CLP Exam II SG Anxiety Disorder Intro and Generalized Anxiety Disorder Anxiety condition experience of being afraid o Immediate fearful reaction to a perceived threat also anxious anticipation o 4 types of symptoms Physiological or Somatic Symptoms Fight or flight Behavioral symptoms Cognitive symptoms Emotional symptoms o Adaptive vs Maladaptive Adaptive fear responses subside when the threat ends Maladaptive anxiety persists after the threat passes and can even lead to anticipatory anxiety about the future 3 Questions Are the concerns realistic given the circumstances Is the amount of fear in proportion to the threat Does the concern persist in the absence of the threat o Fear vs diagnosis of anxiety Two factors to consider when making an anxiety diagnosis Distress and Impairment o Severe enough to lower quality of life o Chronic and frequent enough to interfere with functioning o Anxiety disorders Maladaptive fear DSM IV TR Axis 1 Specific phobias Social anxiety disorder Generalized anxiety disorder Panic disorder PTSD OCD Likely to differ cross culturally Context environment influences the content of fears Generalized Anxiety Disorder o Diagnostic Criteria Anxiety and worry about a number of events occurring more days than not for at least 6 months Associated with 3 of the following more days than not for past 6 months Restlessness or feeling keyed up or on edge Easily fatigued Difficulty concentrating or mind going blank Irritability Muscle tension Sleep disturbance Focus is not confined to features of Axis I disorders Impairment and or distress Not due to substance use GMC or does not occur exclusively during mood psychotic or pervasive developmental disorders o Prevalence and course 3 5 of general population High comorbid with other anxiety disorders Also associated with depression and substance use disorders 50 report onset in childhood or adolescence Course is chronic but fluctuating and often worse during times of stress o Theories Cognitive theory People with GAD think about threat constantly both consciously and unconsciously Function of worry o People with GAD believe that worrying can help them avoid bad events by motivating them to engage in problem solving o Worry is an attempt at suppression of negative images o 2 competing ideas about worry Prevents bad things from happening Dangerous to your health Biological GABA Theory o Individuals with GAD have deficiency in GABA receptors resulting in excessive firing in the limbic system Limbic system is involved in emotional physiological and behavioral responses Genetic theory o Biological vulnerability to GAD is inherited o Treatments Psychosocial Cognitive Behavioral Therapy CBT o Some techniques Therapist works with client to identify and alter negative automatic thoughts Self monitor worrying and schedule worry time o Relaxation techniques Progressive muscle relaxation deep breathing Biological Treatments Benzodiazepines Xanax Valium o Short term relief from anxiety o Very addictive many side effects Tricyclic Antidepressants Tofranil and SSRIs Paxil o Reduced anxiety better than benzodiazepines Serotonin Norepinephrine reuptake inhibitor o Better than placebo PTSD and Related Stress Disorders 3 kinds of Stress Disorders o Axis I Anxiety Disorders Posttraumatic Stress Disorder Acute Stress Disorder o Axis I adjustment disorder PTSD o Events that induce PTSD Combat and war related traumas Combat fatigue syndrome Shell shock Disasters Abuse Tornadoes floods etc Physical emotional sexual Common Traumatic Event Car accidents sudden death of loved ones o Diagnostic criteria Exposed to trauma with both of the following present Even involving actual or threatened death serious injury or threat to physical integrity of self or other o DSM V will change definition addition of sexual assault Response involving fear helplessness or horror o DSM V will drop this requirement Traumatic event is reexperienced Avoidance of stimuli associated with the trauma and numbing of general responsiveness Persistant symptoms of increased arousal Duration more than 1 month Impairment and or Distress 1 Witnessed event 2 Fear helplessness response 3 dissociative symptoms numbing derealization depersonalization dissociative amnesia 1 symptoms of reexperiencing trauma Avoidance of stimuli Symptoms of anxity or increased arousal difficulty sleeping irritability poor concentration hypervigilance etc Distress or impairements Duration 2 days to 4 weeks max occurs within 4 weeks of the trauma Not due to substance GMC other mental illness Acute Stress Disorder o Diagnostic Criteria o Can turn into PTSD Adjustment Disorders o Consists of emotional and behavioral symptoms Depressive symptoms anxiety symptoms and or antisocial behaviors o Also on Axis I but not categorized with depression or anxiety o Criteria Emotional or behavioral symptoms in response to an identifiable stressor occurring within 3 months of the onset of the stressor Symptoms behaviors clinically significant including either of the following Marked distress beyond what would be expected Impairment if social or occupational academic Does not meet criteria for another specific Axis I disorder is not an exacerbation of preexisting Axis I or II disorder Not Bereavements After stressor has terminated symptoms do not persist for more than additional 6 months Specify Acute last 6 months Chronic last 6 months Panic Disorder Diagnostic Criteria o Panic attack o Panic Disorder Can occur in the context of any anxiety disorder Discrete period of intense fear or discomfort Four or more of the following symptoms develop and peak within 10 minute Recurrent unexpected panic attacks At least one panic attack has been followed by 1 month of o Persistant concern of additional attacks o Worry about the implications of the attacks o A significant change in behavior Agoraphobia 1 3 to experience agoraphobia Anxiety about being in places or situations for fear of having a panic attack or panicky feelings o Situations may include Waiting in line Using elevators Being away form home Traveling on public transportation o Some people avoid these situations completely Others force themselves into feared situations but feel anxious and panicky throughout 10 of first degree relatives of someone diagnosed with PD are more likely to develop PD Role of Genetics o Support from family history studies o Support from twin studies 30 40 of variation due to genetics Models o The Kindling Model of PD A biological brain
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