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43 Cards in this Set
- Front
- Back
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what are some types of anxiety disorders?
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Panic Disorders
Social Phobia Specific Phobia Generalized Anxiety Disorder Obsessive Compulsive Disorder Acute stress disorder Post Traumatic Stress Disorder |
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what are the features of anxiety disorders?
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Characteristic Clinical Course
Familial Pattern Emerging Neuroimaging Findings Selective Pharmacological Responses |
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what's this:
Recurrent, unexpected panic attacks Attack followed by at least 1 month of: a) Concern about further attacks b) Worry about consequences c) Significant behavioral change Panic attacks are not due to organic causes Panic attacks are not better accounted for by another psychiatric disorder |
Panic Disorder - DSM IV
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what's this:
Development of sudden, intense anxiety At least four symptoms Peaks within 10 minutes |
Panic Attacks - DSM IV
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what are these the symptoms of?
Tachycardia shortness of breath Chest pain Nausea Sweating Shaking Dizziness Numbness, tingling Fear of dying Fear of loosing control Depersonalization Choking Chills or hot flashes |
panic attack
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what's panic disorder epidemiology?
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Affects 1-2 % of the population
Panic attacks are more frequent (5 -8% of the population) |
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when does panic disorder affect?
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Usual onset during teenage/ early adult period
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what's panic disorder ass w/?
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agoraphobia, depression and alcohol abuse
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what's etiology of anxiety disorders?
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Genetic Vulnerability (30% - 50% concordance in monozygotic twins)
Developmental causes (behavioral inhibition during early childhood) Life experiences/stressors |
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what's link b/w panic and lactate?
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Most studies show 70-80% of patients and <10% of controls have panic attacks after lactate (0.5N, 10 ml/Kg)
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how do you diagnose panic disorder?
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A typical history
Usually present with a physical focus Convinced that they have a “medical” illness Elicit the classic pattern of symptoms Lack of physical signs and risk factors for other medical causes |
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what's treatment for panic disorder?
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Both psychological and pharmacological methods are effective
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what's pharmacological tx for panic disorder?
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Pharmacological
- Selective serotonin reuptake inhibitors (SSRIs) - Tricyclic antidepressants - Benzodiazepines - Monoamine oxidase inhibitors - Others |
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what's psychological tx for panic disorder?
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Psychological: Cognitive behavioral therapy Education
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how do you treat panic disorder w/ SSRIs?
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All currently available SSRIs are effective - sertraline and paroxetine
Start at a very low dose (5 mg fluoxetine, 25 mg sertraline, 25 mg fluvoxamine or 5 mg paroxetine) Many respond to lower doses than depression |
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what's seen in comorbidity w/ panic disorder?
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Depression
Agoraphobia Other anxiety disorders Alcohol abuse Personality disorders |
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what's this?
Marked and persistent fear of one or more social situations Exposure invariably provokes anxiety Recognize that the fear is excessive Feared situations are avoided Significantly interferes with normal life Not due to another condition |
Social Anxiety Disorder (Phobia) - CRITERIA
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what are most common fears?
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Speaking in groups 57%
Meeting strangers 42% Eating in public 25% Writing in public 12% |
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what's epidemiology for social phobia?
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Early ECA studies repoprted prevalence of 2.4% (Regier et al. 1988)
Recent NCS studies indicate 1 year prevalence of 7.9% and lifetime prevalence of 13.3% (Kessler et al. 1994) |
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when is onset/who affected in social phobia?
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Male:female ratio was 1:2.5
Mean age of onset was 11-15 years |
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what's morbidity of social phobia?
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22.3% were on welfare
50% did not complete high school 70% were in the lowest two socioeconomic quartiles Half were single or divorced |
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what's the Major site of action for antianxiety drugs?
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amygdala
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what's cool that they've found they can do w/ priming amygdala?
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A form of synaptic plasticity
Repeated subthreshold stimuli result in full response This heightened responsivity is long-lasting It involves activation of NMDA receptors |
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how do you decrease amygdala activity?
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Prefrontal cortex (Therapy – e.g., CBT)
Serotonin (Antidepressants – e.g., Paxil) GABA (Benzodiazepines – e.g., Xanax) |
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what's psychological tx for social anxiety disorder?
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Cognitive behavioral therapy -A systematic multimodal therapy -Time limited treatment
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what's pharm way to tx social phobia?
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Selective serotonin reuptake inhibitors (SSRIs)
1. Fluoxetine (Van Ameringen et al. 93) 2. Sertraline (Katzelnick et al. 1995) 3. Paroxetine (Stein et al. 1996) 4. Fluvoxamine (Van Vliet et al. 1993) Benzodiazepines 1. Clonazepam (Davidson et al. 1993) 2. Alprazolam (Gelernter et al. 1991) |
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what's this?
A. Excessive anxiety or worry about a number of events or activities for 6 months B. The person finds it difficult to control the worry C. Associated with three of the following: 1) Restlessness or keyed up or on edge 2) Easily fatigued 3) Difficulty concentrating 4) irritability 5) muscle tension 6) sleep disturbance |
GAD DSM IV criteria
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what's this:
Chronic worry Multiple external triggers Not lactate responsive |
Generalized anxiety
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what's prevalence of GAD?
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WOMEN! HAVE MORE current and lifetime prevalence
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what char early onset of GAD?
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-Before 20
-Female>Male -Always been anxious -childhood fears |
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what describes late onset of GAD?
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-Adult onset
-Usually precipitated by stressful event |
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what's used as pharmacotherapy for GAD?
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Benzodiazepines
2) Azospirones (Buspirone) 3) Antidepressants 4) Others |
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Severe trauma
Followed by at least 1 month of symptoms Re-experiencing of the trauma Avoidance of situations/memories Significant numbing of emotions Symptoms of hyperarousal what's this? |
Post-traumatic Stress Disorder DSM IV Criteria
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Usually described as a life threatening or potentially life threatening trauma
There is an inherent subjective nature to the severity of the traumatic experience The most critical elements appear to be a sense of horror and helplessness what's this? |
trauma
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incidence of PTSD?
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a lot after wars
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what are risk factors for developing PTSD?
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Type of trauma
Gender Age Genetic vulnerability |
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what are features of PTSD?
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Characteristic Clinical Course
Familial Pattern Emerging Neuroimaging Findings Selective Pharmacological Responses |
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what pharm tx help in PTSD?
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Serorotonin reuptake inhibitor antidepressants improve about 50% of the subjects with PTSD
Some anticonvulsants are also helpful Usually requires a combination of medications and therapy |
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what's this?
Characterized by obsessions and/or compulsions They cause significant disability/discomfort usually occupy 1 hour or more per day |
OCD
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what are the obsessions usually?
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Irrational thoughts, ideas or images
Usually distressing to the subject Most common types: contamination fears of harm |
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what are the compulsions usually?
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Repetitive behaviors
Usually done to neutralize the anxiety induced by the obsession Most patients acknowledge the futility Common types: cleaning checking |
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what's ocd epidemiology?
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Affects about 2-3%
Earlier onset and severe course in males |
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what's OCD tx?
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SSRIs are the most effective first line treatment
Requires higher doses and longer duration Always combine with behavior therapy |
