Psy 303 Exam 2: Anxiety, Trauma And Stressor Related, And Ocd And Related Disorders

Front 1

Anxiety Disorders

Def, rates and symptoms

Back 1

* Definition: disorder with excessive apprehension, anxiety and avoidance
* Rate: 10-15% of Americans
* Symptoms: physiological and cognitive

Front 2

Cormobiditity

Back 2

* Among people with anxiety disorders, 50% of these cases will have a major depression episode at some point in their lifetime
* Common vulnerability disorders; if you have 1 anxiety disorder, you have higher risk of having 2
* Only 20% of people with anxiety disorder have just 1; 80% have 2.

Front 3

Anxiety Disorders

Symptoms:

Back 3

* Cognitive: include depersonalization, derealization
* Physical: choking, heart palpations, shaking, trembling, sweating
*

Front 4

Yerkes-Dodson Law

Back 4

Some anxiety is good

* Study: looked at performance and anxiety level
* Found that if you want to achieve peak performance you have to have moderate anxiety
*

Front 5

Anxiety versus fear/panic

Back 5

* Chronic – future oriented
* Tension / worry
* More acute – present oriented
* Sympathetic activation (panic attack)
*

Front 6

Panic attacks—types

Back 6

* 1.) Situational (cued)— specific phobia
* 2.) Unexpected (uncued) — panic disorder
* 3.) Situationally predisposed - also p.do.

Front 7

Etiology of Anxiety/Panic

Biological factors: preparedness, genetics,

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* Preparedness (most fears are ‘prepared’)
* Family/Twin Studies: inherited tendency to be anxious/emotional
* Panic: 2% general population has, 31% concordance in MZ twins
* GAD: 30% genetics

Front 8

Etiology of Anxiety/Panic

Neurotransmitters

Back 8

* Lower levels of GABA associated with increased anxiety (likely norepinephrine and serotonin involved)
* GABA reduces postsynaptic activity and inhibits behavior/emotions such as anxiety (inhibits anger and aggression also)
* Polygenetic: probably many genes that produce vulnerability to psychological/social factors
*

Front 9

Panic Attacks:

Characteristics:

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* Abrupt, severe and unexpected attack
* Apprehension and terror
* Sense and loss of control

Front 10

Panic Attack Symptoms:

Back 10

* Cognitive: include depersonalization, derealization
* Physical: choking, heart palpations, shaking, trembling, sweating
* 8-12% of people will have a panic attack at some point in their life.
*

Front 11

Anxiety/Panic

Psychosocial factors: behavioral models, cognitive factors

Back 11

* Erroneous beliefs or interpretations (
* Anxious schema: world is perceived as a dangerous place (has modeling contributed)
* Sense of uncontrollability (remember Seligman)
* Conditioning: (classical, operant, two factor theory)
* Or social learning (modeling)

Front 12

Integrated Anxiety Model: Triple Vulnerability Theory

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* 1. Generalized biological vulnerability
* 2. Generalized psychological vulnerability: see world as dangerous and out of control
* 3. Specific psychological vulnerability: learn some situations very dangerous even though they are not (conditioning, modeling)
* 4. These vulnerabilities are activated under stress (esp. interpersonal stress) or with stressful experience. Cycle feeds on self.
*

Front 13

Anxiety Disorders

Panic Disorder: criteria, agoraphobia

Back 13

* Persistent concern about having attacks
* Worry abut implications of attack
* Change in behavior (interferes with daily functioning)
* With or without AG: intense fear of being in places or situations from which escape would be difficult or help is not available if attack occurs
*

Front 14

Anxiety Disorders Prevalence, gender ratio, course

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* 2:1 female to male
* 75% with agoraphobia are women (cultural factors – men use alcohol)
* Caucasians > African-American / Hispanic
* Prevalence: about 5% lifetime prevalence rate (most have AG)

Front 15

Anxiety Disorder

biological factors, behavioral models (conditioning), cognitive factors

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* Biological factors: 4-7x risk in first degree relatives
* “False alarm”: panic attack for no apparent reason
* “Learned alarm” panic attacks conditioned to CS (internal or external cues) – even if you remove the brain
* 2. Anxiety sensitivity: tendency to view physical symptoms as dangerous (scores predict later panic)

Front 16

Anxiety Disorder:

Treatment: medications,

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* Tricyclic antidepressants (i.e. imipramine) {also pain relief}
* High relapse rates when stop medications: 20-50% with antidepressants; 90% with benzos
* SSRIs “best” (for panic): sexual dysfunction in 75% who take them
*

Front 17

Anxiety Disorder:

Treatment: Psychological

Back 17

* 1. Educate the person about their panic
* Mantra, deep breathes…
* Tell themselves something helpful
* This cause extinction
* 80-100% panic free after 12 weeks, low relapse rates at 2 years

Front 18

combined treatments

Back 18

* You can do the therapies or drugs and both will be effective, you don’t need to do both, that’s overkill statistically. When combined there is not a statistically significant difference. (If you take meds, stay on them)

Front 19

Specific Phobia: Diagnosis, types, prevalence, gender ratio, course

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* 10-11% lifetime prevalence
* More likely in females
* 3:1 black to white
*

Front 20

Blood injury injection type

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* Causes you to pass out (only phobia that can do that) physiologically, strong vasovagal response leads to drop in heart rate, blood pressure.
* Individuals often do faint and phobia may be partly due to this (in other phobias fainting is rare)
* Onset: about 9 years

Front 21

The key to treatment of phobia

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* Using fear hierarchies, they can be gradually exposed; very effective
* Use exposure in order to have extinction
* Social phobia (now social anxiety) is the exception
* 90% of those with phobia do not get treatment
* social anxiety is different because there is no real danger like hat found in animal phobias
*

Front 22

PTSD: Prevalence, rates, symptoms, risk factors

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* (Rape, assault, natural disasters, manmade disasters)
* Kessler et al., 1995
* Rape for both men and women has highest likelihood of persistent PTSD
* Adult US women with varying traumas, 18% had PTSD
* Lifetime PTSD prevalence is 7-8% in North America
* Only 10-20% with traumas in NA develop chronic, persistent problems; fro many, the problem is transient
* 15-17% of Iraq / Afghanistan vets (50% of injured) have PTSD; poor prognosis if continues 1-2 years after trauma; ½ cases recover completely in 3 months.
* 20-30% of children with trauma have PTSD; risk for PTSD tripled if trauma before age 11
* Exposure to repeated trauma increases risk of PTSD
*

Front 23

PTSD

Back 23

* Re-experience the event (flashbacks, nightmares)
* Avoid stimuli that are associated with the event
* Increased arousal (can’t sleep, exaggerated startle reflex, irritability)
* Sxs persists for more than one month (acute stress disorder until then)
* Sxs can be delayed, >3 months “chronic”

Front 24

Risk for PTSD

Back 24

* .28-.41 identical twin concordance rate
* .11-.24 fraternal twin concordance rate
* Anger and blame increase risk; active coping decreases risk
* Conditioning plays a role with sxs (and then anxiety sensitivity?)
* (Because they don’t have coping strategies)
* Social support is a big deal in terms of veterans especially
* Brain structure & function changes (see text)
*

Front 25

Obsessive Compulsive Disorder

Back 25

* Obsessions: persistent thoughts or images and or
* Compulsions: repetitive behaviors or mental acts (ex: praying, counting)
* Compulsions actually relieve anxiety
* Lifetime prevalence: 1.6% (60% female) [very uncommon

Front 26

OCD

Back 26

* Arabic countries: greater obsessions with religious practices, especially cleanliness (Muslim)
* India: also themes of contamination
* Thoughts = action/responsibility for bad outcomes
* Beliefs that thoughts are unacceptable and should be suppressed
*

Front 27

Treatment of OCD

Back 27

* Exposure with response prevention (ERP) techniques (86% respond to this alone)
* Recent studies of changes in brain function after behavioral treatment
* Medication (clomipramine) – 48% respond to this alone, high relapse rates
* No evidence that ERP + meds improve results
* Brain surgery (cingulotomy) – extreme cases (30% benefit)

Front 28

Mood (Affective) Disorders and Suicide:

Overview: Levels of mood (major depression to mania)

Back 28

Levels of Mood:

* depression, dysthymia, hypomania, mania
* Mood Range
* Mania: high (Bi-Polar I)
* Hypomania (Cyclothymia, Bi Polar II)
* Mood normal
* Dysthymia (Cyclothymia)
* Depression: low (Major Depression)

Front 29

Mood Disorders:

Back 29

* Major Depression: 2 weeks, 2 months with death of loved one
* Dysthymia: 2 years
* Cyclothymia: 2 years (no more than 2 months without symptoms
* Bipolar I: mania (depression likely)
* Bipolar II: hypomania and depression

Front 30

Depression:

Back 30

* Key ways to identify depression:1. Anhedonia: without pleasure, lose of interest in things they used to enjoy.
2. Depressed mood most of the day, every day
3. Significant weight lose/gain. Appetite increases/decrease
4. Insomnia/hypersomnia
5. Moving faster, moving slower,
6. Fatigue
7. Feelings of worthlessness, guilt
8. Can’t concentrate, focus
9. Thoughts of death, suicide

Front 31

Depression: Rates, gender ratio, features, course

Back 31

Rates:

* Lifetime prevalence: 13-17%, last year rate 5%
* More than 2:1 female to male
* Major depression average age of onset = 30 years (Hasin et al,. 2005)
* Average length of first episode untreated 4-9 months
* Remission rate high (90% over 5 years)
* High rates of relapse: chance of second episode after the first rate is 85%
* Median lifetime episodes in 4; 25% have 6 or more
*

Front 32

Dysthymia (now Persistent Depression Disorder): rates, gender ratio, course, DSM criteria

Back 32

Rates: lifetime prevalence 3%

* 2 to 1 female to male
* Up to 79% also have MD (major depression)
* onset is early 20’s
* Average duration: 5 years
* About 74% recover but 71% of those also relapse; whole sample sprint 60% of 10 year period with dx
* Onset before 21 years lasts longer poorer response to treatment, increased family transmission

Front 33

Bipolar Disorder: symptoms and criteria, rate, gender ratio

Back 33

* Bipolar I: rate .8%; onset 18 years
* Bipolar II: rate .5%, onset 19-22
* Usually begins suddenly with minor mood swings (1/3 of cyclothymia go on to BP)
* 1/3 causes being in adolescence; rare after 40
* 65% depressed have some manic symptoms but few experience full manic episode (10 year longitudinal study)
*

Front 34

Manic SXS (need 3)

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* Decreased need for sleep
* High energy/overactivity
* Easily distractive
* Excessive and fast speech
* Flight of ideas (racing thoughts)
* Impulsive/poor judgement (risky behavior)
* Grandiosity (inflated self esteem)
* For 1 week-less if hospitalization required; untreated mania typically lasts 3-6 months

Front 35

Bipolar I versus Bipolar II, suicide

Back 35

* Bipolar I: rate .8%; onset 18 years
* Bipolar II: rate .5%, onset 19-22
* Usually begins suddenly with minor mood swings (1/3 of cyclothymia go on to BP)
* 1/3 causes being in adolescence; rare after 40
* 65% depressed have some manic symptoms but few experience full manic episode (10 year longitudinal study)

Front 36

Cyclothymia

Back 36

* 2 years (no more than 2 months without symptoms
* Hypomania
* Dysthemia

Front 37

Etiology of Mood Disorders: genetic, psychosocial, cultural, social support, other

Back 37

* Estimates of genetic contribution (based on 2, 662 twin pairs in Aussie)
* 40% for women
* 20% for men
* Environment may play a stronger role with men than women
*

Front 38

Treatment of Mood Disorders: medication, psychological

Back 38

Medication for bipolar

* Lithium for bipolar (50% respond well-50% reduction in mania)
* Valproate (antivonvulsant) most popular now for bipolar, effective, but 2.7x higher suicide rate than Lithium
* ECT (6-10 treatments) 50-70% without med. benefit will benefit; high relapse so also need meds (serotonin increase, stress hormone blocked, neurogenesis in hippocampus)
*

Front 39

Suicide

Back 39

* Fairly common for people who are having difficult times
* College students: 10-25% thoughts of suicide in past year
* About 15% of these students with thoughts attempted suicide
* Men complete suicide more often than women, women attempt 3x more than men
*

Front 40

Suicide

Back 40

Risk factors:

* Family history of suicide (6x increases in risk)
* Low levels of serotonin (overaction, impulse)
* Psychologcial disorder (90% suicides, 60% with mood disorder)
* Alcohol use 25-50% suicide 1/3 adolescents intoxicated
* Stressful events but including natural disasters 63% increase after earthquake 31% hurricanes
* From 5 to 14 suicide increases and stays stable until 70’s