AnxietyDisorders

Subjectivefeelingsofuncontrollableanxiety
Categories(DSM5)
o Generalizedanxietydisorders
o Panicdisorder
o Agoraphobia
o Socialphobia
o Specificphobias
o Separationanxietydisorder
Comorbidityoccurrenceofaseconddisorder
o Frequentinthiscategory
o Symptomsarenotdisorderspecific/causesarethesame
GAD
o Anxietyisfreefloating
o 5%ofpopulation,beginsinteens;symptomsforatleast6mo.
o Persistentlyworried
Oftenaboutminorthings
Ruminatesthingsaboutproblem,willnotletitgo;cannotsettleonasolution
o Uncontrollableworry
Difficultyconcentrating
Tiringeasily
Restlessness&irritability
Highmuscletension
PanicDisorderorPanicAttacks
o Sudden,unexplainedhyperarousaloftheautonomic(sympathetic)nervoussystem
o Increasedrespirations,heartrate,sweating,drymouth,nausea,chestpain,dizziness,etc.
o Accompaniedbyfeelingofapprehension,terrorandimpendingdoom
o Depersonalization:beingoutsideyourbody
o Derealization:theworlddoesnotseemreal
o Occuronceaweekormore,@2%men,5%forwomen,onsetassociatedwithstressfulevent
Agoraphobia
o Fearofapanicattackinpublicplaces,orplaceswhereescapeisdifficult
Phobias
o Focusedanxiety
o Outofproportiontodanger
o Recognizedbypersonasgroundless
o Causessocialoroccupationalimpairment
o Specificphobias(spiders,snakes,publicspeaking,flying,heights)
o Socialphobias
Avoidsituations(orhaveextremeanxiety)inwhichtheymight
Beevaluated
Showanxiety
Behaveinembarrassingways
Intenseanxietyaboutnegativeevaluation
Symptomspersistforatleast6months
Feeldiscomfortwheninsocialsituation
Mayworkbelowtheirabilityleveltoavoidpeople
Avoidpublicspeaking

Donotspeakupinclassormeetings
Avoideatinginpublic,goingtopublicrestrooms
o Bloodandinjectionphobias
PanicattackfollowedbydropinBPandfainting
3%ingeneralpopulation
64%have1stdegreerelativewithsamedisorder
Tx:tenseup!!
SeparationAnxietyDisorder
o Recurrent&excessivestresswhenseparatedfromparents(notdevelopmentallyappropriate
Excessiveworrythatsomethingbadwillhappentoattachmentfigure
Refusal/reluctancetogotoschool,work,orelsewhere
Nightmaresaboutseparation
Somaticcomplaintswhenseparated
Suchasheadache,stomachache
Treatmentofanxietyandphobias
o Psychoanalyticperspective
Content/uncoverconflict
o Behaviorallearningperspective
Function
o Cognitiveperspective
Schema/cognitivereframing
o Biologicalperspective(diathesis)
Neurophysiologythebrakelesscartonadownhillslope
Specifictreatmentsofphobiasandanxiety
o Drugtherapy:Benzos,BarbsorSSRIs
o Psychoanalysis
o Cognitiverestructuringtalktherapy
o Exposure/extinction
Systematicdesensitization
Flooding
Dcycloserine
BiologicalFactorsinAnxietyDisorders
o Geneticstudiessuggestheritability
o Neurotransmittersystems
Drugsthatcauseincreasedreleaseofnorepinephrine(e.g.yohimbine)inducepanic
attacks
Autonomiclabilitymaypredisposeonetoanxietydisorders
AnxiolyticmedicationsworkviapotentiatingtheinhibitoryactionsofGABA,
whichfunctionsasaneuronalbrake
AlterationsinSerotonincanproducepanicattacks&OCD
o GABAmodel
GABAactsasabrake
ActivationoftheGABAreceptorhyperpolarizestheneuronanddepressesfirng(thereby
decreasingneuronalexcitability)
GABAcausesinhibition
LackofGABAeffects=increasedneuronalexcitabilityandanxiety
GABAreceptors
UsedrugstoincreaseGABAfunction

o Benzodiazepines
o Barbituates
o Alcohol
GABAA
o Ionoporeionchannel
o Ligandgatedopenedbybinding
o Subunit
5subunitsthatassociatetoformapore
withoutGABA,poreisclosed,bindingGABAcausesarotationalchange&
openspore
Chloridemovesintothecellwhenporeisopen
Hyperpolarization(inhibition)occurs
MinorTranquilizersBenzodiazepines
o Benzodiazepines(GABAagonist)
ValiumDiazepam
LibriumChlordiazepozxide
AtivanLorazepan
Barbituates
o GABAreceptors
o Sideeffects
Hightolerance&dependence
Withdrawalisdangerous
o Examples
LuminolPhenobarbitol
NembutalPentobarbitolSodium
SeconalSecobarbitol
SerotoninModel
o Serotoninisfeelgood,thingsareOKNT
o Reuptakethatistoofastproducespanicattacks
o Paxil
Paroxetine
SSRIsite3

Exposure&Extinction
Systematicdesensitization
o Virtualrealitysessions
o Intenseexposuretherapy