The Mind, Anxiety Disorders

Front 1

what is anxiety?

Back 1

a response to an unknown threat, or is internal, vague or conflictual

Front 2

what is an anxiety disorder?

Back 2

occurs when a high level of anxiety persists or recurs that causes interference with social and occupational functioning

Front 3

which type of anxiety disorder does this describe?

-Discrete period of intense fear or discomfort
-Develops abruptly
-Peaks within 10 minutes, lasts 20 minutes to up to 8 hours (most resolve in 30-40 min)
-Not induced by a substance/medical illness
-Up to 20% may have syncope

Back 3

panic disorder

Front 4

what are two criteria which m,ust be met in order to diagnose panic disorder?

Back 4

1. Recurrent unexpected panic attacks
2. At least one of the attacks has been followed by
~one month (or more) of
persistent concern about having additional attacks
~worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, “going crazy”)
~a significant change in behavior related to the attacks

Front 5

What does this describe?

-Anxiety about being in places or situations from which escape might be difficult or in which help may not be available in the event of a panic attack
-Situations are avoided or endured with marked distress; or require the presence of a companion
-Not accounted for by another mental disorders

Back 5

Agoraphobia

Front 6

describe the development of a panic attack?

Back 6

1. low level of anxiety builds slowly until trigger point
2. after trigger anxiety rapidly increases for 10 minutes
3. at peak after 10 minutes, anxiety decreases to normal over a period of 20 minutes

Front 7

what is the usual age of onset for panic disorder?

Back 7

20's

Front 8

how effective is treatment for panic disorders?

Back 8

70% will improve with treatment, however, total remission is rarely seen

Front 9

who is more likely to get a panic attack, men or women?

Back 9

women

Front 10

of those seeking cardiology evaluations, how many may have panic disorder as the underlying cause?

Back 10

50%

Front 11

what is the first and second most likely co-morbid illnesses/problems people with panic disorder present with?

Back 11

1. Depression (50%)
2. Substance abuse (20%)

Front 12

what is the most important feature of panic disorder, even in individuals without co-morbid depression?

Back 12

high suicide rate

Front 13

what are the four substances that are likely to induce a panic attack?

Back 13

1. Isoproterenol (beta-agonist)
2. Yohimbine (alpha2-blocker)\
3. CO2
4. Sodium Lactate

Front 14

List the 5 theories on the cause of panic disorders?

Back 14

1. Elevated catecholamine levels
2. Abnormalities in locus coeruleus (fear response)
3. CO2 Hypersensitivity
4. Problems with lactate activity
5. Abnormal GABA NT system

Front 15

what is the risk of panic disorder in a first degree relative?

Back 15

20%

Front 16

What is the rish of panic disorder in a monozygotic twin?

Back 16

45%

Front 17

what are the two psychological theories which attempt to explain panic disorder?

Back 17

1. Psychoanalytical-repression
2. Behavioral-conditioned response

Front 18

describe the Psychoanalytical-repression explanation of panic disorder?

Back 18

you repress disturbing thoughts into subconsciousness and when the thoughts are very strong the break into consciousness in a distorted way causing anxiety

Front 19

describe the Behavioral-conditioned response explanation for panic disorder?

Back 19

Paired stimuli such as driving a car and being in an accident cause anxiety when getting into a car, we are conditioned be experience to be anxious when experiencing a situation we were traumatized in

Front 20

why does panic disorder cost so much in regards to health care?

Back 20

difuse physical symptoms without a central physical cause can lead to many specialist visits until the underlying panic disorder is diagnosed

Front 21

what is the DOC for treating panic disorder?

Back 21

SSRI's and SNRI's

Front 22

If a patient does not respond well to SSRI's or SNRI's for panic disorder what other two drugs can be considered for treatment?

Back 22

1. Tricyclic antidepressants
2. MAOI's

Front 23

For rapid control of a panic attack, what medications are most effective?

Back 23

Benzodiazepines such as Clonazepam or Alprazolam

Front 24

Cognitive-behavioral therapy is very effective for treating Panic Disorder. What does the cognitive part adress?

Back 24

recognizing incorrect thoughts that cause an increase in anxitey symptoms and replacing those thoughts with thoughts that decrease anxiety

Front 25

What drug can be used to treat Generalized Anxiety Disorder, but not Panic Disorder?

Back 25

Buspirone (Buspar)

Front 26

Why are beta-blockers such an excellent choice for treating Panic Disorders?

Back 26

TRICK- they have little efficacy

Front 27

What anxiety disorder does this describe?

Excessive anxiety and worry occurring more days than not, for at least 6 months, about a number of events or activities

The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

Back 27

Generalized Anxiety Disorder (GAD)

Front 28

Who is the prototypical GAD patient?

Back 28

Woman, African American, younger that 30

Front 29

what percentage of patients with GAD go on to develope panic disorder?

Back 29

25%

Front 30

What are the SSRI's most liekly to be used with GAD? (3)

Back 30

1. Escitalopram
2. Paroxetine
3. Venlafaxine

Front 31

What is the drug that takes weeks to become effective (like a antidepressent)
-has reduced side-effects
-is not as effective in patients who have previosly used benzo's

Back 31

Buspirone (up to 40mg per day)

Front 32

What is the most effective psychotherapy for GAD?

Back 32

Behavioral Therapy

Front 33

what does behavioral therapy for GAD focus on? (2)

Back 33

1. recognize and control symptoms
2. relaxation techniques

Front 34

What anxiety disorder does this describe?

A marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he/she will act in a way that will humiliating or embarrassing

Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally predisposed panic attack

Back 34

Social Phobia (Social Anxiety Disorder)

Front 35

what are the 3 catagories of phobias?

Back 35

1. Agoraphobia (fear of "going out" where escape is not possible
2. Social Phobia (fear of humiliation or embarrassment in public
3. Specific Phobia (fear of specific things or situations)

Front 36

what is the prevalence of social phobia in the general population?

Back 36

12%

Front 37

who is more likely to have social phobia, males or females?

Back 37

they have equal chance

Front 38

When is the mean onset of social phobia?

Back 38

mid-teens

Front 39

what percentage of people with social phobia develop a co-morbid psychiatric disorder?

Back 39

50%

Front 40

what NT is thought to involved in the formation of social phobia?

Back 40

Dopamine - Explains why patients tend to better on MAOI's than TCA's (low dopaminergic activity)

Also brain imaging shows that there are decreased striatal D2 receptors and dopamine transporter binding

Front 41

What is the DOC for social phobia?

Back 41

SSRI's

Front 42

what is a good distinguisher between a social phobia and avoidant personality disorder?

Back 42

persons with avoidant personality disorder feel like people will hurt them, where as the social phobia is more of embarrassment

Front 43

Your medical student friend asks if you think it would be appropriate to give a TCA to treat a person with social phobia. If that a good decision and why?

Back 43

No - TCA's are not dopaminergic and thus will not aid in the symptoms of social phobia which is due to loss of dopamine and dopamine receptors

Front 44

What anxiety disorder does this describe?

Marked or persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation 

Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response, which may take the form of a situationally predisposed Panic Attack

Back 44

Specific Phobia

Front 45

before what age do most cases of specific phobias occur?

Back 45

12, but DSM IV says it must occure before 18

Front 46

what do behavioralists believe causes specific phobias?

Back 46

observing or being involved in a traumatic event

Front 47

what do psychoanalysts believe causes specific phobias?

Back 47

unresolved conflicts in childhood

Front 48

what psychiatric treatments are best for specific phobias?

Back 48

Behavioral therapy with either flooding or systemic desensitization

Front 49

what prescription intervention is most commonly used to treat specific phobias?

Back 49

PRN benzodiazepine - more severe cases

Front 50

what aspect of OCD does this describe?

Recurrent and persistent thoughts, impulses, or images that are
Intrusive and inappropriate
Cause anxiety or distress
Not excessive worries about real-life problems

The patient attempts to ignore or suppress the thought or to neutralize them with some thought or action
Recognized as a product of their own mind

Back 50

OCD Obsession

Front 51

what aspect of OCD does this describe?

Repetitive behaviors or mental acts
Feels driven to perform in response to an obsession or according to rules that must be applied rigidly

The behaviors or mental acts are aimed at
Preventing or reducing distress or preventing some dreaded event or situation
But the behavior or acts are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive

Back 51

OCD Compulsion

Front 52

compulsions/obsessions must occupy what amount of time each day to be considered interfering with daily living?

Back 52

1 hour each day

Front 53

what age range is the onset of OCD most likely?

Back 53

17-22 with almost all cases manifesting before the age of 30

Front 54

who has an earlier onset of OCD, males or females?

Back 54

males

Front 55

what percentage of patients with OCD also have depression?

Back 55

70-80%

Front 56

what are the chances (percentage) of a first degree relative of a person with OCD of getting OCD?

Back 56

20%

Front 57

what type of infection can cause OCD in children?

Back 57

Group A Beta-streptococcal infections

Front 58

what do PET studies of the Cingulate System reveal in patients with OCD?

Back 58

increased metabolism in the frontal lobe and caudate basal ganglion

Front 59

what type of drugs are effective in reducing the symptoms of OCD be reducing metabolism in the frontal lobes and caudate basal ganglion?

Back 59

Drugs which down regulate serotonin production/distribution

Front 60

what type of surgery may cure OCD?

Back 60

Stereotactic Cingulotomy is effective in 40-50% of OCD cases

Front 61

how can you tell the difference between a schizophrenic delusion and an OCD obsession?

Back 61

OCD patients realize there obsessions as being of internal origin and abnormal

Front 62

What is the most effective way to treat compulsions of OCD?

Back 62

behavioral therapy with exposure and response prevention - even better when given with medication

Front 63

What are the 2 DOC for OCD?

Back 63

1. SSRI's
2. Clomipramine

Front 64

What are the 3 major elements of PTSD?

Back 64

1. reexperiencing symptoms
2. avoidance symptoms
3. increased arousal

Front 65

Ned just had a very bad car accident at a car wash. Now he avoids car washes, is having trouble feeling love or other strong emotions, no longer finds joy in his favorite past-times, and has trouble sleeping. What does he suffer from?

Back 65

PTSD

Front 66

How long must symptoms persist for a diagnosis of PTSD to be made?

Back 66

>1 month

Front 67

what percentage of the population suffers from PTSD?

Back 67

7%

Front 68

describe the sleep distrubances that occur in PTSD?

Back 68

decreased rapid eye movement in Stage IV sleep

Front 69

What NT pathways have been implicated in PTSD?

Back 69

noradrenergic and serotonergic pathways

Front 70

what does brain imaging reveal about the brains of people with PTSD?

Back 70

decrease hippocampal volume and increase metabolic activity in the amygdala

Front 71

what is the DOC for treatment of PTSD?

Back 71

SSRI's

Front 72

what is the best treatment option for PTSD?

Back 72

cognitive-behavioral therapy

Front 73

What do the following symptoms describe?

Either while experiencing or after experiencing the distressing event, the individual has three or more of the following dissociative symptoms

A subjective sense of numbing, detachment, or absence of emotional responsiveness
A reduction in awareness of his or her surroundings (e.g., “being in a daze”)
Derealization
Depersonalization
Dissociative amnesia (i.e., inability to recall an important aspect of the trauma)

Back 73

Acute Stress Disorder

Front 74

what is the time frame for the development of Acute Stress Disorder?

Back 74

within 4 weeks of the traumatic event, and lasting 2 days to 4 weeks

Front 75

what drug therapy may be helpful in decreasing anxiety and re-establishing sleep patterns during the short period of Acute Stress Disorder?

Back 75

Benzodiaxepines

Front 76

Describe the disorder associated with this trigger?

Out of the blue high degree of anxiety

Back 76

Panic disorder

Front 77

Describe the disorder associated with this trigger?

Reminder of Trauma

Back 77

PTSD

Front 78

Describe the disorder associated with this trigger?
During a stressor/trauma

Back 78

Acute Stress Disorders

Front 79

Describe the disorder associated with this trigger?

Fear of public embarrasment

Back 79

social phobia

Front 80

Describe the disorder associated with this trigger?

Fear of an event/object/being

Back 80

specific phobia

Front 81

Describe the disorder associated with this trigger?

not able to perform compulsion

Back 81

OCD

Front 82

Describe the disorder associated with this trigger?

Chronic anxiety without panic attacks

Back 82

Generalized anxiety disorder

Front 83

Do people actually realize that their fear is excessive and unreasonable with social phobia (social anxiety disorder?

Back 83

Yes

Front 84

What anxiety disorder is described below?

The avoidance, anxious anticipation, or distress in the feared social or performance situation interferes significantly with person’s routine, occupational functioning, or social activities or relationships, or there is marked distress about having the phobia.

Back 84

Social Anxiety Disorder (Social phobia)

Front 85

Jennifer has anorexia nervosa and does not like to go out to eat in a public place because of her disorder. Does she suffer from a social phobia?

Back 85

No, the fear in social phobia is not of fear is not of stuttering, trembling in Parkinson's disease, or exhibiting abnormal eating behavior in anorexia nervosa or bulimia nervosa

Front 86

If a person who is thought to have Social phobia is scared of most social situations, what other diagnosis might be possible?

Back 86

Avoidant Personality Disorder