Anxiety Disorders

Panic Attack Criteria

- A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms occur: Palpitations, pounding heart, or accelerated HR Sweating Trembling or shaking Sensations or SOB or smothering Feeling of choking Chest pain or discomfort Nausea or abdominal distress Feeling dizzy, unsteady, lightheaded, or faint Derealization (feelings of unreality) or depersonalization (being detached from onself) Fear of losing control or going crazy Fear of dying Paresthesias (numbness or tingling sensation) Chills or hot flashes

Treatment for Anxiety Disorders

-Antianxiety medications and cognitive behavior therapy (CBT) are standard approaches with strong research efficacy for treating anxiety, as well as the behavioral and psychosocial response to fear. -The most commonly used meds are benzodiazepines (BZ's) and certain antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs). - Prozac, paxil, luvox, Zoloft, and celexa are common medications used -BZs include Xanax and Ativan.

Impact on Occupational Performance

-Anxiety d/o's create a substantial burden on the occupational performance -Measurement of QoL are often used to assess an individual's subjective sense of well-being. -Anxiety d/o's significantly compromise QoL and psychosocial functioning. In turn, anxiety hinders learning by interrupting cognition and affective and psychomotor functioning. -The economic costs of anxiety include hospitalizations, medications, absenteeism from work, loss of productivity, and suicide. -Those with PTSD have a significantly higher risk for diminished well-being, consistent employment, physical health and limitation than those without PTSD.

Cognitive and Psychological Factors of PTSD

-Cognitive and psychological factors also play a significant role in development of anxiety d/o's. For ex., the cognitive model of panic d/o purports that only individuals who misinterpret physical and psychological symptoms associated with panic will develop panic d/o's. This misinterpretation of threat can lead to cognitive distortions associated with anxiety. -Associated with cognitive distortions are cognitive schemas or ways of perceiving the world. Cognitive schemas carry with them care beliefs, rules, and attitudes about specific situations and give rise to automatic thoughts. -For ex., an individual w anxiety may hold the dysfunctional schema that "other people will always take advantage of me." This schema will in turn promote automatic thoughts that feed anxiety, such as "I have to always protect myself," or "other people are to be feared."

Agoraphobia

-From Greek, "fear of the marketplace." -Fear of having a panic attack in public and the resulting humiliation and dependence that the attack may cause; previously mistaken for fear of open spaces or crowds -The person avoids situations in which he or she is worried about having a panic attack. NOTE: Agoraphobia is not a diagnosis, but is used as a specifier for panic disorder when it accompanies the condition

The Course of Anxiety

-If untreated, anxiety disorders can become chronic and unremitting. The course of the various types of anxiety disorders varies in terms of age of onset, severity, gender, and functional impairment. The mean age of onset of social phobia has been reported to be 14 year of age; it has a chronic, unremitting course associated with a pervasive detrimental impact on daily functioning. -OCD is chronic and may occur as young as 6 years of age -GAD may extend for 20 years or longer, with low rates of remission.

Anxiety Disorders

-Most common of all psychiatric disorders -Affects approximately 40 million adults or 18% of adults in the U.S. -A fear response is essential to human survival. -However, a prolonged state of anxiety is maladaptive to the human organism -Most common characteristic of an anxiety disorder is the inappropriate expression of fear -Anxiety can range from relatively mild feelings of uneasiness to immobilizing terror

Environmental Factors for PTSD

-PTSD is rooted in experiencing traumatic life events. PTSD is dx'd in those who have experienced a major stressor(s) or traumatic event that was perceived as life-threatening and involved intense emotions such as fear, helplessness, and horror. These types of events include natural disasters, war, acts of violence, and accidents, all of which can lead to development of anxiety disorders. -One study found that as many as 80% of injured children will develop at least one symptom of acute stress response within weeks of the incident, placing them at risk for PTSD. -Some people are more susceptible to PTSD than others. Those with a hx of depression or panic d/o are more likely to develop PTSD after a traumatic event.

Panic Attack vs. Disorder

-Panic disorder is the diagnosis, but panic attack describes the specific symptoms that have to occur. -Panic disorder requires experiencing recurring panic attacks; however, panic attacks may not develop into a disorder if they occur infrequently

Stress Etiology for PTSD

-The CNS is aroused, and the fight-or-flight-or-freeze mechanism begins to defend against noxious stimuli -A stage of adaptation mobilizes major muscles, respiration, and the senses in order to fight or flee -The third and final stage is one of exhaustion, marked by compensatory mechanism that interfere with homeostasis -Selye speculate that the stage of exhaustion was responsible for the onset of diseases he termed diseases of adaptation

Gender Differences for PTSD

-Women are at a significantly higher risk than men for anxiety disorders. This may be due to socioeconomic disadvantage, gender-based violence, subordinate social status, and responsibilities for caring for others. -Symptoms and consequences of symptoms vary in men and women. Women with panic disorder fear the physical consequences of anxiety more than men; women also report more symptoms during panic attacks than men.

Obsessions

A. Recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress B. The thoughts, impulses, or images are not simply excessive worries about real life problems C. The person attempts to ignore, suppress, or neutralize the thoughts, impulses, or images D. The person recognizes that the obsessional thoughts, impulses or images are a product of his or her own mind (not imposed from without as in thought insertion)

Panic Disorder

A. Recurrent, unexpected panic attacks B. At least one of the attacks has been followed by 1 month (or more) of one (or more) of the following: - 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 Panic disorder is further specified as with or without agoraphobia, depending on whether the person meets the criteria for agoraphobia

Compulsions

A. Repetitive behaviors (e.g., hand washing, ordering checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly. B. The behaviors or mental acts are aimed at preventing or reducing distress, or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize. C. At some point, the person recognizes that the obsessions or compulsions are excessive or unreasonable. D. The obsessions or compulsion case marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person's normal routine, occupational or usual social activities.

Obsessive-Compulsive Disorder

Another anxiety disorder that can lead to suffering and impairment. With this d/o, individual may fear, for ex., that he or she is "losing his mind," his child is in danger, or his house will burn down. These thought can lead to compulsive checking behaviors, such as returning to check the stove several times before leaving the house. The individual has either obsessions or compulsions.

Culture-Specific Information

Contributions to stress and anxiety from the cultural environment can include: - Cultural beliefs (e.g., breaking a taboo can cause a voodoo death) - Cultural demands (e.g., academic achievement or the restricted life of a widow) - Discrimination of immigrant groups or separation from family members during the war - Rapidly changing value systems (e.g., young adults wants to break away from the regulated choice of a mate)

Generalized Anxiety Disorder

Excessive anxiety and worry, occurring more days than not for at least 6 months, concerning a number of events or activities The person finds it difficult to control the worry Anxiety and worry are associated with 3 (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months): 1. Restlessness or feeling keyed up or on edge; 2. Being easily fatigued; 3. Difficulty concentrating or mind going blank; 4. Irritability; 5. Muscle tension; and 6. Sleep disturbance The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning superego issue - lack of control of the world, so try to over control their own life

Types of Anxiety Disorders

Panic disorder Agoraphobia Generalized anxiety disorder Obsessive-compulsive disorder Post-traumatic stress disorder Social phobia Specific phobia Substance-induced anxiety disorder Anxiety disorder due to a general medical condition

Genetic Factors for PTSD

Twin studies provide evidence for strong genetic component in anxiety disorders and comorbidity rates of anxiety, depression, and eating disorders

Structural and Functional Neuroanatomical Factors for PTSD

Two brain centers of brain regulate memory storage and emotion: Hippocampus Amygdala -Sensory information sent to the amygdala, where it projects to the hypothalamus, which in turn activates the sympathetic nervous system. -It is the hypothalamic—pituitary—adrenocortical (HPA) axis that activates a defensive response in a person experiencing fear. -fMRI's demonstrate that dysregulation of the HPA axis is associated with anxiety d/o's. -Also, reductions in the size of the hippocampus have been found in people with PTSD. Further, chronic fear can trigger dramatic glucose utilization in the frontal cortex, which has been associated with OCD. -Stressful stimuli activate a cascade of hormones and neurotransmitters that contribute to the behavioral response of anxiety. -Extreme fear or panic cause cortisol to be released from the adrenal gland that sits above the kidney. The job of cortisol is prepare the body for fight or flight; thus, its release leads to increased BP and blood sugar levels. Elevated cortisol levels, however, suppress the immune system and, as mentioned previously, are implicated in the physiological distress associated with anxiety disorder. -Neurotransmitters are also implicated in the development of social phobia, panic disorder, and PTSD.

Post-Traumatic Stress Disorder (PTSD)

Unique among anxiety disorders due to its association with a terrifying or life-threatening event; Impairment result from re-experiencing the event either in dreams or flashbacks, or avoidance of specific places or situations. Criteria: 1. The person has been exposed to a traumatic event with both of the following: The person experienced, witnessed, or was confronted with an event that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. The person's response involved intense fear, helplessness, or horror hypervigilance - can't turn this off at will -very exhausting The traumatic event is persistently re-experienced in one of the following ways: -Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. -Recurrent distressing dreams of the event -Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). -Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event use gentle approaches, calm environment and tone -Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. -Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness as indicated by 3 or more of the following: -Efforts to avoid thoughts, feelings, or conversations associated with the trauma -Efforts to avoid activities, places, or people that arouse recollections of the trauma -Inability to recall an important aspect of the trauma -Markedly diminished interest or participation in significant activities -Feeling of detachment or estrangement from others -Restricted range of affect -Sense of foreshortened future Persistent symptoms of increased arousal (not present before the trauma), as indicated by 2 or more of the following: -Difficulty falling or staying asleep -Irritability or outbursts of anger -Difficulty concentrating -Hypervigilance -Exaggerated startle response -The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

Collectivism

a frame of reference whereby an individual's behavior and worth are determined by the valued groups. Thus, the family's thoughts, feelings, and actions bring worth to individual family members, and individuals who assert their own thoughts, feelings, and actions do so at the risk of alienation.

Psychosocial Intervention Approaches

include cognitive behavioral therapy (CBT), relaxation therapy, and expressive writing or journaling.

Simpatico

is the ability to empathize with others and remain agreeable, even if it means personal sacrifice. Latino cultures tend to value controlling, restrictive, and primarily physical rather than verbal parenting styles, promoting dependent and obedient children. This type of parenting style is linked to avoidance of psychological issues, leading to children who are anxious.