Anxiety Disorders

Psychodynamic: Genetic: -unconscious conflict/impulse signals CGO -increased familial risk Types of Anxiety: Uncued/Spontaneous Anxiety/Panic Cued/Phobic/Situational Anxiety/Panic Anricipatory Anxiety Fear-response to external threat Anxiety-emotional state, unknown source -usually w/ physiological SSx -esp female & 1st degree -alcoholism, 2ndary depression ESP BLOOD-INJURÝ PHOBIA Learned: GAD due to unprediccabllty of (+)/(-) reinforcement Classical conditioning: -learn to avcid neutral/berign situations Theories Arıxiety vs Fear 35% pop'n has >=1/yr 0.7% pop'n w/ PD -usually 15-25yo -prot depression if >40yu oten >fears of death, more attacks, Tx: Biochemical: -LOCUS CERULEUS -70% of NE-releasing neurons -increased via caff, lactete, isoproterenol, epi, yohimbe, p peroxam ->increased anxiety -alpha2 agonists, beta blockers reduce anx -SSRI, MAOI, benzos (down-reg LC's NE) CET, exposure Tx Rx: TCAS, MAOI, SSRI Benzo anxiolylics faster going crazy, being uncontrclled -attacks begin suddenly, last <10min -can be confused w/ anticipatory anx -can->phobias if avoidance of situations where panic has occurred Excessive anx/worry over 6 mos -for majority of days -restiessness, easily fatigued, dif to concentrate, irritable, tense, sleep disturbance can mimic CNS depressant w/draw or caffeine intoxication Ccmbination of both is best PANIC DISORDER Due to GABA-benzo system hyperactivity Tx: benzos GENERALIZED ANXIETY D/o Can be w/ or w/out açoraphobia Agora. more often w/OUT PD Panic Attacks: 4+ Aorupt Sx: Palos/tachycard, sweating, trembling, SOB, chcking, chest pain, nausea/abd distress, dizzy/light-headedness, derealization/depersonalization, fear of losing control/going crazy, fear of dying, paresthesias, chills/hot flashes -but recurrence on discontinuir buspirone -TCAS, venlafaxine (FDA-approv- -behavioral Tx not very effecti -can't specify stimuli Anxiety Disorders A.Experience/witness event + Responds w, horror/fear B.Then recurrent images/thoughts/dreams C.Avoidance of stimuli ass'd w/ trauma D.Persistent state of arousal E.All Sx > 1 mɔ (acute if <3mo) -acute mɔst Ilikely curable "Delayed onset" if >6mo from trauma SPECIFIC PHOBIA DDx-early 20s; rare after 40yo -ask about avoided situations -do they feel "trapped"? -they feel they will panic, etc. If in those situations -most realize fears are ridiculcus -what do you do to face it? -does anxiety decrease if there for a long time? Blood-Injury Phobia -they actually faint-vasovagal syncope -due to sight, experience, discussion of blood Fear of flying can look like agoraphobia SOCIAL PHOBIA POST-TRAUMATIĆ STRESS D/O Recognized irrational fear of embarrassment, humiliation when perfcrming in public Orset at puberty, present in 20s Tx: beta-blockers 1 hr before performance benzos-dependency risk gabapentin-no depencence MAOI, SSRI good SSRI-first-line treatment Tx: Obsessions: repetitive, intrusive Ideas, Images, Impulses Compulsions: rituals to decreese anxiety or discomfort If can't perform ritual->anx OCD can be 2ndary to MDD Perhaps serotonin dysfunction Tx: Exposure therapy: single most effective Tx Rx: use lowest effective dose -state-dependen: learning Acute-encourage to talk about experience -returned to front lines Chronic-exposure helpful if avoidance behavior is present -Rx for depressive, anx, dream Sx -beta-blockers if tremor present -SSRIS for arousal, numbing/avoidance -sertraline FDA-approved for PTSD -exposure (in fantasy if needed) AGORAPHOBIA Fear of being caught in stuation OBSESSIVE-COMPULSIVE D/o from which exit would be difficult if pt had panic attack or discomfort Eg: auditoriums, crɔwds, lines, Tx: Rx-potent SSRIS TCA-clomipramine Anxiolytics sometimes helpful Antipsychotics sometimes Other: ECT w/ primary depression -ant. cingulotomy, capsulotomy -for SEVERE OCD mass transit, driving ->hyperventilation, rare fainting DDx: different from phobias -fears are more complex -more concern w/ resulting rituals, not rcally fearing the object -phobics w, more anxiety