Anxiety Disorders Flashcards
(56 cards)
Define fear
Emotional response to real or perceived imminent threat
Define anxiety
Anticipation of a future threat
What is most a/w ANS arousal - fear or anxiety?
Fear
What is anxiety most associated with in relation to body response?
Hyper-vigilance and muscle tension in preparation for future danger
How do anxiety disorders differ from general fear/anxiety?
Anxiety disorders are excessive or persist beyond developmentally appropriate periods (a 4 yr old being scared of monster in the closet is appropriate vs. a 51 yr old)
Who is MC affected by generalized anxiety disorder (GAD)?
- Females 2:1
- Diagnosis peaks in middle age (decreases in later years)
Etiology of GAD
- Learned
- Cognitive theory (anxiety results from incorrect views of oneself, the environment, future)
- Neurobiology (abnormal functioning of serotonin and cortisol, increased NE)
Proposed neurobiological model of GAD?
- Hyperactive amygdala results in hyperactive ANS activity and cortisol secretion
- Chronically increased cortisol results in increased serotonin uptake and other changes
Clinical presentation of GAD
- Excessive and persistent worrying
- Hyperarousal, muscle tension
- HAs, neck/shoulder pain w/o specific cause
How to diagnose GAD?
- 3 or more symptoms (present on more days than not) for over 6 months
- GAD 7 scale (99% negative predictive value)
Treatment of GAD
Psychotherapy/CBT (along with some meds)
Pharm treatment of GAD
Use anxiolytics (short acting)
- BZD used with SSRI/SNRI
- Buspirone (no abuse potential, no cognitive impairments, takes longer than BZDs, may work better w/SSRI or SNRI)
- SSRIs and SNRIs
Define panic disorder
Recurrent unexpected panic attacks
Define panic attack
Abrupt surge of intense fear/discomfort that reaches a peak within minutes and 4 or more specific symptoms occurs
Types of panic attacks?
Expected and unexpected
Define unexpected panic attack
No obvious cue or trigger (when relaxing, waking up)
Define expected panic attack
Obvious cue or trigger at time of occurrence (spiders, public speaking)
DSM V panic disorder definition
BOTH 1 and 2
- Recurrent, unexpected panic attacks
- At least one panic episode has been followed by at least 1 month of: persistent worry about additional attacks or maladaptive behavior related to attack
* Also panic attacks are NOT related to substance abuse or other medical condition
Who is MC affected by panic disorder?
- Females 2:1
- Onset usually 15-35 yo
If person 40 or older presents with panic attacks, what should be considered?
Think depression or medical cause - onset of panic disorder is usually younger
Treatment of panic disorder
- Psychotherapy alone for mild disease
- Meds are started if functionally impaired
Pharm treatment of panic disorder
- SSRIs
- TCAs (many side effects though)
- MAOis (low tyramine diet to avoid HTN crisis)
- BZDs
Define agoraphobia
Fear and/or avoidance of places or situations where escape may be difficult or embarrassing or help may not be available
What often occurs concurrently with agoraphobia?
Panic disorder
