Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
58 Cards in this Set
- Front
- Back
|
What are the anxiety disorders?
|
Post Traumatic Stress Disorder
Generalized Anxiety Disorder Anxiety Disorder due to a Medical Condition Substance- Induced Anxiety Disorder Anxiety Disorder NOS Panic Disorder Specific Phobia Social Phobia Obsessive-Compulsive Disorder Acute Stress Disorder |
|
|
Autonomic nervous systems starts in the ....
|
hypothalamus
|
|
|
Sympathetic Nervous System =
|
fight or flight
|
|
|
What is the physiological reaction to acute stress?
|
Bronchial Tubes dilate
Blood Vessels constrict Fibrinogen released Glucose released Endorphins Released |
|
|
How does HPA Axis work?
|
Hypothalamus( influences mood) secretes hormone:corticotropin-releasing factor
CRF travels to pituitary gland Pituitary secretes adrenocorticotropic hormone ACTH circulates in blood to adrenal glands Adrenals release hormone, cortisol Cortisol( is a glucocorticoid)>rush of energy and alertness, effects cardiovascular& immune systems |
|
|
Consequences of chronic stress
|
Osteoporosis
Menstrual/fertility difficulties Decreased testosterone levels erectile problems Loss of libido ^ risk of auto-immune diseases ^ risk of infectious diseases Anxiety Disorders Myopathy Inefficient energy use ^ severity of adult onset diabetes Hypertension Atherosclerosis ^ risk of ulcers ^fat deposition, obesity Psychogenic dwarfism ^ risk of diabetes, addictions |
|
|
Amygdala's fxn with stress and anxiety...
|
is associated with emotions and fear
|
|
|
Hippocampus' fxn with stress and anxiety...
|
processes emotions and long term memories
|
|
|
Locus Ceruleus fxn with stress and anxiety...
|
helps determine which stimuli deserve attention
|
|
|
Cerebral Cortex fxn with stress and anxiety...
|
evaluates data about a perceived threat and forms judgments
|
|
|
Chronic Stress and the Brain
HIPPOCAMPUS |
Impairment of formation and retrieval of Long Term Memory
Decreased neurogenesis Prolonged depression Dopamine depletion, receptor disregulation Impaired judgment |
|
|
Chronic Stress and the Brain
AMYGDALA |
Increased anxiety and robust fear conditioning
|
|
|
Chronic Stress and the Brain
Dopamine depletion in the Ventral tegumentum/ nucleus acumbens: the reward system |
Anhedonia-depression
|
|
|
Neurotransmitters Related to Anxiety
GABA |
-modulates other neurotransmitters, lowers anxiety
|
|
|
Neurotransmitters Related to Anxiety
Serotonin |
regulates emotions, sleep, appetite, libido, inhibits pain
|
|
|
Neurotransmitters Related to Anxiety Norepinephrine-
|
affects mood, sleep, attention, learning, memory
|
|
|
Neurotransmitters Related to Anxiety
Epinephrine |
stress response
|
|
|
Neurotransmitters Related to Anxiety
DOPAMINE |
-affects complex movement, motivation, cognition, emotional response
|
|
|
Neurotransmitters Related to Anxiety
Acetylcholine |
controls sleep/wake cycles
|
|
|
Neurotransmitters Related to Anxiety
Glutamate |
-excitatory-too much>neurotoxicity
|
|
|
Genes and Relationship to Anxiety
|
Early evidence of genetic predisposition
Unlikely to be a single “anxiety gene” 5-HTT gene, regulates serotonin -more prevalent in GAD and OCD Potential markers on Chromosome 15, 11 and 1, seen more frequently in Panic and Phobias No genetic tests available Genes are not Destiny |
|
|
Personality Traits that Contribute to anxiety Disorders
|
Shyness
Anxiety sensitivity Avoidant personality inhibited |
|
|
Life Experiences & susceptibility to Anxiety
|
HPA axis becomes hypersensitive
Smaller hippocampus Amygdala becomes hypersensitive Traumatic events especially early in life Abuse, neglect, emotional deprivation Maternal separation Being unwanted |
|
|
Symptoms Characteristic of All Anxiety Disorders
|
Hypersensitive to possibility of danger
Feelings of dread, fear or danger are irrational Tension Worry Physical Symptoms: agitation, trembling, nausea, dizziness, shortness of breath, hot or cold flashes, freq urination |
|
|
Anxiety Interventions on 3 Levels
|
1. Reduce physiologic activity
2. Eliminate avoidance Behavior 3. Change subjective interpretations which perpetuate worry. |
|
|
What are 1st line medications for anxiety?
|
SSRIs
Benzodiazepines |
|
|
SSRIs are...
|
Citalopram
Escitalopram Fluoxetine Paroxetine Sertraline |
|
|
Benzodiapzepines
|
Alprazolam
Clonazepam lorazepam |
|
|
What are 2nd line choices for anxiety?
|
Tricyclics
MAOIs Dual reuptake Inhibitor Buspirone Beta Blockers |
|
|
CBT includes
|
Education
Relaxation training Desensitization Exposure Cognitive restructuring |
|
|
Alternative Treatments for Anxiety....
|
EMDR -(eye movement desensitization and reprocessing)
Biofeedback Hypnosis |
|
|
Anxiety Disorders DSM-IV
|
Panic Disorder without Agoraphobia 300.01
Panic Disorder with Agoraphobia 300.21 Agoraphobia Without History of Panic Disorder 300.22 |
|
|
300.01 Panic Disorder without Agoraphobia
|
Recurrent, Unexpected Panic Attacks
Persistent concern, for at least a month about having another attack Worry about the implications or consequences of the attacks Behavioral change related to the attacks |
|
|
300.21 Panic Disorder with Agoraphobia
|
Sx of panic disorder + presence of agoraphobia
Panic attacks not due to physiological effects of a substance or a general med condition And are not better accounted for by another mental disorder |
|
|
300.22 Agoraphobia without HX of Panic Disorder
|
Similar to Agoraphobia WITH panic disorder EXCEPT:
Never had a full blown Panic Attack Fear is on the occurrence of an incapacitating or very embarrassing situation Sx not due to substance If general med condition-fear is in excess for that usually associated with the condition |
|
|
Treatments for Panic Disorder
|
SSRI’s
Short course benzodiazepines Tricyclic antidepressants MAOI’s CBT |
|
|
Anxiety Disorders DSM-IV
|
Specific Phobia
Social Phobia(Social Anxiety Disorder) Obsessive- Compulsive Disorder Acute Stress Disorder Post Traumatic Stress Disorder Generalized Anxiety disorder Anxiety Disorder Due to a General Medical Condition Substance Induced Anxiety Disorder |
|
|
Specific Phobia 300.29
|
Marked, persistent excessive fear, cued by presence or anticipation of a specific object or situation
Exposure to above invariably provokes an immediate anxiety or panicked response Person recognizes the response as unreasonable Causes distress and interferes with functioning and relationships Common subtypes: flying, heights, insects, injections, blood |
|
|
Associated Features Specific Phobia
|
Causes: Traumatic events, genetic predisposition
10% of population have this Women have slightly higher risk Effective Treatments: Behavioral Therapy-desensitization, relaxation/breathing, benzodiazepines |
|
|
300.23
Social Phobia |
Marked, persistent fear of social or performance situations where one is exposed to unfamiliar people or scrutiny.
Avoidance of exposure significant anxiety/panic Recognition that fear is excessive Interferes significantly with life |
|
|
Associated Features
Social Phobia |
4% of Americans have this
Twice as common in women Children, adolescents and young adults have highest risk, rarely starts after 25 Causes:decreased levels of serotonin and dopamine, sensitive amygdala |
|
|
Treatments for Social Phobia
|
SSRIs
Combination with benzodiazepines CBT: anxiety management training and cognitive restructuring Group CBT to improve social skills |
|
|
300.3 OCD
|
Recurrent Obsessions or Compulsions that are severe enough to be time consuming, cause marked distress, significant impairment, and are recognized as unreasonable
|
|
|
Obsessions
|
Persistent ideas, thoughts, images, or impulses that are intrusive, ego-dystonic, and are recognized as the product of one’s own mind
|
|
|
Compulsions
|
Repetitive, driven behaviors
Goals: a)Prevent the experience of anxiety or stress b)reduce distress c)prevent dreaded situation or event Behaviors are disconnected with what they are trying to neutralize Recognized at some point that they are excessive or unreasonable |
|
|
Associated Features of OCD
|
1% of Americans
About equal in males and females 1 in 50 adults and 1 in 200 children Most common in young adults and adolescents Commonly seen: with Anxiety Disorders. Tourette’s, Major Depression, Eating Disorders, Learning Disorders Causes:Abnormal activity in the basal ganglia(effects motor function, ritualistic, repetitive behavior)) Low levels of serotonin and high levels of dopamine Complication of brain infections or head trauma |
|
|
Treatments for OCD
|
SSRIs-alone or in combination with tricyclics and/or benzodiazapines
CBT VERY RARE -neurosurgery to sever brain circuitry from basal ganglia |
|
|
308.3
Acute Stress Disorder |
Similar to PTSD but shorter duration- lasts 2 days to less than 1 month after the traumatic event and occurs within 4 weeks of the event
Person experienced, witnessed or was confronted with events that involved death, serious injury or threat to physical integrity of the self or others. The response involved intense fear, helplessness or horror During or after the event the individual experienced dissociative symptoms |
|
|
Dissociative Symptoms
|
Numbing, detachment, absence or emotional responsiveness
Being in a daze-less aware of surroundings Derealization Depersonalization Dissociative amnesia( unable to recall aspects of the traumatic event |
|
|
Symptoms of Acute Stress Disorder
|
Recurring images, flashbacks, dreams, intrusive thoughts
Avoidance of stimuli that remind one of the event Marked sx of anxiety: increased arousal-difficulty sleeping, irritability, poor concentration, hypervigilance, ^ startle response Significant distress impairment of functioning |
|
|
Associated Features of Acute Stress Syndrome
|
14%-33% of individuals exposed to trauma
Risk factors: mental disorders, lack of supportive relationships, emotional deprivation during childhood. |
|
|
Treatment for Acute Stress
|
Brief Psychotherapy
CBT-cognitive restructuring Short term meds for sleep and anxiety Do not require processing of memories and associated affect in immediate aftermath of event: may compound the stress reaction may cause over-consolidation of traumatic memories may activate anxiety without allowing for habituation |
|
|
300.02
Generalized Anxiety Disorder |
Persistent and excessive worry about several different things , more days than not, for at least 6 months
Difficulty controlling worry Feeling restless, on edge, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep problems Significant distress and impairment of functioning |
|
|
Features Associated with GAD
|
Appears between childhood and middle age
Causes:low level of GABA, serotonin, increased activity is seen in the cortex and decreased activity in the basal ganglia may prime the pump for overreaction Treatments: anti-anxiety/depressants CBT 5% develop this disorder Genetic predisposition: family members with mood disorders or having a mood disorder History of anxiety as a child Symptoms worsen under stress Twice |
|
|
293.89 Anxiety Disorder due to a General Medical Condition
|
Prominent anxiety, panic attacks or obsessions
Evidence from history, physical, lab findings that the disturbance is the direct physiological consequence of a medical condition Is not accounted for by another mental disorder does not occur exclusively during delerium Causes significant impairment in functioning |
|
|
Associated General Medical Conditions with anxiety
|
Endocrine: hyper and hypo-thyroidism,Pheochromocytoma, hypo and hyperglycemia, diabetes hypoadrenocorticism
Cardiovascular: congestive heart failure, pulmonary embolism, arrhythmias,valve disease, angina, MI Respiratory: Asthma, COPD, pneumonia,hyperventilation syndrome Metabolic:vitamin(B12) or mineral deficiency, porphyria Neurological: vertigo, seizures, stroke Severe allergic reactions, anaphylactic shock |
|
|
Substance Induced Anxiety Disorders
|
Prominent anxiety, panic attacks, obsessions or compulsions( agitation and increased heart rate and BP)
evidence from history, physical exam or lab findings of: Sx developed during, within 1 month of substance intoxication or withdrawal Medication use is etiologically related to the disturbance |
|
|
Substances Causing Anxiety
|
Anticonvulsants
Asthma meds Overuse of benzodiazepines Abrupt withdrawal from benzodiazepines, sometimes from SSRIs and tricyclics Withdrawal from heroin Gasoline, paint, pesticides, carbon monoxide, fluorocarbons Alcohol, caffeine, nicotine, cocaine, otc diet pills, decongestants, Stimulants: ritalin, dexedrine, amphetamines Cardiovascular meds, Corticosteroids, |
