Mood And Anxiety Disorders

Front 1

What are the two components of anxiety?

Back 1

Front 2

What is this?

Back 2

Mood

Front 3

What type of disorders?

Back 3

Anxiety disorders

Front 4

What are all these?

Back 4

Major anxiety disorders

Front 5

Recurrent panic attacks, occurring at over at least one month, involving anticipatory anxiety (the fear of having an attack) and avoidance of situations where panic is likely to occur or help is unavailable.

Which disorder?

Back 5

Panic disorder

Front 6

Palpitations, sweating, pounding heart, trembling, shaking, dyspnea, feeling smothered, etc. You've had one so you know the symptoms.

Back 6

Panic attack (at least four must develop abruptly and reach a peak within 10 minutes)

Front 7

Between what ages do panic attacks occur?

Can they be chronic and relapsing?

What is the prevalence and male to female ratio?

Back 7

Early teens => 40s

Chronic, relapsing

1-3% community, 3-8% primary care

Female to male = 2:1

Front 8

What is fear (or panic), often with blushing, of anticipated humiliation or rejection by others in social situations. While the person desires social activities and relationships, the dread of embarrassment leads to avoidance.

Back 8

Social anxiety disorder (social phobia)

Front 9

Which disorder is bimodal in onset (age 5 or early adolescence), chronic but may remit with positive social experiences?

It has a prevalence of 3-4% but performance anxiety is more common and a female to male ratio of 3:2 where more males seek treatment?

Back 9

Social anxiety disorder (social phobia)

Front 10

Familial modeling

Being bullied

Humiliation as a form of discipline

Disfiguring lesions (visible burns or deformities)

What are all of these?

Back 10

Developmental experiences contributing to social phobia/avoidant personality disorder

Front 11

What are phobias characterized by fear responses to specific cues?

When should they be treated?

Back 11

Simple phobia

Treated only if they interfere with important activities

Front 12

What condition should you be mindful of if patient needs MRI?

What is the response some have to situations that involve blood, needles, and injury?

Back 12

Front 13

Simple phobias:

Onset:

Animals?

Blood?

Situations?

May remit with experience

Prevalence? Which is more common in males?

Back 13

Animals = 7

Blood = 9

Situations = 2-7 and early 20s

Prevalence = 11% (most common anxiety disorder)

Blood, injury, injection phobias more common in males

Front 14

Diagnosis?

Back 14

Agoraphobia

Front 15

Identify what is being treated.

Back 15

Front 16

Persistant (>6 months) pattern of uncontrollable worries about health, safety, access to resources, and threats to other people. Multiple signs of arousal and autonomic dysfunction.

What is the disease? Onset? Female:male?

Back 16

Generalized anxiety disorder

Onset = Mid teens to mid 20s (may occur after onset of chronic illness)

Duration > 6 months

Prevalance 5% (female:male 2:1)

Front 17

Characterized by intrusive, arousal, and avoidance symptoms.

Onset males 6-15, females 20-29 (also post partum)

Gradual onset, 5% episodic, 15% severely deteriorate, waxes and wanes with stress

Prevalence 2%, males >females

Adults (males = females)

Back 17

Obsessive-compulsive disorder

Front 18

What are all of these?

Back 18

Common compulsions

Front 19

What can all of these cause?

Back 19

Substance/Medication-Induced Anxiety disorder

Panic attacks predominate

Front 20

What can all of these medical conditions cause?

Back 20

Anxiety disorder

Front 21

Back 21

Front 22

What type of disorder?

Back 22

Mood disorder

Front 23

Back 23

Front 24

What does SIG-E-CAPS stand for?

Back 24

Sleep, loss of interest, guilt, energy, concentration difficulty, appetite disturbance, psychomotor retardation/agitation, suicidal thoughts

FIVE REQUIRED FOR A MAJOR DEPRESSIVE EPISODE

Front 25

Is bereavement abnormal?

Can it turn into major depression? How is it treated?

Back 25

Front 26

What does this describe?

Back 26

Front 27

Marked affective lability, irritability, anger, interpersonal conflicts, feeling on edge, anxiety, depression, over-eating, food cravings, sleep problems, feeling overwhelmed and out of control. All of this in the week before onset of menses.

Symptoms must last for most of year and be documents PROSPECTIVELY for at least 2 menstrual cycles. They must also disappear shortly after menses.

Diagnosis?

Back 27

Front 28

Diagnosis?

Back 28

Cyclothymic disorder

Front 29

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Front 30

Bipolar 1 or 2?

Back 30

Bipolar 1

Front 31

Bipolar 1 or 2?

Back 31

Bipolar 2

Front 32

Overeating, oversleeping while depressed, preserved reactivity to reward. Which mood features?

Back 32

Atypical features

Front 33

Detachment from the environment while awake; negativism including immobility, mutism, refusal to eat or drink. May be life threatening.

Back 33

Catatonic features

Front 34

Dense anhedonia, lack of response to reward, terminal insomnia (early morning awakening), diurnal variation (morning worse).

Back 34

Melancholic features

Front 35

Depressive episode within one month of childbirth by definition. Clinically this period of markedly increased risk may be >3 months. Often includes marked anxiety.

Back 35

Postpartum onset

Front 36

Marked congruent in depression: delusions of poverty, guilt, nihilism, illness, self-disgust; derogatory auditory hallucinations.

Mood congruent in mania: delusions of special powers or unlimited resources, paranoia, auditory hallucinations.

Back 36

Psychotic features

Front 37

Review table 47.1

Back 37

Review table 47.1

Front 38

Identify structure involved:

Short term memory

Cognitive inefficiency, recollection bias (depressed people cannot access happy memory; mania makes sad memory inaccessible)

Back 38

Hippocampus

Front 39

Identify structure involved:

Individual nuclei are part of three distinct circuits that link cortical areas with sensory cortices and subcortical structures. These regulate emotion, motivation, arousal, and attention.

Erratic arousal, subjective distress, compromised attention/concentration

Loss of pleasure responses to sensation in depression

Sometimes associated with hypersensitivity to sensory input in mania

Back 39

Thalamus

Front 40

Identify structure involved:

Conscious thought, executive functions (selection among alternatives, anticipation, inhibition of impulses, sequencing)

Helplessness, indecisiveness, hopelessness, distorted sense of time (slowed in depression, accelerated in mania)

Back 40

Dorsolateral prefrontal cortex

Front 41

Identify structure involved:

Assess risk in pursuit of reward, relate new information to context (memory and environment)

Overestimation of risk and reduced reward in depression; underestimation of risk in mania

Back 41

Orbitofrontal cortex

Front 42

Identify structure involved:

Integration of emotion and cognition

Abnormal motivation (apathy in depression)

Dysregulation or arousal

Back 42

Anterior cingulate gyrus

Front 43

Identify structure involved:

Fear, rage, selective attention

Anxiety, irritability, vigilance, hypersensitivity to negative environmental cues

Back 43

Amygdala

Front 44

Identify structure involved:

Reward

Lack of pleasure (depression), decreased or increased motivation

Back 44

Nucleus accumbens

Front 45

Identify structure involved:

Sleep, appetite, sexual behavior, metabolic rate, adaptation to acute or chronic environmental or social stress

Insomnia/hypersomnia, lack of or increased sexual interest, hyperphagia or anorexia

Back 45

HPA axis

Front 46

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Front 47

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