Fear / Aversion

"Situationally-confined" hyperarousal

Ex: Agoraphobia = fear of crowds, wide spaces

"Spontaneous" Hyperarousal

Avoidance behaviors

Obsessions (Nonsensical)

And/Or

Compulsive Behavior

Re-experiencing

Disassociation

Adjustment Disorder With Anxious Mood

6 Stressors

Childbirth/rearing

Caregiving

Work

Life transitions

Illness

Grief

Adjustment Disorder With Anxious Mood

Treatment

1) Time

2) Psychotherapy

3) CBT

4) Benzodiazepines

5) Sleep meds

Generalized Anxiety Disorder (GAD)

1) Chronic worry

2) Subjective anxiety

3) Reactivity to stressors

4) Sympathetic Activity

Related to neurotic/reactive temperament

*Risk factor for depression!

Excessive anxiety for at least 6 months

Difficulty controlling worrying

3 or more of following:

1) Restlessness

2) Easily fatigued

3) Diffulty concentrating

4) Irritable

5) Muscle Tension

6) Sleep disturbance

Family

Finances

Work

Criticism/Embarrassment

CBT - to inc inhibition of amygdala via Glut input to GABA internurons

SSRI

Buspirone: 5HT receptor partial agonist

Benzodaizepines: Act as GABA to inhibit amygdala and LC

Phobia

Essential Features

Persistent fear to specific stimuli

Social and occupational impairment

1) Excessive unreasonable fear of specific situation or object

2) Immediate anxiety upon exposure every time

3) Pt avoids exposure or endures it w/intense anxiety

4) Exposure interfers w/nml activies/relationships

5) No other disorder

Animals: Snakes, dogs, spiders

Natural Environment: storms

Blood/Infection/Injury

Situations: Flying, enclosed spaces, heights, dentists, clowns

Pathological shyness

Fear of embarassment/humiliation of one's own actions or words to toehrs

"Inhibitied temperament" is risk factor for it

1) Fear of situation where person will be exposed to unfamiliar people and will do something humiliating

2) Immediate anxiety upon exposure, most of time

3) Person knows fear is excessive and unreasonable

4) Fear is avoided or endured w/anxiety

5) Fear intefers w/function and relationships

6) Not due to medical condition or drugs

Public speaking

Public eating

Use of public bathrooms

Answering questions in class

Writing in front of others

#1 Behavioral Therapy with Systematic Desensitization

= progressive exposure to feared situation until fear is gone

For social phobia, use CBT and/or meds ->

Anxiolytics: Benzodiazepines + beta blockers

Antidepressants (SSRIs)

DO NOT USE BUSPIRONE (the serotonin 1a receptor agonist inc LC firing -> worsened panic)

Panic disorder

Essential Features

Repeating Severe Anxiety Attacks

that may result in avoidance

Panic Disorder

DMS criteria

Recurrent unexpected panic attacks

Need both ***'s

*** Period of intense fear plus 4 or more of following reaching max intensity w/i 10 min:

1) Palpitations, Tachycardia

2) Sweating

3) Trembling/shaking

4) SOB

5) Choking

6) Chest pain

7) Nausea/ abdominal pain

8) Dizzyness, lightheaded

Paresthesia

Chills/hot flashes

Fear Losing control / going crazy

Fear of dying

*** Over one month of following

1) persistent concern about having more attacks

2) Worry of sequelae

3) Significant change in behavior

Not accounted for by general medical condition, or other mental disorder

Fear/avoidance of situations where panic attacks have occured or escape may be difficult in case of one

Often evolves from panic disorder

DMS Criteria

1) Anxiety around places/situations where excape may be difficult or help unavailable in case of panic attack

2) Such situation are avoided (restricted travel), or endured with marked distress, or require companion

Evolution from panic disorder to agorphobia

l

Agoraphobia

Public areas (stores/malls)

Theatres

Places of worship

Crowds

Closed spaces

Spontaneous activation of Locus Ceoruleus

Hypersensitivity to CO2 = false suffocation

Hypersensitivty to minor physical sensations -> actue fear -> more physical sensations

Psychotherapy

1) CBT!!!correct misinterpretation of physical sensations

2) Desensitization to intentially generated physical sensations

Medication

1) SSRI!!! main txt + very effective

*Must start low and titrate up slowly

2) Antidepressants (effective but rarely used)

Acute panic txt

1) Benzodiazepines (high pot. clonazepam)

Caution: dependency

Essential Features: Recuring obsessive thoughts and/or compulsive behavior

Time consuming

Social and work impairing

Obessesion: 1) recurring intrusive & inappropriate thoughts, that cause marked anxiety

2) attempts to ignore/supress/neutralize thought w/action (compulsion

3) Recognitin that thoughts are self derived

Compulsion: Repititve behavior/mental acts - that person feels driven to do (respone to obsession or rigid rules)

1) aimed to reduce distress of dreaded event

3) unrealistic excessive behavior

Marked distress for >1 hour to day- impairs nml fn or relationships

#1 Multiple

#2 Contamination

#3 Doubt

4 Somatic

Symmetry

Agression

Sex

Multiple

Checking

Washing

Counting

Confessing

Symmetry

Hoarding

Psychotherapy

1) CBT

2) Exposure w/response prevention

Medications: SSRI

1) Sertraline (Zoloft) 

2) Clomipramine (Anafranil)

3) Fluoxetine (Prozac)

4) Paroxetine (Paxil)

5) Fluvoxamine (Luvox)

PTSD

General description

Acute and Post-traumatic stress disorder = reactions to stressors out of normal range of exp w/maladaptive management of memories of events

Acute stress disorder: present <30 days

PTSD: >30 DAYS

PTSD

DSM Criteria

Exposure to Traumatic Event

1) experienced / witnessed event, w/threatened death, serious injury, phystical threat to self or others

2) intense fear, helplessness, horror

Reexperiencing trauma

1) reccurent intrusive memories 

2) Recurrent distressing dreams

3) Acting as if trauma is recurring

4) Psychological distress or physiological reacivity at exposure to internal external cues of event

Avoidance: of stimuli

1) effort to avoid thoughts/feelins asso w/trauma

2) avoiding activites, places, people that remind one of trauma

3) inbiltiy to recall aspects of trauma

4) dim. interest/participation in sig activities

5) feeling detached or estranged

6) restricted affect

7) sense of foreshortened future

natural disaster

accident

combat

rape sexual abuse

robbery

Genetic + freq/severity of trauma

Childhood + later trauma = inc risk PTSD

Ex of genetics: SNP in chaperone protein for glucocorticoid receptor inc HPA sensitivity to stressor