Anxiety Disorders

Question 1

Fear vs Anxiety

Answer 1

Different things:

• Fear
  
  • present/oriented mood/emotional state
  • immediate response to danger or threat
    
    • fight/flight/freeze
    • abrupt sympathetic nervous system activation
  • Drives avoidance/escape behaviors
• Anxiety:
  
  • Future-oriented mood
  • Somatic levels of tension and lower-level SNS activation
  • Drives avoidance/escape behaviors, BUT also worry about future danger/misfortune

Question 2

Responses to threat:

Answer 2

Multisystem

• Somatic
• Emotional
• Cognitive
• Bahavioral

Question 3

Freeze Response

Answer 3

• When Fight or flight won’t work
• Adaptive
• normal physiological response
• Assault

Question 4

Anxiety Disorders: Prevalence

Answer 4

• Specific phobias
  
  • 12 month prevalence: 7-9%
• Agoraphobia
  
  • 12 month prevalence: 1.7%
  • females twice as likely
• Social Anxiety Disorder
  
  • 12 month prevalence: 7%
• Panic Disorder
  
  • 12 month prevalence: 2-3%
  • lower for asian, african american and latin america countries: 0.1%-0.8%
• Generalized Anxiety Disorder
  
  • 12 month prevalence:
    
    • 0.9%: adolscence
    • 2.9% adults
• Seperation Anxiety Disorders
  
  • 12 month prevalence
    
    • 0.9-1.9%

Question 5

Specific Phobias

Answer 5

• Unreasonable or irrational fear of specific object or situation
• Consistent
• Prevalent
• Avoided or endured with difficulty
• Categories according to DSM-5
  
  • Animal type
  • natural enviroment type
  • Situational type
  • Blood-injection injury type
    
    • ​Will see as a dentist: scared of needle

Question 6

Dental Phobia

Answer 6

• Type of specific phobia
• 70% of dental patients report some dental anxiety, only 10-20% report extreme dental phobia
  
  • vary by type of procedure
• Medication effective in short term
• Psychological treatments in long term anxiety and avoidance reduction
• Endo and Perio treatment patients report more anxiety than restorative or prohphylactic

Question 7

Panic Attack

Answer 7

Short & intense period

• experience many symptoms of anxiety

Question 8

Panic Disorder

Answer 8

• Panic Attack
  
  • Short and intense
  • many symptoms of anxiety
• Begin to worry about attack so avoid triggers
• 28% of adults experience occasional panic attacks
  
  • only 3-5% develop panic disorder

Question 9

Agoraphobia

Answer 9

• accompany panic disorder
  
  • 50% have history of panic attacks or another anxiety disorder
• People fear:
  
  • places where they might have trouble escaping or getting help if they become anxious
  • that they will embarras themselves if others notice their symptoms or effort to escape
• Evident on bus, train, plane, boat, crowded places, being alone
• Extreme cases
  
  • do not leave their home alone

Question 10

What is the key feature of Generalized Anxiety Disorder?

Answer 10

Worry

• not just anxiety

Question 11

Generalized Anxiety Disorder

Answer 11

• Worry=key feature
  
  • not just anxious all the time
• Frequent and difficult to control worry about a number of events or activities
• Trouble concentrating, irritability, restlessness, muscle tension

Question 12

Social Anxiety Disorder

Answer 12

• Become anxious in social situations
  
  • afraid of being rejected, judged, or humiliated in public
  • focus on avoiding these events
• Persistent
• Out of proportion to actual threat
• more common in women
• Develops in early preschool years or adolescence

Question 13

Factors influencing anxiety disorders

Answer 13

• Biological Factors:
  
  • Anxiety response=in our physiology and heritable
  • Impaired inhibition of sub-cortical brain structures by prefrontal cortex
  • Low GABA systems activity
• Psychological factors
  
  • early learning of how to cope with fear/anxiety
  • learn to associate danger (fear) with enviromental stimuli very readily
  • Avoidance/Escape feels good
  • Worry/anxiety serve a prep funciton
    
    • ineffective when taken to extreme

Question 14

Treatments of Anxiety Disorders

Answer 14

• Pharmacological Treatment:
  
  • SSRIs
  • Beta-blockers
  • Benzodiazepines
    
    • benzos are a form of avoidance
    • don’t result in long-term gains
• Psychological treatments
  
  • vary
  • all involve exposure training
  • most involve relaxation and coping skills
  • very effective in the long term
  • exposure overwrites the fear learning with new learning

Question 15

Implications for dental care and management

Answer 15

• They aren’t less likely to be adherent at home
  
  • helps them to avoid dental visits
• LIkely to exhibits symptoms of anxiety in the office
  
  • tension in face or body
• Give them some control

Question 16

Obsessive-compulsive and related disorders: Prevalence

Answer 16

• Split into a seperate section in the DSM5
  
  • used to be classified as anxiety disorders
• Obsessive-compulsive disorder (OCD)
  
  • 12 month prevalence: 1.2%
• Body dysmorphic disorder
  
  • 12 moth prevalence: 2.4%
• Hoarding Disorder
  
  • 12 month prevalence: 2-6%
• Trichotillomania (hair-pulling disorder)
  
  • 12 month prevalence:1-2%
• Excoriation (Skin-picking) disorder
  
  • lifetime prevalence: 1.4%

Question 17

Obsessions vs Compulsions

Answer 17

• Obsessions:
  
  • thoughts, images, ideas, or impulases that are persistent
    
    • uncontrolled
    • intrude upon consciousness
    • cause significant anxiety or distress
• Compulsions:
  
  • repetitive behavior or mental acts
  • rules rigidly applied
  • performed in order to reduce anxiety or stress
• Time consuming and/or cause distress or impairment

Question 18

OCD

Answer 18

• common type of obsession in OCD
  
  • thoughts and images associated with aggression,sexuality, and/or religion
  • symmetry and ordering
  • contamination and a cleaning compulsion
  • checking
• “magical thinking
  
  • feel that there is a cause-effect relationship
  • varying levels of insity
    
    • “but what if”

Question 19

other disorders related to obsessions and compulsions

Answer 19

• hair-pulling disorder (Trichotillomania)
  
  • recurrent pulling hair out
  • noticeable hair loss
• Excoriation disorder
  
  • recurrent picking scabs or places on skin
  • create significant lesions that often become infected and cause scars
• Both can involve tension and subsequent relief after engaging in behavior, but othen the beavhior is automatic
• Body Dysmorphic disorder
  
  • sees certain body part as defective or flawed
  • repetitive behavior or mental acts to flaw
    
    • comparison
    • checking
    • picking
  • muscle dysmorphia specifier

Question 20

Treatment for OCD and related disorders

Answer 20

• SSRIs
  
  • selective serotonin reuptake inhibitors
  • 50-80% respond, reducing obsessions and compulsions by 30-40%
  • side effects:
    
    • drowsiness
    • constipation
    • loss of sexual interest
• Cognitive behavioral treatments
  
  • exposure with response prevention
    
    • exposure to stimuli that elicit obsessions, then prevent engagement in compulsions
    • for OCD, effective in 60-90% of patients for up to 6 years
    • effective, but less research on the other OCD-related disorders