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This Concept Map, created with IHMC CmapTools, has information related to: Anxiety Disorders, Anxiety Disorders Theories Psychodynamic: -unconscious conflict/impulse signals EGO, Anxiety Disorders POST-TRAUMATIC STRESS D/O Tx: Acute-encourage to talk about experience -returned to front lines Chronic-exposure helpful if avoidance behavior is present -Rx for depressive, anx, dream Sx -beta-blockers if tremor present -SSRIs for arousal, numbing/avoidance -sertraline FDA-approved for PTSD -exposure (in fantasy if needed), Anxiety Disorders AGORAPHOBIA Tx: Exposure therapy: single most effective Tx Rx: use lowest effective dose -state-dependent learning, Anxiety Disorders PANIC DISORDER 35% pop'n has >=1/yr 0.7% pop'n w/ PD -usually 15-25yo -prob depression if ᡠyo -often ->fears of death, more attacks, going crazy, being uncontrolled -attacks begin suddenly, last min -can be confused w/ anticipatory anx -can->phobias if avoidance of situations where panic has occurred, Anxiety Disorders GENERALIZED ANXIETY D/O Due to GABA-benzo system hyperactivity Tx: benzos -but recurrence on discontinuing -buspirone -TCAs, venlafaxine (FDA-approved) -behavioral Tx not very effective -can't specify stimuli, Anxiety Disorders PANIC DISORDER Panic Attacks: 4+ Abrupt Sx: Palps/tachycard, sweating, trembling, SOB, choking, chest pain, nausea/abd distress, dizzy/light-headedness, derealization/depersonalization, fear of losing control/going crazy, fear of dying, paresthesias, chills/hot flashes, Anxiety Disorders OBSESSIVE-COMPULSIVE D/O Tx: Rx-potent SSRIs TCA-clomipramine Anxiolytics sometimes helpful Antipsychotics sometimes Other: ECT w/ primary depression -ant. cingulotomy, capsulotomy -for SEVERE OCD, Anxiety Disorders PANIC DISORDER Tx: CBT, exposure Tx Rx: TCAs, MAOI, SSRI Benzo anxiolytics faster Combination of both is best, Anxiety Disorders PANIC DISORDER Can be w/ or w/out agoraphobia Agora. more often W/OUT PD, Anxiety Disorders AGORAPHOBIA DDx-early 20s; rare after 40yo -ask about avoided situations -do they feel "trapped"? -they feel they will panic, etc. if in those situations -most realize fears are ridiculous -what do you do to face it? -does anxiety decrease if there for a long time?, Anxiety Disorders SPECIFIC PHOBIA Blood-Injury Phobia -they actually faint-vasovagal syncope -due to sight, experience, discussion of blood Fear of flying can look like agoraphobia, Anxiety Disorders OBSESSIVE-COMPULSIVE D/O DDx: different from phobias -fears are more complex -more concern w/ resulting rituals, not really fearing the object -phobics w/ more anxiety, Anxiety Disorders Anxiety vs Fear Types of Anxiety: Uncued/Spontaneous Anxiety/Panic Cued/Phobic/Situational Anxiety/Panic Anticipatory Anxiety, Anxiety Disorders Theories Genetic: -increased familial risk -esp female & 1st degree -alcoholism, 2ndary depression ESP BLOOD-INJURY PHOBIA, Anxiety Disorders Theories Learned: GAD due to unpredictability of (+)/(-) reinforcement Classical conditioning: -learn to avoid neutral/benign situations, Anxiety Disorders SOCIAL PHOBIA Recognized irrational fear of embarrassment, humiliation when performing in public Onset at puberty, present in 20s Tx: beta-blockers 1 hr before performance benzos-dependency risk gabapentin-no dependence MAOI, SSRI good SSRI-first-line treatment, Anxiety Disorders Anxiety vs Fear Fear-response to external threat Anxiety-emotional state, unknown source -usually w/ physiological SSx, Anxiety Disorders AGORAPHOBIA Fear of being caught in situation from which exit would be difficult if pt had panic attack or discomfort Eg: auditoriums, crowds, lines, mass transit, driving ->hyperventilation, rare fainting, Anxiety Disorders OBSESSIVE-COMPULSIVE D/O Obsessions: repetitive, intrusive ideas, images, impulses Compulsions: rituals to decrease anxiety or discomfort If can't perform ritual->anx OCD can be 2ndary to MDD Perhaps serotonin dysfunction, Anxiety Disorders GENERALIZED ANXIETY D/O Excessive anx/worry over 6 mos -for majority of days -restlessness, easily fatigued, diff to concentrate, irritable, tense, sleep disturbance -can mimic CNS depressant w/drawal or caffeine intoxication