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Flashcards in Anxiety Disorders Deck (10):
1

Types of Anxiety

panic anxiety '
generalized anxiety
conditioned anxiety
anticipatory anxiety
social anxiety
situational anxiety

2

DSM-IV Anxiety Disorders

Panic Disorder
Generalized Anxiety Disorder
Social Phobia
Obsessive Compulsive Disorder
Post-Traumatic Stress Disorder
Simple Phobia
Agoraphobia without Panic

3

Biological Theories of Anxiety

Sympathetic system
- Simple autonomic dysregulation unlikely
- Locus coeruleus
-Dysregulated noradrenergic function
GABA-benzodiazepine system
-Decreased BZD receptor binding in hippocampus in panic patients
-Decreased BZD receptor binding in prefrontal cortex during panic attack Neurocircuitry of Fear
-Integrates neurochemical, imaging, and treatment findings
Fear Generation – Amygdalocortical interactions
Fear Extinction – Orbitofrontal Cortex & Prefrontal Cortex

4

Styles of Clinical Presentation of
Depression and Anxiety in Primary Care

Psychologizer

“Doctor – I’ve been really anxious lately.” Initial Somatizer

“Doctor – I’ve been really tense and fatigued lately. Could it be anxiety?” Facultative Somatizer

“Doctor – I’ve been really tense and fatigued lately.”

“Have you been feeling anxious?” Persistent Somatizer

“Doctor – I’ve been really tense and fatigued lately.”

“Have you been feeling anxious?”

“No! I’ve just been tense and fatigued!”

5

Panic Disorder

Sudden overwhelming episodes of anxiety that include both somatic and psychic elements - along with worry about either the implication of the attack or about having future attacks
Can occur with or without agoraphobia
Lifetime prevalence = 1.5% - 3.5%
Female:Male = 2:1
Age of Onset = typically early adulthood

6

Symptoms of Panic Attack

Palpitations, pounding heart, or tachycardia shortness of breath or sensation of smothering
sweating
trembling or shaking
feeling of choking
chest pain or discomfort nausea or abdominal distress
dizziness, feeling faint
paresthesias chills or hot flushes
derealization or depersonalization fear of losing control or going crazy
fear of dying

7

Differential Diagnosis of Panic

Hyper/hypothyroidism Hyperparathyroidism Mitral valve prolapse Cardiac arrhythmias
Coronary insufficiency
Pheochromocytoma Hypoglycemia True vertigo
Drug/Alcohol withdrawal
Cannabis intoxication

8

Panic Disorder rx

Pharmacologic treatment
Benzodiazepines
Tricyclic antidepressants
Monoamine oxidase inhibitors
Serotonin specific reuptake inhibitors
Serotonin Norepinephrine reuptake inhibitors
Non-pharmacologic treatment
Cognitive behavioral therapy (Panic Reduction Therapy)

9

Generalized Anxiety Disorder epi

Excessive worry and more generalized somatic symptoms of anxiety (Worry, Anxiety, Tension)
Approximately 75-90% comorbid with other psychiatric disorders (most commonly depression)
Chronic condition with estimated lifetime
prevalence = 5.1%
Female:Male = 2:1

10

Generalized Anxiety Disorder rx

Pharmacologic Treatment
 Benzodiazepines
 Buspirone
 TCAs
 MAOIs
 SNRIs
 SSRIs
Non-pharmacologic Treatment
 Cognitive behavioral therapy