Anxiety Disorders

Social Phobia {Treatment}

- Preferred treatment CBT ; this is what should be done first! - Beta blockers (relaxes heart so your not as afraid); don't develop coping methods in the long run - Tricyclic antidepressants - Monoamine oxidase inhibition (bad side effects and cannot mix w/other meds) - PRIMARILY USED: SSRI (FDA approved) RELAPSE RATE HIGH AFTER MEDICAL DISCONTINUATION

Panic Attack: Positive feedback loop

Physical symptoms arouse thoughts/action and then the thoughts cause an increase in physical symptoms

What IS a panic attack?

Physical symptoms that have to do with intense fear or discomfort and must last only 5 minutes and reach its peak - It is analogous to fear - 4 symptoms = full panic attack - 3 symptoms= limited panic attack

Anxious parents can be a strong _ for children to become anxious

model

GAD is the anxiety disorder that is _ likely to occurs as comorbid condition

most

PTSD {Facts}

- 7.8 % of population - affects a lot of returning troops but not all b/c of diathesis! Some people have a predisposition due to DNA Most common traumas - sexual assault - Combat - Accidents Causes - Intensity of trauma and the person's rxn - Previous trauma - Weak social support - Uncontrollable or unpredictable

Panic Disorder {Treatment}

- BEST : CBT Alone - SSRI (PREFERRED) - No advantage seen for combination -nocturnal attacks (not due to nightmares) HIGH RELAPSE RATE AFTER MEDICATION

OCD {Treatment}

- BEST: CBT ALONE (ERP)= prevents compulsion rxn - Psychosurgery (ANT./POST. Cingulate, which is in overdrive) - SSRI's (benefits 60%) RELAPSE IS COMMON AFTER MEDICAL DISCONTINUATION

What causes phobias?

- Biological/evolutionary vulnerability - Direct conditioning - False alarm - Observational Learning - Information transmission

PTSD {Treatment}

- CBT (EFFECTIVE) to increase + coping skills & social support

What are the features of anxiety?

- FUTURE oriented; apprehensions about future danger - NO activation of SNS; just tension

PTSD {Criteria}

- Impairment/distress - Within 1 MONTH after trauma there is an experience of symptoms: re-experiencing (at least 1), avoidance (3 or more), arousal (2 or more) - Delayed onset: after 6 MONTHS or more after trauma

Pathological Anxiety

- Influenced by cognitions more - Overestimation of threat - Underestimation of coping resources - Attempts to control mood, thoughts, environment

Generalized phobia

- More severe and includes almost all specific phobias - Less educated - More depressed - More likely to abuse alcohol

When does anxiety/ fear becomes a disorder?

- PERVASIVE & PERSISTENT - EXCESSIVE AVOIDANCE - SIGNIFICANT DISTRESS/IMPAIRMENT

What are the features of fear?

- PRESENT oriented - Abrupt SNS activation (automatic) - Strong avoidance/ escapist tendencies

List of anxiety disorders

- Panic Disorder - GAD - Specific Phobia - Social Phobia

Social Phobia {Criteria}

- Persistent fear - 6 months with 1 or more social situation where person is exposed to possible scrutiny (negative evaluation) - Exposure= anxiety or panic - Avoidance & distress - Impairment

Why is comorbidity b/w anxiety disorders and depression so high?

They are a part of a larger group of internalizing disorders; 58% MDD meet criteria for anxiety

GAD _ risk of having MDD

increases

Definition of internalizing disorder

inward-focused experiences/behaviors

Anxiety disorders are the _ domain of psychopathology

largest

Specific Phobia

limited to specific activity in public

Specific phobia {Facts}

- 11% if population - affects more females - don't go away w/put treatment - starts young, 15-20

Fear is _ to cognitive influences; controls thoughts

immune

Panic Attack {Facts}

- 3.5% of population - females - acute onset; 25-29 - Can be present in any anxiety disorder but ate unexpected and feared in panic disorder

GAD {Facts}

- 4 % of population affected - Occurs to females more often - behavior seems harmless at first - early adulthood - runs in families - highly related to depression - Avoidance tendency (worry to suppress arousal)

Panic Disorder {Criteria}

- Recurrent UNEXPECTED (can't expect it) /FEARED (ongoing) panic attacks **** - At least 1 attack was followed by 1 MONTH or more of the following: ***** Concern for another attack Worry about possible consequences of attack Change in behavior due to attacks - Not due to substance use - Presence/Absence of Agoraphobia - Not accounted for by an Axis I disorder - Subtypes of Panic Attack: Certain situations (cued) Nothing in particular (uncued) Sometimes they do or don't

Common etiological factors?

- Temperament (shyness, behavior inhibition, Anxiety sensitivity, vigilance of threat) *inhibition starts in childhood - Sensitive to negative evaluation - Stressful life events

GAD {Criteria}

- excessive anxious apprehension (odd) - uncontrollable - Causes distress and impairment - Presence of 3 or more symptoms (TENSION, FATIGUE, IRRITABILITY, TROUBLE CONCENTRATING) - Occurring more days than not 6 MONTHS OR MORE - NOT DUE TO PHYSICAL CONDITION OR INGESTION OF SUBSTANCE

What is a specific phobia?

- extreme, irrational fear of an object/animal/situation - interferes with functioning - people know its unreasonable - avoidance of objects that arouses phobia

Is anxiety inherited?

- genetic contribution may ^ w/age - twin studies: 30-40% can be accounted foe by genetic influences

Subtypes of PTSD

1. Acute PTSD (1-3 MONTHS POST) 2. Chronic PTSD (after 3 MONTHS POST) 3. Delayed onset (after 6 MONTHS POST) 4. Acute stress disorder ( LESS than 1 MONTH POST)

Types of Specific phobias

1. Blood-injury-injection 2. Situational (PA, planes) 3. Natural environment (heights, storms) 4. Animal 5. Other (choking, vomiting) 6. Separation anxiety disorder (happen to you if away or to the other person)

What does comorbidity suggest?

Anxiety disorders have common factors & about half of patients have 2 or more secondary diagnosis

Agoraphobia

Avoiding situations where you might not have help or cannot escape IF you have a panic attack - on highways (no escape) - being alone - in line (crowded) - movie theater (crowded)

GAD {Treatment}

CBT & Benzodiazapenes/SSRI's

Specific Phobia {Treatment}

CBT (very effective; 1-2 days) Exposure

OCD { Criteria- cont.}

Can have OBSESSION w/out compulsion but you cannot have compulsions w/out obsession and still meet criteria

The integrated view of anxiety

Caused by genetic, psychological, experiential and social variables

_ comorbidity b/w MDD, panic and social phobia

High

What is unique about PTSD in the DSM?

It is the only one that involves past experiences as a part of criteria

OCD- not otherwise specified

Just a compulsion or not 1 hour of ritual

When is social phobia not just shyness?

Must cause high impairment and interference in work, social functioning and perhaps substance abuse

Definition of Anxiety

Negative mood state w/ bodily symptom & apprehension of the future

OCD {Criteria}

Obsessions - intrusive, not appropriate thoughts (recurrent)**** - irrational or rational but extreme - attempt to suppress, ignore thoughts with some some other thought/action - person knows that this is in their own mind (UNLESS ITS A CHILD) Compulsion - repetitive, intentional behaviors or mental acts IN RESPONSE to the obsession - this is meant to REDUCE DISTRESS (acts are not connected with obsession or are clearly excessive) This all must be severe Time consuming (1hr a day) in 1 month Interfere with normal routine - Not due to ingestion of substance or other medical disorder - Content of obsession/compulsion is not restricted to presence of Axis 1 disorder ( if present)

Symptoms for PTSD

Re-experiencing: AT LEAST 1 - recurring situations where person feels as if event is occurring - recurring dreams of event - recurring recollections of events Avoidance: 3 OR MORE - avoid situations that are symbolic or represent the event - amnesia for important parts of the event - efforts to avoid thoughts/feelings about event - restricted effect Arousal: 2 or more - heightened startle reflex - very angry, irritable - sleeping issues - hyper-vigilance Interpersonal problems

Are anxiety and fear different?

Yes. However, both have marked negative effect and can appear to be out of control

Fear learning is organized around _

amygdala

More likely to fear things that threatened survival of our _

ancestors

Parents must be _ and _ of anxious children

challenging, non-supportive

Comorbidity is _ across anxiety disorders; most common?

common; Major depression- they are closely related

Fear can be _ to cues associated with _

conditioned; danger

Amygdala mediates input from _ and _ to _ and _ nuclei that control aspects of overt fear behavior

cortical; thalamic to hypothalamic; brain stem

Anxiety and fear are _ related

evolutionarily

Can be conditioned to _ almost anything

fear

Panic disorder contains elements of both _ and _

fear (flight/fight) ; worry (disorder)

Fear motivates _

response

Toshiaki Furukawa found _ medication worked for GAD and MDD

same

There is a link between shyness and later development of _

social phobia