Lecture 13-Anxiety 1 Flashcards Preview

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Flashcards in Lecture 13-Anxiety 1 Deck (26):
1

Name the physical manifestations of anxiety

Sympathetic NS: diaphoresis, mydriasis, tachycardia, tremor

Hyperventilation → dizziness and syncope, parasthesia

2

Name the psychological manifestations of anxiety

Restlessness, Irritability, Trouble concentrating, worry

3

Norepi & _____ = anxiety

cortisol

4

Anxiety symptoms must be present for _____ months

≥6

5

Traumatic events or extreme stressors (PTSD, Panic attack) may help _____ the anxiety disorder

create

6

Can anxiety be learned?

YES (GAD)

7

Gender bias in anxiety (disorder dependent) in that women ______ men are affected (Except OCD men _____ women)

>; =

8

In anxiety:

____ Serotonin(5-HT) and ____ GABA activity

____ NorEpi and ____ Glutamate activity

↓,↓; ↑, ↑

Norepi & glutamate increased activity; and serotonin and GABA are decreased in anxiety

9

A 35 year old female comes to your office asking for help. She claims that she and her husband have been arguing a lot more lately. She says he can’t take her constant worrying. She worries about his job and whether he is making enough money, if the mail will be delivered on time, and about how well she is raising her kids in such a sad and cruel world. She says she has worried about things as long as she can remember. She doesn’t like that she doesn’t sleeps well at night. What is her most likely diagnosis?

Panic disorder
Generalized Anxiety Disorder
Acute Stress Disorder
Obsessive Disorder

Generalized Anxiety Disorder

10

General anxiety disorder:

Excessive anxiety/worry, occurring more days than not for ≥ ____ months, about ≥ ____ event/activity

Associated with ≥ ____ of the following symptoms:
Restlessness
Easily fatigued
Difficulty concentrating
Irritability
Muscle tension
Sleep disturbance

6; 1; 3

11

People with anxiety self medicate with what?

alcohol--increases GABA tone

12

Axiety prognosis?

Without treatment tends to worsen over time. (especially during stressful times)

13

What type of cognitive therapy do you give for anxiety?

CBT

14

What type of medical therapy do you give for anxiety?

SSRI or SNRI--Increases SR or NE or both, downregulates or desensitizes receptors (increases in NE desensitizes receptors)

Buspirone (a 5HT1a receptor agonist)--Initially lowers SR activity as these autoreceptors are stimulates but eventually renders them inactive allowing increases in SR output

Benzodiazepines: (GABA-A receptor positive allosteric modulator allows more Cl- channels to open

Beta Blockers. For symptomatic relief of performance anxiety, not GAD!!!

15

A 35 year old, Caucasian female, presents to your office with complaints of heart palpitations starting a year ago. She doesn’t consider herself a person that worries too much. They are not constant and she hasn’t noticed that they are related to any particular event. She also reports diaphoresis along with the palpitations. She denies any headache, vision change, nausea, vomiting, radiating chest pain, or change in her bowel habits. She denies any past traumatic events.. Her physical exam is normal. What is her diagnosis?

General Anxiety Disorder
Atrial fibrillation
Panic Disorder
Social Anxiety
Hyperthyroidism

Panic Disorder

16

What is a panic attack?

An abrupt surge of intense fear or discomfort, peaks within minutes, that is unexpected with ≥ 4 of the following:

Palpitations, pounding heart, or accelerated heart rate
Sweating
Shaking/trembling
Sensation of shortness of breath or smothering
Choking feeling
Chest pain/discomfort
Nausea
Dizziness, lightheadedness or fainting
Chills or heat
Paresthesias
Derealization (slow motion)
Fear of Losing of control
Fear of dying

17

In panic disorder there are

Recurrent unexpected panic attacks
≥ __ attack followed by ≥ __ month of ≥ __ of the following:

Concern about _____ panic attacks or consequences

Significant ______ change in behavior related to attacks (stay away from locations where one has had a panic attack)

1; 1; 1;

additional; maladaptive

18

What is agoraphobia?

Agoraphobia (panic disorder)
Fear/Anxiety about ≥ 2 of the following situation:

Using public transportation
Being in open spaces
Being in enclosed spaces
Standing in line or in a crowd
Being outside the home alone

Fear of not being able to escape situation
Situation almost always produces fear/anxiety
Avoids situations
Fear/anxiety out of proportion to actual danger
≥ 6 months

19

Psychotherapy for panic disorder?

Emergency treatment: fast-acting benzodiazepines (alprazolam)

Long Term 1st line: SSRI/SNRI

Intermediate or long acting benzos (not 1st line 2nd to addiction potential…)

20

A 29 year old asks that you help her with her problems and reveals that for the past 7 months she has had to push her self to go work. During her last office presentation, she stumbled and fell off stage. Since then she has worried that something will happen during her next presentation, which is in 2 weeks. She can’t concentrate on anything as she is consumed with her fear of being embarrassed in front of her coworkers again. She now takes the service elevator and leaves work early to avoid seeing her coworkers. She has no other areas in her social life where she is not doing well and actually did a successful presentation at a parent teacher organization meeting yesterday. What is the most likely diagnoses?

Panic disorder
Social Anxiety
Performance Anxiety
Generalized Anxiety
PTSD

Performance Anxiety

21

What is a specific phobia?

Specific phobia
Diagnostic criteria (DSM-V):

≥ 6 months

Causes significant impairment

Marked fear/anxiety about a specific object/situation

Object/situation almost always provokes fear/anxiety

Actively avoids object/situation

Fear/anxiety out of proportion to actual danger

No other explanation for symptoms

22

What is social anxiety disorder?

≥ 6 months

Causes significant impairment

Marked fear/anxiety when exposed to social situation with possible scrutiny by others

Fear of acting in ways that will be negatively scrutinized

Social situation provokes fear

Avoids social situations

Fear/anxiety out of proportion to actual threat

No other explanation for symptoms

23

What is performance anxiety?

Performance anxiety only – Fear is restricted to public speaking or performing and does not generalize to other social aspects of life

24

What type of therapy do we do for specific phobia?

Therapy (1st line): Flooding, systemic desensitization (CBT)

25

What do we give for performance anxiety?

Beta Blockers (propranolol) – 1st line for performance only variant

26

What do we give for Social Anxiety Disorder?

SSRI/ SNRI

sometimes we give MAOI's