Term
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Definition
| unpleasant state of anticipation, apprehension, fear, or dread often accompanied by a physiologic state of autonomic arousal, alertness, and motor tensions |
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Term
| psychological symptoms accompanying anxiety |
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Definition
(what's going through your mind)
-fear, apprehension, dread, sense of impending doom
-worry, rumination, obsession
-nervousness, uneasiness, distress
-derealization (world seems distorted or unreal)
-depersonalization (one's body feel unreal or disconnected) |
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Term
| physiological symptoms of anxiety |
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Definition
| sweating, diarrhea, dizziness, flushing/chills, hyperrelexia, hyperventilation, lightheadedness, numbness, palpitations, pupil dilation, restlessness, SOB, syncope, tachycardia, tingling, tremor, upset stomach, urinary frequency |
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Term
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Definition
| ADAPTIVE psychological and physiological response to a stressful or threatening situation |
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Term
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Definition
**MALADAPTIVE response to real or imagined stress or threat**
-response is disproportionate to stress or threat
-stress or threat is nonexistent, imaginary, or misinterpreted
-symptoms interfere with adaptation or response to stress or threat
-symptoms interfere with other life functions |
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Term
| neuronal pathways of the normal fear response |
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Definition
-3 types of input to amygdala
-amygdala processes information and coordinated response
-3 output destinations from amygdala
-modulated by neurotransmitters |
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Term
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Definition
| key brain region that modulates everything about the anxiety response |
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Term
| input to the amygdala in the normal fear response neuronal pathway |
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Definition
1. thalamus and sensory cortex
2. hippocampus
3. medial prefrontal cortex |
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Term
| thalamus and sensory cortex |
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Definition
| provide sensory information to the amygdala |
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Term
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Definition
-contextual memory
-interpretation of sensory input
-emotional valence of memories
input to amygdala
NE |
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Term
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Definition
-mediation of response
-interpretation of complex stimuli
-extinction of conditioned fear and emotional memory (suppress the fear)
-declarative memory
-learning
input to amygdala
5HT |
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Term
| output to the amygdala in the normal fear response neuronal pathway |
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Definition
1. brainstem
2. hypothalamus
3. motor cortex |
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Term
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Definition
locus coeruleus, raphe nuclei
-autonomic arousal (tachycardia, tachypnea, diarrhea), occurring before you are cognizant of what's going on
-cognitive arousal, attention, startle
-visceral sensory activation
output from amygdala
5HT |
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Term
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Definition
-activation of HPA ais
-cortisol release, major mediator of body's stress response int he short term
output of amygdala
CRH |
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Term
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Definition
-behavioral response ("run away")
output of amygdala
5HT |
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Term
| neurotransmitters involved in the neuronal pathway of the normal fear response |
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Definition
NE (to frontal cortex, limbics, brainstem, spinal cord)
5HT (to cortex, limbics, hypothalamus)
GABA (inhibitory interneurons)
CRH/corticotropin releasing hormone (to hypothalamus, cerebral cortext) |
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Term
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Definition
-neurons are physically changing with learning
-learning leads to neurogenesis, dendrite formation, synpase formation, and synapse turnover
-cortisols and CRH BLOCK neuroplasticity, leading to indelible memories |
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Term
| learning theory of pathophysiology of anxiety |
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Definition
Classical fear conditioning
Inhibitory avoidance
Sensitization |
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Term
| classical fear conditioning |
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Definition
(cue-specific fear)
learned association between a neutral stimulus and fear response leads to episodic anxiety
(Pavlov) |
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Term
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Definition
(contextual fear)
repeated exposure to fear-inducing stimulus leads to pervasive anxiety |
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Term
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Definition
| early life trauma leads to anxiety in later stressful situations |
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Term
| neural mechanisms in the pathophysiology of anxiety |
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Definition
Reconsolidation
Extinction |
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Term
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Definition
-neural mechanism in the pathophys of anxiety
-repeated reactivation of neural pathways strengthens memories and anxiety responses = same thing happening over and over reinforces the anxiety
-transient destabilization of synapses with each activation
-therapeutic interventions are most effective during reconsolidation-->can change neuronal response (basis of exposure therapy in phobias) |
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Term
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Definition
-neural mechanism in the pathophys of anxiety
-learning new memories and responses (not forgetting existing memories) via the medial prefrontal cortex and sensory cortex
-ex: practice breathing technique while imagining the stimulus |
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Term
| NE neurochemical abnormalities |
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Definition
| stress increases noradrenergic activity in the locus coeruleus (brainstem, output) |
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Term
| 5HT neurochemical abnormalities |
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Definition
-anxiety occurs with decreased serotonin-1A receptors
-stress induced reduction of receptors early in life has permanent effects on receptor activity
-level of receptor activity is genetically determined |
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Term
| GABA neurochemical abnormalities |
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Definition
| decreased activity in cerebral cortex and subcortical regions is associated with anxiety |
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Term
| CRH neurochemical abnormalities |
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Definition
-increased amygdala corticotropin releasing hormone activity is associated with anxiety
-increases anxiety related behaviors
-decreased routine activities (ex eating, sex growth) |
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Term
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Definition
| a discrete period of intense fear or distress, accompanied by specific physical and psychological symptoms |
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Term
| panic attack characteristics |
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Definition
-rapid onset (seconds)
-symptoms peak within 10 minutes
-symptoms may be spontaneous OR in response to a specific stimulus
-may occur in the context of panic disorder, social phobia, other anxiety disorders, or as an isolated incident |
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Term
| panic attack differential diagnosis |
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Definition
-many physical disorders
-rule out by hx, PE, labwork |
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Term
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Definition
-anxiety about being in situations from which escape might be difficult or help would not be available if a panic attack occurred
-being outside home, traveling in car or plane, being on a bridge, being in public places are avoided or endured with great distress
-usually secondary to panic disorder
-often extremely debilitating |
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Term
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Definition
recurrent panic attacks, accompanied by at least one month of persistent concern about having another attack, or a change in behavior due to the attacks
+/- agoraphobia |
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Term
| panic disorder epidemiology |
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Definition
-2x higher F>M
-onset in young adulthood
lifetime risk =1% w/ agoraphhobia; =4% w/o agoraphobia |
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Term
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Definition
strong biological component (15-20% concordance with 1st degree relatives)
behavioral component has been suggested |
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Term
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Definition
-course is variable
-agoraphobia tends to worsen if panic attacks are present
-untreated attacks w/o agoraphobia can lead to its development (much harder to treat then)
-comorbidities with MDD, suicide, alcohol abuse |
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Term
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Definition
Meds: SSRIs, TCAs, MAOIs, benzodiazepines (buspirone not effective)
behavioral therapies and MAOIs most effect for agoraphobia |
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Term
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Definition
marked and persistent fear of embarrassment in social or performance situations, which is recognized as being excessive, and which interferes with the person's function
**fear is related to being observed (NOT related to shyness/intimacy) |
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Term
| social phobia epidemiology |
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Definition
-prevalence 2-5%
-2xF>M
-adolescent onset, often in a shy child |
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Term
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Definition
-more common among 1st degree relatives
-associated with high automonic arousal |
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Term
| social phobia course and treatment |
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Definition
-course is typically lifelong and continuous
-Tx: beta blockers for performance anxiety, behavioral therapy, SSRIs, benzo, MAOIs |
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Term
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Definition
(formerly "simple phobia")
-marked and persistent fear of a specific object or situation
-exposure to the "phobic stimulus" almost always provokes an immediate anxiety response, recognized as being excessive, which leads to avoidance of the stimulus, and interferes with the person's function |
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Term
| specific phobia epidemiology |
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Definition
-10% prevalence
-3xF>M
-onset usually childhood, 2nd peak of onset in 20's |
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Term
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Definition
| more common among 1st degree relatives |
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Term
| specific phobia course and treatment |
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Definition
-usually lifelong and continuous
-comorbidities are vasovagal fainting, alcohol abuse
-Tx: behavioral (exposure) therapy is most effective; benzo for scheduled exposure (ex plane ride) |
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Term
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Definition
-recurrent and persistent thoughts (obsessions) or behaviors (compulsions) that are recognized as being excessive and unreasonable
-cause either marked distress (often experienced as extreme anxiety), are time-consuming, or interfere with the person's function |
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Term
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Definition
| recurrent and persistent thoughts, impulses, or images that are intrusive and disturbing |
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Term
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Definition
repetitive behaviors (eg hand washing, checking, counting) that the person is driven to perform in response to obsessions or according to rigid rules, in order to reduce distress or prevent a feared situation
*meaningless repetition |
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Term
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Definition
-not rare, prevalence of 2-3%
-onset in early teens (M) and mid-20's (F) |
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Term
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Definition
-highly biologic disorder
-30% concordance rate among 1st degree relatives
-75% concordance rate between MZ tiwns |
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Term
| OCD course and comorbidities |
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Definition
-course is usually lifelong
-waxing and waning of symptoms
-severe symptoms cause extreme disability
-comorib with MDD, eating disorders, panic disorder, generalized anxiety, Tourette's, schizotypal traits |
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Term
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Definition
-SSRIs
-clomipramine
-behavioral therapy
-psychosurgery in severe cases (one of the few cases that can be indicative of surgical treatment) |
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Term
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Definition
**following a severe traumatic event, the person re-experiences the trauma through flashbacks, nightmares, or disturbing memories
**consciously or unconsciously avoids stimuli associated with the trauma
**experiences increased arousal (overall becomes more anxious)
-symptoms last more than 1 month
-symptoms significantly interfere with the person's function |
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Term
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Definition
-sensory phenomena
-loose track of who they are |
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Term
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Definition
-relatively common with 2-9% prevalence
-highest prevalence is following war experiences and sexual assault
-lower prevalence following MVA, fires, natural disasters
-F>M |
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Term
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Definition
| predisposing factors include anxiety, depression, and antisocial traits in the individual or family |
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Term
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Definition
-onset of symptoms may be immediate (w/in 6 months) or delayed (>6 months) of the trauma
-course is variable
-comorbid with suicide, MDD, substance abuse |
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Term
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Definition
-behavioral therapy
-SSRIs, TCAs, MAOIs
-combo of beh therapy + antidepressant med |
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Term
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Definition
-similar to PTSD
-onset within 1 month of the traumatic event
-symptoms subside within 1 month of onset
**1 month limitation** |
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Term
| generalized anxiety disorder |
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Definition
| excessive anxiety and worry about several events or issues, accompanied by at least 3 somatic or psychological symptoms, lasting at least 6 months, and interfering with the person's ability to function |
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Term
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Definition
-5% prevalence
-F>M
-onset usually in early life, but may occur at any age |
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Term
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Definition
| weak association with anxiety disorders of all types among 1st degree relatives |
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Term
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Definition
-chronic
-waxing and waning often in response to stressful situations
-commonly comorbid with other anxiety disorders
-may be comorbid with MDD |
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Term
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Definition
-benzo
-busiprone
-SSRIs
-TCAs
-behavioral (relaxation) therapy |
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Term
| adjustment disorder with anxiety |
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Definition
-significant anxiety, worry, or nervousness arising in response to an identifiable psychosocial stressor
-onset within 3 months of stressor
-symptoms resolve within 6 months of stressor |
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Term
| anxiety disorder due to a general medical condition |
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Definition
-anxiety, panic attacks, or obsessive compulsive symptoms arise as a direct physiological effect of the medical condition
-anxiety arising as an emotional response to the stress of an illness should be diagnosed as an adjustment disorder
**NOT being anxious because you have a medical condition** |
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Term
| substance induced anxiety disorder |
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Definition
| anxiety, panic attacks, or obsessive compulsive symptoms arising from substance intoxication or withdrawal |
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Term
| substances commonly associated with anxiety symptoms |
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Definition
intoxication: amphetamine, caffeine, cocaine, hallucinogens, inhalants, marijuana, nicotine, phencyclidine
withdrawal: alcohol, opiate, sedative |
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