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Flashcards in Anxiety disorders Deck (36):
1

Anxiety disorder impact

considerable suffering/impaired functioning
Prevalence: among the most common psychiatric disorders
1 year prevalence: 12-17%
leading cause for seeking mental health services

2

Normal/clinical anxiety

anticipation of future threat
characterized by:
- muscle tension
- vigilance in preparation for danger
- cautious or avoidant behaviours

3

Normal/clinical fear

Emotional response to real or perceived therat
characterized by:
- surges of autonomic arousal
- thoughts of immediate danger
- escape behaviours

4

Clinical fear and anxiety

excessive in relation to degree of threat
persistent
significant distress/impairment in social and occupational functioning

5

Features of anxiety/related disorders

Unwanted emotions: panic attacks, chronic hyperarousal, excessive fear

Unwanted thoughts: obsession, excessive worries, intrusive recollections

Unwanted actions: avoidance, escape, distraction, compulsions

Fear of consequences and maladaptive behaviours

6

Major DSM-5 anxiety disorders and related disorders

Panic disorder
Agoraphobia
Specific phobia
Social anxiety disorder
GAD
PTSD
OCD

7

Panic attacks

occurs in all anxiety disorders
discrete period of intense fear or discomfort
abrupt onset
peaks w/in 10 minutes
peak intensity lasts an average of 20 minutes
can occur during waking hours/during sleep
>=4 symptoms required to define a panic attack
attacks with fewer than four symptoms = limited symptom panic attacks

8

Panic attack symptoms

Need four or more, otherwise a "limited symptom" panic attack
Palpitations
trembling/shaking
choking sensations
nausea/GI distress
chills/hot flushes
derealization/depersonalization
fear of dying
sweating
dyspnea
chest pain or discomfort
paresthesias (numbness, tingling)
dizziness/faintness
fear of losing control/going crazy

9

Unexpected/spontaneous panic

characteristic of panic disorder

10

Expected panic attacks

triggered by a phobic stimulus

11

Cognitive model of panic attacks

Trigger --> perceived threat --> apprehension --> body sensations --> interpretation of sensations as catastrophic --> threat, etc.

12

Panic disorder

Recurrent, unexpected panic attacks
A month or more of:
- persistent concern about further attacks
- worry about implications
- significant change in behaviour

13

Agoraphobia

typically a result of panic disorder
Fear of situations in which escape might be difficult or embarrassing if panic-like symptoms occur
feared situations are avoided/endured with dread

14

Situations commonly feared/avoided in agoraphobia

Travelling
being far from home
enclosed spaces
wide open spaces
supermarket line-ups
high places
being alone

15

Specific phobia

severe, excessive, persistent fear
exposure evokes fear/panic
avoidance
recognizes fear is unreasonable
Not panic disorder
Subtypes:
animal, natural environment stimuli, situations, blood-injection-injury, others

16

Specific phobia of dentistry

80% adults apprehensive, 20-30% only visit when in pain
5% visit only in extreme circumstances
Commonly due to traumatic childhood experiences
50% have blood-injury injection phobia

Tx: BDZ prior to visit, but will relapse; CBT with lasting benefits

17

Social anxiety disorder

Severe, excessive, and persistent fear of:
- social intreactions
- social performance situations
exposure to phobia evokes fear/panic
extreme fear of negative evaluation
person typically avoids
recognizes fear is unreasonable

18

Generalized anxiety disorder

excessive anxiety and worry
difficulty controlling worry
thinks worrying is proactive
associated symptoms: restless, tension, feeling "on edge", concentration difficulties, irritability, insomnia
lasts at least 6 months

19

OCD

either obsessions or compulsions
rule-forming
Obsessions: recurrent, persistent thoughts, impulses, or images
- intrusive, unwanted
- not simply excessive worries

Compulsions:
- repetitive behaviours/mental acts
- aimed at reducing distress or preventing harm

20

PTSD

exposure to a traumatic event
4 groups of symptoms:
1) re-experiencing
2) avoidance
3) negative changes in mood/cognition
4) hyperarousal

> 1 month

21

Trauma exposure and PTSD

PTSD is comparatively rare to trauma!
most people are resilient

22

Trends of anxiety disorders

most: F:M gender ratio range from 2-3:1
OCD: gender ratio 1:1 but earlier onset in males
age of onset:
- varies with disorder
- varies with exposure to stressors
- most arise in adolescence
- phobias often arise in childhood

23

Conditioned fear reactions

Classical conditioning
Operant conditioning (avoidance learning)
Role in PTSD, phobias)

24

Maladaptive fears

prominence role in panic disorder and social anxiety disorder
appear to play a role in other anxiety disorders

25

Genetics factors - anxiety disorder

No big genes associated with anxiety disorders
Polymorphisms?
Suggestive evidence of the role of genes involved in NT function and neuronal development

26

Environmental factors - anxiety disorder

Family environment not as important as previously thought, although likely plays some role
extreme family family environments are likely to contribute to risk of developing anxiety disorders
Expressed emotion of family membranes can exacerbate/perpetuate anxiety disorders
environmental experiences outside of family are important: fear conditioning experiences

27

Neuroanatomy implicated in anxiety disorders

Amygdala
HPA axis
prefrontal cortex
hippocampus
frontal-striatal circuits (OCD)

28

Circuit implicated in anxiety

Sensory thalamus
Amygdala
Cortex
Hippocampus
HPA axis
all interplay (amygdala/cortex in the middle)

29

Frontal-striatal circuits implicated in OCD

Thalamus:
Putamen - anterolateral OFC (motor control, response inhibition)
Dorsal caudate - dorsolateral PFC (working memory, executive function) - ACC/ventromedial PFC 9error monitoring, doubting) - nucleus accumbens

30

Neurotransmitter systems implicated in anxiety disorders

GABA
Glutamate
Serotonin
Noradrenaline
Dopamine

31

Cognitive factors in anxiety disorders

Dysfunctional beliefs
Selective attention to threat
Misinterpretation of threat

32

Anxiety sensitivity

fear of arousal-related body sensations (fear of fear)
Arises from beliefs about consequences of sensations
- somatic: discomfort vs death
- cognitive: mild vs permanent mental incapacitation
- social: none vs social ostracism/ridicule

33

Anxiety treatment

1) CBT (exposure therapy, cognitive restructuring), SRI (fluoxetine, sertraline, paroxetine, clomipramine)

34

Norepinephrine production metabolism

Tyrosine --> L-DOPA --> Dopamine --> DA --> Norepinephrine

35

Circuits involed in anxiety disorders

Amygdala centered circuit
Cortico-striato-thalamic circuit

36

Neurochemistry of anxiety

GABA is the key NT
Benzodiazepine: enhances GABA activity in limbic/cortical circuits
Increased NE: symptoms of anxiety
increased 5HT turnover in limbic regions in acute stress
Less evidence for changes in HPA axis