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28 Cards in this Set
- Front
- Back
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What is Anxiety?
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A normal, developmental response
-involves a person’s psychology, internal environment (physiology) and external environment (reality) Different forms -Fear, Anxiety, Pathological Anxiety, Panic and Phobia |
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Fear
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-A cognitive process that leads to the conclusion that there is a threatening stimulus; a clear and present danger in the outside environment
-Involves a pathway for activation of the adrenal cortex BEFORE threat is even identified -It is the appraisal of danger |
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Anxiety
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-Feeling of arousal we experience when we perceive either concrete or abstract danger
-This danger often exists in the form of a possible threat in the future -remember: ALL fear activates anxiety, but not all anxiety comes from identifiable fear (fear is normal, anxiety is pathological) -Anxiety as an adaptive response --Triggering vulnerability mode --Shifting strategy (“attention getter”) (first freeze, then flight, then fight) |
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Pathological Anxiety
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-“The fear of fear itself”
-recurrent and unexpected (Panic) -Specific, but viewed as excessive/unreasonable (Phobias) -interferes significantly with the person’s normal routine, occupational (academic) functioning, or social activities relationships (all anxiety disorders) |
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Panic
Phobia |
An intense, acute state of anxiety associated with other dramatic physiologic, motor, and cognitive symptoms
A specific object of fear “The main quality of a phobia is that it involves the appraisal of a high degree of risk in a situation that is relatively safe.” |
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How does pathology develop?
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Four prevalent theoretical and clinical orientations:
Biological Theory Behavioral Theory Cognitive Theory Psychodynamic Theory |
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Biological Theory
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-Central noradrenergic system
--Locus coeruleus is the major source of the brain’s adrenergic innervations --Stimulation of the LC generates panic -Limbic system --GABA neurons mediate general anxiety, worry, and vigilance -Serotonin systems (esp. raphe nuclei) --important modulators of the two systems outlined above |
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CBM
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Behavioral: Anxiety is mistakenly paired
-Classical Conditioning: Neutral stimuli paired with noxious responses -Stimulus Generalization Cognitive: Anxiety is “disordered thought” -catastrophic interpretations of events/symptoms -hypersensitive alarm system -impaired objectivity and “mislabeling” -loss of voluntary control -dichotomous thinking -fortune telling without evidence |
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Classical Conditioning Constructs
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Unconditioned Stimulus
-Stimulus which produces automatic response Conditioned Stimulus -Neutral, new stimulus that elicits same response (through pairing) as an Unconditioned Stimulus Important term: Generalization -Neutral stimuli similar to CS begin to elicit response, without effort or practice |
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Anxiety Disorders (DSM-IV)
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-9 + 3 = 12 total discrete diagnoses
-9: PASS GO, PA -Panic D/O with or without Agoraphobia -Agoraphobia without Panic D/O -Specific Phobia -Social Phobia -Generalized Anxiety Disorder -Obsessive Compulsive Disorder -Post Traumatic Stress Disorder -Acute Stress Disorder |
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3 ‘other’ diagnoses (NOT less important)
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Anxiety Disorder due to a General Medical Condition
Substance-Induced Anxiety Disorder Anxiety Disorder Not Otherwise Specified |
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Panic Disorder
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-“A discrete period in which there is the sudden onset of intense apprehension, fearfulness, or terror, often associated with feelings of impending doom. During these attacks, symptoms such as SOB, palpitations, CP, choking or smothering sensations, and fear of ‘going crazy’ or losing control are present.”
-Recurrent, unexpected attacks are required for diagnosis -Agoraphobia may or may not be present |
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Panic Disorder
-onset -course -prevalence |
Onset: Most frequently in the third decade of life within 6 months of a major stressful life event.
Course: Within 2 months of first attack, symptoms intensify and become more frequent. Usually symptoms are chronic and unremitting Prevalence: Studies vary, but lifetime prevalence likely 2% or more |
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Agoraphobia
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-Essentially a fear of situations in which one might feel trapped
-Most commonly develops in patients who are already experiencing panic attacks -Like panic disorder, usually chronic and unremitting |
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Social Phobia
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-Marked and persistent fear of social or performance situations in which embarrassment may occur
-Exposure to the situation almost invariably provokes an immediate anxiety response -Patient recognized fear is excessive or unreasonable -Most often, the situation is avoided, although it is sometimes endured with dread -“Unlike agoraphobics, social phobics fear scrutiny rather than the crowd itself.” |
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Social Phobia
-onset -course -prevalence |
Onset: Late childhood thru early adulthood
Course: Chronic; often with pervasively impaired functioning Prevalence: unclear, perhaps as high a 5% lifetime prevalence, with female preponderance |
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Specific (Simple) Phobia
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A persistent fear of a specified stimulus other than panic, entrapment, or social criticism
Snakes, needles, cats, coins, etc. Lifetime prevalence 10% |
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Generalized Anxiety Disorder
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-Characterized by excessive anxiety and worry, occurring frequently and chronically, about numerous events or activities
-The worry is difficult to control, and accompanied with some emotional or physical symptoms -The individual DOES NOT ALWAYS identify the worry as excessive, but DOES recognize subjective distress |
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Obsessive Compulsive Disorder
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-Obsessions are persistent ideas, thoughts, impulses, or images.
-Obsessions are experienced as intrusive and inappropriate and cause marked anxiety or distress. Attempts to resist them fail. -Compulsions are repetitive behaviors or mental acts, with a goal of preventing or reducing anxiety or distress (no pleasure). -Compulsions are either clearly excessive or not connected in a realistic way to what they are designed to neutralize or prevent |
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Post Traumatic Stress Disorder
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-Characteristic symptoms develop following exposure to an extreme traumatic stressor
-Response to stressor involves intense fear, helplessness or horror (passivity) -Symptoms include flashbacks, avoidance of associated stimuli, emotional numbing, and exaggerated startle response -Lifetime prevalence likely 10% |
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Anxiety Disorder due to a General Medical Condition
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-A variety of medical conditions may cause anxiety symptoms
-Usually endocrine, cardiovascular, respiratory, metabolic, or neurological -Some medical work up is indicated in the assessment of every patient with new-onset anxiety |
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Substance-Induced Anxiety Disorder
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-Anxiety symptoms are judged to be due to the direct physiological effects of a substance (intoxication OR withdraw)
-Not just alcohol and “street drugs” (think about medications, toxin exposures, caffeine, etc.) -Considering substance-induced anxiety is necessary in the assessment of every patient with new-onset anxiety |
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Treatment of Anxiety D/O
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Three main approaches:
1. Pharmacotherapy 2. Psychotherapy 3. Behavioral therapy |
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Pharmacotherapy
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-Mainstay of psychopharmacology in treatment of anxiety disorders is the SSRI’s (selective serotonin reuptake inhibitors)
-SSRI’s are first line pharmacotherapy for Generalized Anxiety D/O, Panic D/O with and without Agoraphobia, Social Anxiety D/O. -SSRI’s also used in PTSD and OCD (rarely effective as monotherapy) -Benzodiazepines -Used to treat symptoms in a variety of anxiety disorders. -Benzos frequently used to bridge therapeutic efficacy in GAD, panic d/o, social phobia. -Can be used as needed in phobia -Should be avoided in PTSD |
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Psychotherapy
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-Numerous psychotherapeutic approaches used to treat anxiety disorders.
-Includes psychodynamic, interpersonal, supportive, cognitive-behavioral -Psychotherapy alone can be used to treat most anxiety disorders (CBT has most data) -Psychotherapy combined with pharmacotherapy best approach for PTSD -Psychotherapy combined with pharmacotherapy best approach for most psychiatric d/o |
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CBT
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-Cognitive Behavioral Therapy is best studies, used in greatest variety of psychiatric disorders
-Can be used to treat all anxiety d/o alone or in combination with pharmacotherapy (not necessarily the best treatment in all cases) |
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Behavior Therapy
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-This is not CBT
-Involves exposure to feared stimulus and desensitization -Various forms effective in OCD, Phobia, and in PTSD (pts are exposed to detailed recall of traumatic events) |
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OCD and PTSD - tx
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-SSRI’s first line in both (higher doses for OCD)
-SSRI’s alone rarely effective in either -In OCD usually add behavioral therapy -In PTSD add EMDR, CBT or other psychotherapy, or Behavioral therapy -Augmentation of SSRI’s w/other psychopharm also often necessary in both |
