Flashcards in Psych - Anxiety Deck (17):
Difference Between FEAR and ANXIETY?
Fear is a response to a KNOWN, EXTERNAL, DEFINITE and NONCONFLICTUAL threat
ANXIETY is a response to a threat that is VAGUE, INTERNAL and either UNKNOWN or CONFLICTUAL
1) It is an EMOTIONAL STATE OF ANTICIPATORY FEAR --> has to be a stressful stimulus which is processed as eminent danger via sensory input -> amygdala --> hypothalamus; these symptoms are temporarily appropriate in proximity to the stressor and remit in LESS THAN TWO WEEKS
2) There is an action tendency/response that function to warn or prepare us; this adaptive response allows for an OPTIMAL LEVEL OF AROUSAL
Stimulus --> increased anxiety --> response --> decreased anxiety
Those with a DISORDER get stuck in a pattern of stimulus --> anxiety --> more anxiety --> more anxiety (no remedy to decrease the anxiety/no adequate anxiolytic response)
Occurs with an internal stimulus of anxiety and a corresponding compulsive pathologic response that does NOT DIMINISH the stressors
Emotional - anticipatory fear; anxiety is a FUTURE-ORIENTED fear - a fear of what MAY happen!
Cognitive - Worry; core fear is a lack of control over the outside world!
Action - constant readiness and vigilance --> this decreases the body's threshold for autonomic response by distracting the brain, which can also disrupt the normal function of sleep and appetite while promoting caution and inhibition
Epidemiology of Anxiety Disorders
1 in 4 adults meet the criteria for any anxiety disorder
Onset is usually before 35 y.o., duration may last a lifetime
Significant co-morbidities --> substance abuse, MDD, other anxiety disorders, mental illness
Occurs in WOMEN more than men (2 : 1)
Physical symptoms of anxiety disorders
Autonomic arousal -- include dizziness, lightheadedness, sweating, trembling, shaking, short of breath, smothering sensation, choking feeling, chest pain/discomfort, palpitations, diarrhea, nausea, urinary frequency, parenthesis, numbness and tingling in extremities, chills, hot flashes, sexual dysfunction!
Cognitive symptoms of anxiety disorders
Feeling of unease with the realization that something is wrong, derealization, depersonalization (detached from oneself), fear of losing control/going crazy, fear of dying, sense of shame that others will judge, etc
Maintenance of insight
Patients KNOW that their thoughts and actions are not rational and are out of proportion of what they should reasonably feel - this characteristic is what distinguishes them from psychosis
Abrupt onset of physical anxiety symptoms
Intense apprehension and feeling of impending doom
Fear of dying, going crazy, losing control
May be CUED or UNCUED
Duration is usually 10-30 minutes
May involve this RECURRENT TRIAD --> ACUTE PANIC ATTACK, ANTICIPATORY ANXIETY (what if it happens again!?!?!?!), and PHOBIC AVOIDANCE
These can lead to PANIC DISORDER!
Panic Attacks and the Amygdala
Surprisingly, panic attacks DO NOT ORIGINATE IN A FEAR RESPONSE -- animals without an amygdala still had panic attacks!
They are actually conducted by a SUFFOCATION RESPONSE mediated by the PERIAQUEDUCTAL GRAY tissue with a carbon dioxide alarm and pain sensation leading to the attack
As they occur, other parts of the brain - limbic system - are recruited to bring memory into the attacks
Characterized by panic attacks that occur and significantly impair function or cause distress
The panic attacks are usually UNCUED, have an abrupt onset, give intense fear or discomfort, and are associated with 4 or more of the physical symptoms
Recurrent triad (acute attack, anticipatory anxiety, phobic avoidance) associated with the disorder
Patients are inhibited to a point where it is truly upsetting and inhibits functioning
Can be WITH or WITHOUT AGORAPHOBIA (anxiety of being in places or situations where a panic attack may occur and thus avoiding these places)
Panic Disorder With and WIthout Agoraphobia
WITHOUT - recurrent, unexpected panic attacks with at least a month of persistent concern about additional attacks, and the attacks cannot be accounted for by another mental disorder, the effects of a substance, or a medical condition.
WITH - avoid situations in which they fear panic attacks, and if they must endure them they have significant distress or require a companion --> necessary to rule out SOCIAL phobia, SPECIFIC phobia, PTSD, separation anxiety disorder, and OCD
Strong, persistent fears of specific objects, situations, or experiences for reasons that are unclear to the patient, but they are aware the fear exists
SPECIFIC phobias -- involve an irrational fear of a specific object, activity, or situation with a conscious avoidance of it; there is an anticipatory anxiety when confronted by the stimulus and consequently avoidance behavior is developed, which can significantly impair social and/or occupational functioning; knows the fear is irrational; 10-11% lifetime prevalence
SOCIAL Phobias -- involve a persistent fear of social or performance situations (any situation in which the patient is exposed to unfamiliar people or scrutiny from others) --> patient is afraid of acting in an embarrassing or humiliating manner; knows it is unreasonable/excessive, yet they still very much avoid the situation or endure them with INTENSE anxiety or distress;
Social Phobia will occur earlier in children and must last FOR AT LEAST 6 MONTHS! In ADULTS it has to last for 2 months.
GENERALIZED ANXIETY DISORDER
Characterized by excessive anxiety and worry about a number of events and activities occurring more days than not for AT LEAST 6 MOTNHS
Patients cannot control their worry despite their desire to feel calm and in control
Must have 3 of the following --> restlessness, on edge, fatigue, poor concentration, irritability, mind going blank, muscle tension/headaches, sleep disturbances
NOT due to meds, other conditions, etc.
Obsessive Compulsive Disorder - Obsessions component
Disruptive condition characterized by obsessions and compulsions
The OBSESSIONS are defined by 4 criteria --> 1) recurrent and persistent thoughts/impulses/images that are experienced intrusively and inappropriately to cause anxiety/distress;
2) thoughts/impulses/images are not simply excessive worries about real life problems
3) patient's attempts to ignore or suppress the thoughts or to neutralize them with another thought or action
4) person recognizes that the thoughts are a product of his/her own mind
OCD - Compulsions component
Defined by 2 criteria
1) Repetitive behaviors or mental acts the patient feels driven to do following specific rules in response to the obsession
2) behaviors are aimed at preventing or decreasing the distresses or actually preventing the dreaded event or situation, but are not connected in a realistic way or are clearly excessive to remedy what they are OCD about
Treatment of Anxiety disorders
Psychotherapy + Pharmacologic Therapy are best
SSRI are FIRST LINE for MDD, GAD, PANIC DISORDER, PTSD, OCD and SOCIAL PHOBIA
Benzos --> potentiate GABA and cause a decrease in rate of neuronal and muscle cell firing, which decreases autonomic symptoms (good) and slows cognition (not so good) --> best in SHORT TERM due to buildup of tolerance and dependence
Short term use is indicated in panic disorders, phobias and an adjunct to GAD
Buspirone -- serotonin agonist and D2 mixed antagonist/agonist --> can be used as monotherapy, but is usually combined with SSRI; NO DEPENDENCE or WITHDRAWAL, short half life
Used in MDD with anxiety, GAD
NOT USED for panic disorder or PTSD