear"
What are Panic attacks?
Unexpected and rapidly progressing bursts of anxiety accompanied by an array of cognitive and autonomic symptoms including:
Criteria for Panic Attacks?
At least 4 symptoms of the following:
palpitations, sweating, trembling, SOB, chocking, chest pain, N/Dizziness
Fear of losing control/going crazy
Fear of dying
Chills or hot flashes
What is Agoraphobia?
Marked fear or anxiety about 2 or more:
standing in lines / crowds
Individual fears or avoids these situations bc thoughts that escape might be difficult or that help might not be available in the event of developing a panic attack or other incapacitating or embarrasing symptoms
What is Interoceptivity? How does it effect pts?
Interoceptivity is heightened awareness of internal body function
Anxious people ar emore away of body changes and so treatment with SSRIs/antidepressants started with half the usual dose bc feel side effects more (ex. Orthostatic Hypotension)
How are tricyclics used in treating anxiety? What are the drugs used? Side effects?
effective for panic disorders and GAD but have greater side effect burden - more useful for patients who dont respond to SSRIS
Imipramine, Notriptyline, Desipramine Amitryptilline, Doxepin
Side Effects - ANTICHOLINERGICS
How is CBT used for treating Panic/Anxiety?
Situation --> Thought --> Feeling
change thoughts and change emotions bc anxiety/panic has to do with maladaptive cognitive responses so correct cognitive misperceptions
What are Specific Phobieas? Risk with them?
Specific Phobias - situational, blood injection, natural environment, animals, spiders, choking, loud sounds etc
60% more likely for suicide events!!!!
What are Social Phobias?
Social Phobia - marked fear or anxiety about one or more social situations in whcih the individual is exposed to possible scrutiny by others and fears that he/she will act in a way or show anxiety symptoms that are negatively evaluated
Social component and fear of being judged
What is Focal Cognitive Therapy for Panic Disorder? Principles behind it?
Deal with Catastrophic Misinterpretations and reduce the belief in them
Do Panic inductions and pts learn to control themselves with breathing technique so that they ahve control
Use Rational and Emotional role plays