DSM Anxiety Part 2 (Panic Disorder, Panic Attack Specifiers, Agoraphobia, GAD, Sub/Med, Other)

Question 1

how many symptoms are there for panic attack

Answer 1

13

Question 2

what are the possible symptoms of a panic attack

Answer 2

1. palpitations, pouding heart, accelerated HR
2. sweating
3. trembling or shaking
4. sensations of SOB or smothering
5. feelings of choking
6. chest pain or discomfort
7. nausea or abdominal distress
8. feeling dizzy, unsteady, lightheaded or faint
9. chills or heat sensations
10. parethesias (numbness/tingling)
11. derealization (feelings of unreality) or depersonalization (being detached from oneself)
12. fear of losing control or “going crazy”
13. fear of dying

Question 3

how many symptoms of the 13 for panic attack must you have to meet criteria A for panic disorder

Answer 3

4

Question 4

what is a panic attack

Answer 4

abrupt surge of intense FEAR or intense DISCOMFORT that reaches a peak within minutes, and during which you have the required symptoms

Question 5

what is criterion A for panic disorder

Answer 5

recurrent UNexpected panic attacks

(that meet criteria with 4/13 symptoms)

Question 6

criterion B for panic disorder

Answer 6

at least one of the panic attacks has been followed by ONE MONTH or more of one or both of the following:

1. persistent concern or worry about additional panic attacks or their consequences (i.e losing control, going crazy, having a heart attack)
2. a significant maladaptive change in behaviour related to the attacks (i.e behaviours designed to avoid panic attacks, such as avoidance of exercise or unfamiliar situations)

Question 7

criteria C and D for panic disorder

Answer 7

not attributable to med or substance, to another med condition or to another mental disorder

Question 8

what is the 12 month prevalence of panic disorder

Answer 8

2-3% in adults and teens

Question 9

what populations have higher rates of panic disorder

Answer 9

non-latino whites and american indians (in usa)

Question 10

what is the gender difference in panic disorder

Answer 10

female:male 2:1

gender difference is already observable before age 14 years

Question 11

can panic disorder occur in children

Answer 11

panic attacks occur in children but overall prevalence of panic disorder is low before age 14

Question 12

what is the median age at onset for panic disorder

Answer 12

20-24

Question 13

what is the usual course of panic disorder if untreated

Answer 13

chronic, but waxing and waning

some people have episodic outbreaks with years of remission in between and others may have continuous severe symptomatology

Question 14

name two temperamental risk factors for panic attacks

Answer 14

negative affectivity and anxiety sensitivity (disposition to believing that symptoms of anxiety are harmful)

Question 15

what early childhood adverse experiences may precipitate panic disorder

Answer 15

reports of sexual and physical abuse in childhood more common in panic disorder than in other anxiety disorders

Question 16

list environmental risk factors for panic disorder

Answer 16

childhood physical/sexual abuse

smoking

identifiable stressors in months prior to first panic attack

Question 17

what medical condition is associated with panic disorder

Answer 17

respiratory disturbance such as asthma

Question 18

there is an association between panic disorder and what gene

Answer 18

COMT gene–> in FEMALES only

Question 19

list some agents than can provoke panic attacks in individuals with panic disorder (at greater rates than in general pop)

Answer 19

sodium lactate

caffeine

isoproterenol

yohimbine

CO2

cholecystokinin

Question 20

how do panic attacks affect suicide risk

Answer 20

panic disorder and panic attacks increase risk of suicide even when other risk factors are controlled for

Question 21

ddx panic disorder

Answer 21

other specified anxiety disorder or unspecified anxiety disorder

anxiety due to another medical condition

sub/med induced anxiety disorder

other mental disorders with panic attacks as an assoc. feature

Question 22

list medical conditions that can cause panic attacks

Answer 22

hyperthyroidism

hyperparathyroidism

pherchromocytoma

vestibular dysfunctions

seizure disorders

cardiopulmonary conditions like arrhythmias, SVTs, COPD

Question 23

what is the usual amount of time to peak intensity of symptoms in panic attacks

Answer 23

withi minutes

Question 24

what is the 12 month prevalence of panic attacks in the USA

Answer 24

11.2%

Question 25

are panic attacks common in kids?

Answer 25

not before puberty but then increases

Question 26

how many "agoraphobia situations" are there

Answer 26

5

Question 27

how many situations must someone fear to meet criterion A for agoraphobia

Answer 27

2/5

Question 28

list the 5 "agoraphobia situations" listed in criterion A for agoraphobia

Answer 28

1. using public transportation 2. being in open spaces 3. being in enclosed spaces 4. standing in line or being in a crowd 5. being outside of the home alone

Question 29

what is criterion A for agoraphobia

Answer 29

marked fear or anxiety about 2+ of the 5 situations

Question 30

criterion B agoraphobia

Answer 30

individual fears or avoids these situations because of thoughts that ESCAPE might be difficult or fears help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms

Question 31

criterion C agoraphobia

Answer 31

the agoraphobic situations almost always provoke fear or anxiety

Question 32

criterion D agoraphobia

Answer 32

the agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety

Question 33

criterion E agoraphobia

Answer 33

fear/anxiety is out of proportion to actual danger

Question 34

criterion F agoraphobia

Answer 34

persistent--6+ months

Question 35

criteria G-I agoraphobia

Answer 35

clinically significant distress/impairment if another medical condition is present, the fear/anxiety or avoidance is clearly excessive not better explained by another mental disorder

Question 36

what are considered "panic like symptoms" in agoraphobia

Answer 36

any of the 13 symptoms of panic attacks

Question 37

what are considered "other incapacitating or embarrassing symptoms" in agoraphobia

Answer 37

vomiting or IBS symptoms fear of falling sense of disorientation or getting lost (esp. in kids)

Question 37

what are considered "other incapacitating or embarrassing symptoms" in agoraphobia

Answer 37

vomiting or IBS symptoms fear of falling sense of disorientation or getting lost (esp. in kids)

Question 38

what is the prevalence of agoraphobia

Answer 38

1.7% of teens and adults

Question 39

what is the gender disparity in agoraphobia

Answer 39

females 2x as likely to have agoraphobia compared to men

Question 40

when does incidence of agoraphobia peak

Answer 40

late adolescence and early adulthood in 2/3 of people onset is before age 35; second high incidence risk phase after age 40 mean age at onset is 17 years for agoraphobia (25-29 if no preceding panic attacks/disorder)

Question 41

what % of people report panic attacks or panic disorder preceding onset of agoraphobia

Answer 41

community--30% clinical--50%

Question 42

what is the typical course of agoraphobia

Answer 42

typically PERSISTENT and CHRONIC complete remission is rare unless agoraphobia is treated

Question 43

agoraphobia is associated as a risk factor for what other disorders

Answer 43

substantially elevated risk of secondary MDD, PDD and SUDs

Question 44

what is the heritability for agoraphobia

Answer 44

61% *of the various phobias, agoraphobia has the STRONGEST and MOST SPECIFIC association with the genetic factor that represents proneness to phobias

Question 45

what is a major determinant of degree of disability associated with agoraphobia

Answer 45

agoraphobia severity--> irrespective of the presence of comorbid panic disorder, attacks and other comorbid conditions

Question 46

what proportion of those with agoraphobia are completely homebound and unable to work

Answer 46

about 1/3

Question 47

ddx agoraphobia

Answer 47

*note that when criteria for agoraphobia and another disorder are both fully met, both diagnoses can be given (unless fear is entirely explained by the other disorder) specific phobia--situational type separation anxiety disorder social anxiety disorder panic disorder acute stress and PTSD MDD other medical conditions

Question 48

how do you distinguish agoraphobia from specific phobia--situational type

Answer 48

in agoraphobia there are MORE situations feared (2+) and the cognition is around fear of panic sx or other incapacitating symptoms/unable to escape in specific phobia, its just one situation and the cognitions are different i.e fear of plane crashing (cognitions usually around being harmed by the situation directly)

Question 49

what are the most frequent additional diagnoses in those with agoraphobia

Answer 49

anxiety disorders--often preceeds agoraphobia depressive disorders--typically secondary to agoraphobia PTSD AUD--typically secondary to agoraphobia

Question 50

criterion A for GAD

Answer 50

excessive anxiety and worry (apprehensive expectation), occurring more days than not for AT LEAST 6 MONTHS, about a NUMBER of events or activities (i.e work or school performance)

Question 51

criterion B for GAD

Answer 51

the individual finds it difficult to control the worry

Question 52

criterion C for GAD

Answer 52

the anxiety and worry are associated with THREE (or more) of the following SIX symptoms (with at least some of the symptoms having been present for more days than not for the past 6 months) 1. restlessness or feeling keyed up or on edge 2. being easily fatigued 3. difficulty concentrating or mind going blank 4. irritability 5. muscle tension 6. sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep)

Question 53

how many symptoms must you have to meet criteria for GAD

Answer 53

3/6

Question 54

criteria D-F GAD

Answer 54

clinically significant distress/impairment not attributable to physiological effects of med/substance not better explained by another mental disorder

Question 55

what types of things do people with GAD worry about

Answer 55

everyday, routine life circumstances i.e possible job responsibilities, health and finances, health of family members etc

Question 56

what is the 12 month prevalence of GAD in teens and adults

Answer 56

0.9% in teens 2.9% in adults in the general community in the usa

Question 57

how many criteria are required for diagnosis of GAD in kids (i.e out of the 6 symptoms in addition to worry)

Answer 57

1

Question 58

what is the gender disparity in GAD

Answer 58

females 2x more likely to have than males

Question 59

when does the prevalence of GAD peak

Answer 59

in middle age declines across later years of lfie

Question 60

what population is more likely to experience GAD

Answer 60

those of European descent

Question 61

what is the lifetime morbid risk of GAD

Answer 61

9%

Question 62

what is the median age at onset for GAD

Answer 62

30--but broad range

Question 63

what is the usual course of GAD

Answer 63

chronic wax and wane across the lifespan fluctuates between syndromal and subsyndromal level rates of full remission are very low

Question 64

list 3 temperamental risk factors for GAD

Answer 64

behavioural inhibition negative affectivity harm avoidance

Question 65

what proportion of the risk of having GAD is genetic

Answer 65

about 33%

Question 66

ddx GAD

Answer 66

anxiety due to another medical condition sub/med induced anxiety disorder social anxiety disorder OCD PTSD and adjustment disorders depressive, bipolar, adjustment disorders

Question 67

what are the criteria for substance/medication induced anxiety disorder

Answer 67

basically same as sub/med induced mood disorder--> anxiety/panic attacks predominate in clinical picture, there is evidence that symptoms started during intox or withdrawal or after exposure to a med, and its not better explained by another anxiety disorder not during only the course of a delirium causes clinical impairment/distress

Question 68

once substance or treatment is discontinued, how long does it usually take the symptoms of anxiety/panic to resolve in substance/medication induced anxiety disorder

Answer 68

within days to weeks to a month if lasting longer than a month from sub/med/withdrawal d/c, should consider other dx possibilities

Question 69

list classes of substances that can result in substance/medication induced anxiety disorder due to intoxication

Answer 69

alcohol caffeine cannabis phencyclidine other hallucinogens inhalants stimulants other

Question 70

what classes of medications can cause panic/anxiety in withdrawal states

Answer 70

alcohol opioids sedatives hypnotics anxiolytics stimulants

Question 71

what classes of drugs can invoke panic/anxiety symptoms

Answer 71

anesthetics and analgesics sympathomimetics or other bronchodilators anticholinergics insulin thyroid preparations oral contraceptives antihistamines antiparkinsonian agents corticosteroids antihypertensives cardiovascular meds anticonvulsants lithium antipsychotics meds antidepressant meds *heavy metals and toxins can also do this

Question 72

ddx substance/medication induced anxiety disorder

Answer 72

substance intox or withdrawal anxiety disorder delirium anxiety disorder due to another medical condition

Question 73

what are the criteria for anxiety disorder due to another medical condition

Answer 73

"Panic attacks or anxiety is predominant in the clinical picture. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition. The disturbance is not better explained by another mental disorder. The disturbance does not occur exclusively during the course of a delirium. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning."

Question 74

list diseases known to cause anxiety and a symptomatic presentation

Answer 74

endocrine disease--> hyperthyroid, pheochromocytoma, hypoglycemia, hyperadrenocortisolism cardiovascular disease--> CHF, PE, arrhythmia respiratory illness--> COPD, asthma, pneumonia metabolic disturbance--> B12 deficiency, porphyria neuro illness--> neoplasms, vestibular dysfunction, encephalitis, seizure disorders

Question 75

ddx for anxiety disorder due to another medical condition

Answer 75

delirium mixed presentation of symptoms i.e mood and anxiety substance or med induced anxiety disorder primary anxiety disorder illness anxiety disorder adjustment disorders associated feature of another mental disorder (AN, schizophrenia)

Question 76

name two scales that can be used to assess anxiety

Answer 76

GAD-7 and Beck Anxiety Inventory (BAI)

Question 77

what brain structures are thought to be implicated in the worry in anxiety disorders

Answer 77

the cortico-striatal-thalamic-cortical (CSTC) loop (also for obsessions in OCD)

Question 78

if anxiety is due to a fear of panicking, dying or losing control, what disorder should you think of?

Answer 78

panic disorder

Question 79

if anxiety is due to worry about being trapped or unable to escape, what disorder should you think of?

Answer 79

agoraphobia

Question 80

if anxiety is due to being embarrassed in front of, or judged by others, what disorder should you think of?

Answer 80

social anxiety

Question 81

if anxiety is due to constant, pervasive worries and they cant stop worrying, what disorder should you think of?

Answer 81

GAD