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13 Cards in this Set

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How would DSM define GAD? Psychological and somatic symptoms? time frame? What are common comorbidites? What receptor is problematic?
excessive anxiety and worry for over 6 months (about children, finances, etc.) Patient can't control
Somatic- increase HR/BR, sweating, upset/nausea stomach, clammy hands, twitching, lump in throat
Comorbidites include: MDD (>50%), drug abuse, insomnia.
GABA- A receptor
What is panic disorder according to DSM? Physically? Precipitated? Predominantly what race? wHY SO DEBILITATING?
A disorder characterized by panic attacks, which are discrete episodes of 10 mins that feel like an intense heart attack. Both precipitated by identifiable stressor/interpersonal problems and UNPRECIPITATED
Seen across races, but W>M. vERY DEBILITATING BECAUSE these people chronically worry about their next attack. It dominates their life
What is agoraphobia? Social phobia?
Avoidance of social situations where a person can't escape or will feel embarassed. Similar to social phobia in that it is debilitating. 3-13% of people have this.
What are the first line treatments for anxiety disorders in general? Why? What is frequently used in conjunction with SSRI's? Why? Remember side effect profile! TCAs are effective for treatng all anxiety disorders except? Role of CBT in anxiety disorders? What does the evidence say? Results for all MODALITIES?
SSRI's calm them down, but more importantly frequently can treat the comorbid depression, etc.
Often used in conjunction with BENZO's. Have incedibly rapid onset, which is effective until SSRI's kick in. Only problem, have to worry about abuse/addiction.
TCAs- great for GAD, PD with agoraphobia, but NOT for SOCIAL PHOBIAS
Largest effect size (compared to all psychopharm) and best attrition rates. Nevertheless, only 35% of patients achieve complete remission!
Pathophysiology of Anxiety Disorders? What are our detection centers in brain? Which area discriminates between harmful or benign stimuli? How bout novel vs. known stimuli?
Int/ext stimuli detected in Thalamus
Harmful vs. benign = amygdala
Novel vs. known = hippocampus
What are the three components of our innate response circuitry? What area is responsible for defensive behaviors to noxious stimuli? for arousal? autonomic rsponse?
thalamus-amygdala-cortex, generally return to baseline
Periaqueductal grey
Locus Ceruleus
Hypothalamus
Reasons for anxiety disoders include:
Whay neurochemically might someone be a chronic worrier? How about panic disorder?
Some people are timid and withdrawal in novel situations.
Exaggerated autonomic/HPA response for novel stimuli- less habituation
Chronic worrier- allelic variations in serotonin transporter gene
Panis disorder= a response that is strongly emotional but lacks cognition
PTSD..what are the major symptoms present? (4) somatic? What is the time course and how does that compare with ASD (acute stress disorder)
Flashbacks alng with
Avoidance behaviors..don't watch the news/movies/books..feel stranged from fam/friends..Hyperarousal/insmnia..reliving that event also see somatic symptoms such as inceased HR/BP and sweating
PTSD= >1month whereas ASD is a few days up to a month
What is the # risk factor for developing PTSD? What is dysregulated in the neurobiology behind PTSD? Discuss the hierarchy of stressors?
How do you treat acutely for an episode? Chronically?
A previous psychiatric illness
A dysregulation of NOREP/EPI
Highest would be a prison camp/terrorist experience, followed by murderous/rape, than injury, then lowest is natural disaster stuff
Acute- just restore order, safety and social scene. Also, use BENOZos and B-blockers to sedate/calm down hyperarousal(autonomic)
Chronic- do psychotherapy and SSRI due to frequent cormorbidities of depression and insomnia
OCD; what is an obsession (most common) and a compulsion (most common)? what is pathologic doubt?
obsession= thought
compulsion= behavior/mental ritual
Common obsessions include fear of contamination, pathologic doubt (i.e. did I hit that kid, turn off oven, lock door, etc?), need for symetry, or harm/sexual related side effect
Compulsions= repitive behaviors like handwashing, touching or mental acts like praying, counting, repeating words, etc
What % of US suffers from OCD? Mean age? Is there a genetic component?
2.3%, = 30 y/o, 53-87% concordance in twins, YES, huge genetic influence
What areas (2) in brain show inceased firing during OCD on PET scan? What is TX? Most effective? Biggest strategies of CBT?
orbital cortex and caudate nucleus...this is a disease of a constantly firing basal ganglia
TX is SSRI's and CBT. CBT is definitly the most effective because you figure out what people are most afraid of and have them do it!
Baxter's Model of OCD? What is a MACRO? w/ OCD?
Macros are social/behavioral norms/habits...these are the routine things in life that we do and are not conscious of, such as smile, nod, laugh, etc.
With OCD, macros are fragmented and express themselves in anappropriate situations