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Flashcards in Anxiety Disorders Deck (11)
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1
Q

Anxiety Disorders

A

DSM 5 General changes

  1. no longer includes OCD
    1. (obsessive-compulsive and related dx)
  2. PTSD and acute stress dx
    1. (trauma- and stressor-related dx)

Includes:

  1. Agoraphobia, Specific Phobia, and Social Anxiety Dx (Social Phobia)
  2. Panic Attack
  3. Panic Dx and Agoraphobia
  4. Specific Phobia
  5. Social Anxiety Disorder (Social Phobia)
  6. Separation Anxiety Dx
  7. Selective Mutism.
2
Q

Separation Anxiety

A

DSM 5

  1. Anxiety Dx
  2. includes more detail about the expression of separation anxiety symptoms in adulthood.
  3. adults: symptoms with leaving their children and/or workplace.
  4. No longer onset before 18 yo as substantial number of adults report onset of separation anxiety after age 18!
  5. Duration: typically lasting for 6 months or more has been added.
  • Persistent fear of being alone
  • Excessive distress when separated from home or attachment figure.
  • Frequent physical complaints when separation from attachment figures occurs or is anticipated.
  • Children with Separation Anxiety often come form close caring families and symptoms are frequently precipitated by a major life stress such as death of relative/pet or move to new neighborhood.

School Refusal

  1. intense anxiety about going to school with stomachach, headache, nausea, or other physical symptoms
  2. 5-7 (first school) is more sign of anxiety, 11-12 (change of schools) and 14+yo is more sign of depression or other more severe disorder.
  3. treatment should include an immediate return to school
3
Q

Agoraphobia,

Specific Phobia,

Social Anxiety Disorder (Social Phobia)

A

DSM 5

  • Deletion of requirement that those 18 yo and older recognize that their anxiety is excessive or unreasonable.
  • anxiety must be out of proportion to the actual danger or threat in the situation (after taking cultural context in to account).
  • 6-month duration is extended to all ages (not just under 18yo).
    • minimize diagnoses of transient fears.

panic disorder and agoraphobia are no longer linked together.

They are now recognized as two separate disorders. The APA justifies this unlinking because they found that a significant number of people with agoraphobia do not experience panic symptoms.

4
Q

Anxiety and Depression

A
  1. overlap of depressive and anxiety symptoms: imparied concentration, memory, irritability, fatigue, insomnia, and selse of hopelessness.
  2. Anxiety: higher level of positive affect and autonomic arousal
  3. Pure Anxiety: tension, apprehension, trembing, worry and nightmares.
  4. Depression: depressed mood, anhedonia, loss of interest in usual activities, SI and decreased libido.
  5. outpatients with anxiety dx 50% with another dx as well.
  6. GAD: highest comorbidity 90%, most often with MD or dysthymia, substance abuse, simple phobia and social phobia.
5
Q

Agoraphobia

A

Agoraphobia symptom criteria:

“although endorsement of fears from two or more agoraphobia situations is now required, because this is a robust means for distinguishing agoraphobia from specific phobias,”

“Also, the criteria for agoraphobia are extended to be consistent with criteria sets for other anxiety disorders (e.g., clinician judgment of the fears as being out of proportion to the actual danger in the situation, with a typical duration of 6 months or more).”

anxiety about being in situations or places from which escape may be difficult or embarrassing or which help may not be available if a panic attack or other symptoms occur.

fear of being outside the home alone, being in a crowd, and travel on bus, train, or car.

feared situations are avoided or endured with distress.

**Prevalence: **

1-2% Panic Dx, w/ .3-.5 of those with Agoraphobia.

Prepubertal children may have physical symptoms of panic, they rarely receive the dx of Panic Dx

  • childrene have cognitive limits that do not allow them to make catastrophic interpretations of their bodily symptoms (maybe?).

PDA(panic dx with agoraphobia): higher rates of comorbidity, 59% also had mood or other anxiety dx, MDD most common, followed by GAD and then social phobia.

Treatment:

  • In vivo exposure with response prevention (flooding) is most effective treatment for panic attacks and agoraphobia.
  • Exposure is supplemented with CBT, relaxation and breathing retraining and/or Meds.
  • experience a decrease in symptoms when they have a trusted friend with them.
6
Q

Panic Attacks

A

DSM 5

  1. Unexpected and expected manic attacks are now only 2 different types.
  2. Panic attacks function as a marker and a prognostic factor for severity of diagnosis, course, and comorbidity across an array of disorders, in addition to anxiety dx.
  3. panic attack can be listed as a specified that is applicable to all DSM 5 dx’s.

2 or more unexpected panic attacks, with at least one of the attacks being followed by one month of persistent concern about having another attack, worry about the implications of the attack, significant change in bx related to the attack. Can occur during sleep!

discrete period of intense apprehension, fear, or terror that develops abruptly, peaks w/in 10 min, and is often accompanied by a sense of doom or urge to escape.

4 characteristic symptoms and at least some of the panic attacks be unexpected (spontaneous/uncued).

some may have dituationally bound (cued) and situationally predisoposed attacks, which are also characterisitic of other dx’s.

1-2% rate of dx.

treatment:

imipramine and other TCAs, SSRIs, benzodiazepines, and for some anticonvulsants

30-70% relapse of symptoms with Meds alone, w/in months of discontinuing the drug.

7
Q

Specific Phobia

A

Specific phobia symptom criteria remain unchanged from the DSM-IV, except:

  1. adults no longer must recognize that their anxiety or fear is excessive or unreasonable.
  2. Symptoms must also now have been present for at least 6 months for all ages in order for a diagnosis to be made of specific phobia.
  3. Different types of specific phobias now referred to as specifiers: animal, natural environment, situational(flying, elevators), blood-injection-injury, and other.
    1. *​Blood-injection-injury: *initial increase in heart rate and blood pressure and then immediatly drop in both and thus…fainting. Treatment is paradoxical, to tense muscles with feared stimuli.

marked and persistent fear of a specific object or situation other than those associated with agoraphobia or social phobia.

exposure to the feared stimulus almost always procues a panic attack, so it is avoided or endured.

ONSET: usually in childhood or in the mid-20’s.

8
Q

**Specific Phobia **

Etiology

Treatment

A

Etiology:

Mower’s two-factor theory:

  1. avoidance conditioning: combination of classical and operant conditioning.
  2. first people learn to fear a neutral (conditioned) stimulus because its pairing with an intrinsically anxiety-arousing (unconditioned) stimulus:
    1. their avoidance response is then negatively reinforced because it keeps them from experienceing anxiety.
      1. (i don’t fly, i stay calm)
      2. people avoid the conditioned stimulus, they never extinguish the conditioned fear.

Social Learning Theory:

  • phobic reactions as the result of vicarious learning in which excessive anxiety and avoidance bx are acquired by observing the bx of parents and others.

Treatment:

  1. In vivo exposure with response prevention (flooding) is treatment of choice for specific phobia.
  2. cognitive self-control has also been found effective for children’s fear of the dark.
    1. incorporates relaxation, visualization of a pleasant scene, and positive self-statements (i am brave).
9
Q

Social Anxiety Disorder

(social phobia)

A

DSM 5

  1. Now called Social Anxiety Disorder
  2. ‘generalized’ specifier replaced with ‘performance only’ specifier.
  3. individuals who fear only performance situations appear to represent a distinct subset of social anxiety disorder in terms of etiology, age at onset, physiological response, and treatment response.

marked and persisitent fear of social or performance situations that may cause embarrassment or humiliation.

exposure to feared situation produces an immediate panic attack or intense anxiety, avoids, or endures w/distress.

Etiology:

  1. Biological: serotonergic, dopaminergic and noradrenergic system abnormalities
  2. Classical Conditioning
  3. Cognitive Factors: information processing biases, including a tendency to attend selectively to socially threatening information, and to overestimate the likelihood for negative outcomes in social situations.

Treatment

  • Exposure therapy and its benefits may be enhanced when combined with social skills training or cognitive techniques.
  • MEDS:
    • several antidepressants have been effective
    • beta-blocker propranolol also useful for reducing the somatic symptoms of anxiety.
10
Q

Selective Mutism

A
  1. Now classified as an anxiety disorder, given that a large majority of children with selective mutism are anxious.

Children and adults with selective mutism are fully capable of speech and understanding language but fail to speak in certain situations, though speech is expected of them.

The behaviour may be perceived as shyness or rudeness by others. A child with selective mutism may be completely silent at school for years but speak quite freely or even excessively at home.

There is a hierarchical variation among people with this disorder: some people participate fully in activities and appear social but do not speak, others will speak only to peers but not to adults, others will speak to adults when asked questions requiring short answers but never to peers, and still others speak to no one and participate in few, if any, activities presented to them.

In a severe form known as “progressive mutism”, the disorder progresses until the person with this condition no longer speaks to anyone in any situation, even close family members.

Selective mutism is by definition characterized by the following:

  • Consistent failure to speak in specific social situations (in which there is an expectation for speaking, e.g., at school) despite speaking in other situations.
  • The disturbance interferes with educational or occupational achievement or with social communication.
  • The duration of the disturbance is at least 1 month (not limited to the first month of school).
  • The failure to speak is not due to a lack of knowledge of, or comfort with, the spoken language required in the social situation.
  • The disturbance is not better accounted for by a communication disorder (e.g., stuttering) and does not occur exclusively during the course of a pervasive developmental disorder, schizophrenia, or other psychotic disorder.

Selective mutism is strongly associated with anxiety disorders, particularly social anxiety disorder.

In fact, the majority of children diagnosed with selective mutism also have social anxiety disorder (100% of participants in two studies and 97% in another).

Some researchers therefore speculate that selective mutism may be an avoidance strategy used by a subgroup of children with social anxiety disorder to reduce their distress in social situations.

11
Q

Generalized Anxiety Disorder

GAD

A

Excessive anxiety and worry about multiple events or activities that are relatively constant for at least 6 months, the person finds difficult to control, and are disproportionate to the feared events or their potential impact.

restlessness or feeling on edge/keyed up,

easily fatigued, difficulty concentrating, irritability

muscle tension, sleep disturbance

AGE:

  1. Children/adolescents: worry about performance in school and sports acgtivities or about earthquatkes, tornados, or other disasters.
  2. young adults: worry about work, family, money, and the future.
  3. older aldults: worry about personal health and minor/routine matters.
    1. anxiety disorders are twice as common than depression in these older groups, with GAD being the most diagnosed.
    2. cognitive impairment, sleep distrubances, and problems carrying out daily activities
    3. may lead to anxious depression if untreated.

**Treatment: **

  1. multicomponent CBT, combination of CBT and Meds is most beneficial.
  2. SSRIs and anxiolytic buspirone (Buspar) effective.

Differential Diagnosis:

those with nonpathological anxiety feel they can control their anxiety to some degree, are anxious about a fewer number of events, and less likely to have associated physical symptoms.