• prevalance- 8% (25% lifetime incidence)
• can be minor (simple phobia) or severe and disabling (panic, PTSD)

Five basic mood states that can be associated with anxiety

fear

sadness

elation

anger

(disgust)

• PTSD
• panic disorder
• social phobia
• specific phobia
• OCD
• GAD

• anxiety disorders
• depression
• bipolar disroder
• schizophrenia and other pychoses
• borderline PD
• dependent PD
• avoidant PD
• substance related

COMORBIDITY is the rule, not exception.

• Anticipation/Apparisal (cognitive)
• Arousal (physiological)
• Avoidance (behavioral)

Conditions associated with panic disorder

specific phobias

social phobia

norepinepherine

serotonin

what chemical terminate/prolonge anxiety response

epidemiology, course, treatment response

nature of trigger

pattern of arousal

nature of avoidance

• fear of panic attack for more than a month
• anticipatory anxiety
• avoidance
• second only to PTSD in general practice settings

• cardiac
• sweat
• trembling
• SOB
• choking
• derealization
• depersonalization
• fear of dying/feelings of doom
• dizziness
• paresthesias
• nausea

Build quickly (10 minutes) and subsides in 30 minutes usually.

• hyperthyroidism
• CN VIII problem
• asthma
• superventricular tachycardia
• hypoglycemia in diabetics
• substance intoxication and withdrawal

• physical exam, esp. bp
• concurrent meds
• CBC, general chem, TFT's, drug levels
• urin toxicology
• EKG
• CXR

Symptoms of social phobia

• panic plus blushing
• trigger- fear of humiliation, scorn, scrutiny
• must dread social encounters, either specific or general
• avoid dreaded situation
• associated with tremor
• associated with alcohol abuse and later dependence
• early onset (males seek more treatment even though incidence btw men and women equal)

• anticipation- obsession, espc. contamination, offending those in power, danger
• arousal- triggered by obsessions
• avoidance- compulsive neutralizing behaviors
  • washing
  • counting
  • checking
  • praying
  • idiosyncratic

• genetic influence in early onset (males more than females)
• occur in depression and psychosis

• anticipation/appraisal- everything
  • health, money, appearance, rejection
• arousal- persistent
• avoidance- inhibit curiosity, social activity

• seen in older patients
• common sequel to trauma
• common in patients with medical conditions like diabetes

neurobiology influence on three A's

• appraisal- cortical, frontal, hippocampal, basal ganglia
• arousal- locus coeruleus regulate ANS as well as NE feedback to cortex (via serotonin)
• pathways meet amygdala

• influences temperment (chromosome 1 codes for serotonin transmitter implicated in neuroticism)
• experience will cause neurobiological change
• conditioning/learnming reshape NS

• habituation
• extinction
• psychological defenses
• correction of cognition
• exposure

• drugs
  • SSRI's
  • MAOI's
  • Benzodiazapine for GAD
  • alprazolam for panic
• breathing, relaxation
• psychotherapy- unlearn or modify patterns
• self help, social support, prayer