Published on August 27, 2007
Anxiety Disorders: Anxiety Disorders 3.1.06 3.1.06: 3.1.06 Adult anxiety disorders Panic disorder Phobias OCD GAD PTSD Internalizing Background: Background Anxiety vs. Fear Negative mood state, somatic symptoms of tension, and the apprehensive anticipation of future danger Immediate alarm reaction to present danger Is fear always bad? Is anxiety always bad? Yerkes-Dodson law: Yerkes-Dodson law Background: Background Prevalence, sex ratio, onset and comorbidity Self-medicating Types of symptoms: Cognitive Physiological Behavioral Insight and impairment Panic disorder: Panic disorder Recurrent, unexpected panic attacks 1+ month of: Concern about having more attacks Worry about implications of the attack Change in behavior b/c of attack With or without agoraphobia Panic attack: Panic attack 4+ sxs, peak within 10 min: Pounding or racing heart Sweating Trembling/shaking Short of breath, smothered Choking Chest pain Nausea Dizzy, lightheaded Derealization, depersonalization Fear of losing control or going crazy Fear of dying Numbness or tingling Chills, hot flashes Panic disorder: Panic disorder Recurrent, unexpected (i.e., uncued) panic attacks Versus: cued/situationally bound, situationally predisposed 1+ month of: Concern about having more attacks Worry about implications of the attack Change in behavior b/c of attack With or without agoraphobia Agoraphobia: Agoraphobia Anxiety about being in places/situations from which escape might be difficult/embarrassing, or in which help may not be available in the even of having panic symptoms/attacks Situations avoided or endured with marked distress/anxiety Panic disorder: Epidemiology: Panic disorder: Epidemiology Prevalence Sex ratio Age at onset Panic disorder: Etiology: Panic disorder: Etiology Biological vulnerability Twin and family studies Psychological vulnerability Stressful situations Learned fearfulness -andgt; physical/cognitive spiral Panic disorder: Etiology: Panic disorder: Etiology Perceived threat Trigger stimulus Bodily sensations Trigger stimulus Catastrophic interpretation of sensations Apprehension or worry Panic disorder : Treatment: Panic disorder : Treatment Psychological CBT + exposure Drugs Antidepressants, benzodiazepines Phobias: Phobias Fear is out of proportion to the object/situation Stimulus always provokes anxiety Person recognizes that fear is excessive Impairment or distress Not just a normal fear response Slide15: Specific phobia: Specific phobia Fear of a certain object/situation Animal type Natural environment Blood-injury-injection Situational Other Epidemiology Etiology Treatment Slide17: Social phobia: Social phobia Social anxiety vs. social phobia A persistent fear of social or performance situations in which embarrassment may occur. 'Generalized' specifier Social phobia: Social phobia Epidemiology Etiology Skills deficit Cognitive self-evaluation model Evolutionary preparedness Biological/genetic predispostion Diathesis-stress Treatment Obsessive-compulsive disorder: Obsessive-compulsive disorder Recurrent obsessions OR compulsions that cause marked distress, are severe enough to be time consuming (andgt;1 hr/day) OR significantly interfere with functioning. Obsessions – recurrent, intrusive thoughts that one tries to resist/eliminate Ego-dystonic Compulsions – repetitive behaviors/mental acts OCD: OCD ___________ Contamination Repeated doubts Aggressive impulses Sexual thoughts Blurting or thinking obscenities/insults ___________ Checking Cleaning/washing Counting Ordering Routinesin normals: Routines in normals OCD: OCD Hoarding Epidemiology Etiology Behavioral models Cognitive models Biological/genetic models Diathesis-stress Treatment Slide24: A 27-yr-old married electrician complains of dizziness, sweating palms, heart palpitations, and ringing of the ears. This has been going on for more than 18 months. He has also experienced dry mouth and throat, periods of extreme muscle tension, and a constant 'edgy' and watchful feeling that has often interfered with his ability to concentrate. These feelings have been present most of the time over the previous 2 years; they have not been limited to discrete periods. Although these symptoms sometimes make him feel 'discouraged,' he denies feeling depressed and continues to enjoy activities with his family. Because of these symptoms, the patient had seen a family practitioner, a neurologist, a neurosurgeon, a chiropractor, and an ear-nose-throat specialist. He had been placed on a hypoglycemic diet, received physiotherapy for a pinched nerve, and told he might have 'an inner ear problem.' He also has many worries. He constantly worries about the health of his parents. His father suffered a stroke 2 years ago, but has completely recovered. He also worries about whether he is 'a good father,' whether his wife will ever leave him (there is no indication that she is dissatisfied with the marriage), and whether he is liked by co-workers on the job. Although he recognizes that his worries are often unfounded, he can’t stop worrying. For the past two years, the patient has had few social contacts because of his nervous symptoms. Although he has sometimes had to leave work when the symptoms became intolerable, he continues to work for the same company he joined for his apprenticeship following high-school graduation. He tends to hide his symptoms from his wife and children, to whom he wants to appear 'perfect,' and reports few problems with them as a result of his nervousness. Generalized Anxiety Disorder: Generalized Anxiety Disorder Excessive, chronic (andgt;6 mo), uncontrollable and unrealistic worry about a number (andgt;2) of things 3+ physical sxs: Muscle tension Easily fatigued Restlessness, on edge Difficulty concentrating, mind goes blank Irritability Sleep disturbance GAD: GAD Epidemiology Etiology MDD Treatment Post-traumatic Stress Disorder: Post-traumatic Stress Disorder Exposure to a traumatic event Witness, victim, confrontation Outside realm of typical human experience Respond with fear, helplessness, horror Traumatic even is persistently reexperienced Avoidance and emotional numbing Increased arousal PTSD: PTSD Exposure to a traumatic event Respond with fear, helplessness, horror Traumatic even is persistently reexperienced Avoidance and emotional numbing Increased arousal PTSD: PTSD Exposure to a traumatic event Respond with fear, helplessness, horror Traumatic event is persistently reexperienced Distressing memories Nightmares Sense of reliving it, or flashbacks Psychological or physiological reactivity to cues Avoidance and emotional numbing Increased arousal PTSD: PTSD Exposure to a traumatic event Respond with fear, helplessness, horror Traumatic even is persistently reexperienced Avoidance and emotional numbing Avoid thoughts, feelings, talk about the trauma Avoid places, activities that remind Can’t recall important aspects of the trauma Anhedonia Restricted affect Sense of foreshortened future Increased arousal PTSD: PTSD Exposure to a traumatic event Respond with fear, helplessness, horror Traumatic even is persistently reexperienced Avoidance and emotional numbing Increased arousal Difficulty falling/staying asleep Irritability, outbursts of anger Difficulty concentrating Hypervigilance Exaggerated startle response PTSD: PTSD Impairment Duration andgt;1 mo. Acute stress disorder Epidemiology PTSD: Etiology: PTSD: Etiology Proximity and severity of traumatic event Poor social support Bio/genetic vulnerability Early trauma Psychodynamic/cognitive model Biological model Learning theory PTSD: Treatment: PTSD: Treatment Stress inoculation training Coping for the 3 channels of anxiety reaction Physical Behavioral Cognitive Prolonged exposure Anxiety disorders: Anxiety disorders 30yo male doesn’t want to throw things out. Has a basement full of unless junk. Says 'I might need that later on.' 35yo female who has racing heart, sweating, chills, shortness of breath every time she goes to mall. Eventually only goes with husband. 22yo male is stressed for an exam the next day. Takes extra 30 min to fall asleep. 22yo female chooses classes based on whether will have to give a speech. If so, takes different class. DSM-IV Watson, D. (2005). Rethinking the mood and anxiety disorders: A quantitative hierarchical model for DSM-V, Journal of Abnormal Psychology, 114 (4), 522-536.: DSM-IV Watson, D. (2005). Rethinking the mood and anxiety disorders: A quantitative hierarchical model for DSM-V, Journal of Abnormal Psychology, 114 (4), 522-536. DSM-IV: DSM-IV DSM-IV: DSM-IV DSM-IV: DSM-IV Factor 1 Factor 2 Bipolar dysthymia MDD Panic Agoraph. SimPho SoPho GAD PTSD XXXX The Internalizing Alternative: The Internalizing Alternative Slide41: Copyright restrictions may apply. Krueger, R. F. Arch Gen Psychiatry 1999;56:921-926.