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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

Anxiety Disorders

shared by googlear on Jun 14
Anxiety disorders are the most common of emotional disorder and occur with other mental or physical illnesses, including alcohol or substance abuse.



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