Anxiety Disorders
Objectives:
- Appreciating the prevalence and the burden of various anxiety disorders
- Describing the key features of various anxiety disorders
- Understanding how to differentiate between different anxiety disorders.
- Recognizing comorbidities of different anxiety disorders
- Planning psychopharmacologic and psychotherapeutic approaches to different anxiety disorders
Types of Anxiety Disorders (DSM-5)
WHAT ARE ANXIETY DISORDERS?
- A group of 7 diagnosable disorders
- some shared features
- some distinct
- The most prevalent group of psychiatric conditions
Diagnosing Anxiety Disorders
DIAGNOSING ANXIETY DISORDERS DSM 5
- PANIC DISORDER
- AGORAPHOBIA
- PHOBIA
- GENERALIZED ANXIETY DISORDER (GAD)
- Social Anxiety Disorder (SAD)
- SOCIAL PHOBIA
- SPECIFIC PHOBIA
- SEPERATION ANXIETY
- SELECTIVE MUTISM
Treatment of Anxiety Disorders
Normal vs. Abnormal Anxiety
- ANXIETY AND FEAR ARE NORMAL!!
- SERVES IMPORTANT ROLES:
- ADAPTATION, INITIATION, MOTIVATION
- ANXIETY PREPARES US TO TAKE ACTION
- AND IS NORMAL IN MODERATE AMOUNTS
Benefits of anxiety
Yerkes-Dodson law: Performance improves as a function of anxiety up to a threshold beyond which there is a fall off in performance
The Continuum Between Normal and Abnormal Anxiety
- Anxiety is an expectable part of everyday life
- Pathological anxiety is on the extreme end of the continuum for:
- Trait anxiety: how anxious a person feels in general (as in generalized anxiety disorder) and/or
- State anxiety: how anxious a person feels in response to specific events (as in phobias)
Shared Clinical Features of Anxiety Disorders
SHARED CLINICAL FEATURES
- Triggered by innocuous stimuli
- Maladaptive thinking patterns: tend to catastrophize, misjudge probability
- Prominent physical symptoms: autonomic arousal
- Typical behavioral responses: escape, avoidance, help-seeking
Importance and Prevalence of Anxiety Disorders
WHY ARE ANXIETY DISORDERS IMPORTANT? THE MOST PREVALENT PSYCHIATRIC DISORDERS IN ADULTS
| MALE | FEMALE | |
|---|---|---|
| LIFETIME | LIFETIME | |
| ANY ANXIETY DISORDER | 19.2% | 30.5% |
Impact of Anxiety Disorders
ANXIETY DISORDERS CAUSE IMPAIRMENT
| Daily life effects | Increased risk of |
|---|---|
| - Physical functioning | - Less Income |
| - Social functioning | - Fewer than 16 years of education |
| - Pain | |
| - Fatigue | |
| - General health | |
| - Sense of well being |
Increased Risk of Suicide
INCREASED RISK OF SUICIDE
- Overall Anxiety Disorders associated with 3 fold risk for suicide attempts
- PTSD: 6 fold risk
- Panic Disorder and GAD: 5.6 fold risk
- Social Phobia: 2.1 fold risk
Comorbidity of Anxiety Disorders
COMORBIDITY Anxiety Disorders co-occur with many mental and physical disorders, esp.
- Major Depression
- Bipolar Disorder
- Other Anxiety Disorders
- Substance Use Disorders
Cultural Prevalence of Anxiety Disorders
Eye on Culture: Prevalence of Anxiety Disorders and Obsessive-Compulsive Disorder (Compared to Rate in Total Population)
| Female | Low Income | African American | Hispanic American | Elderly | |
|---|---|---|---|---|---|
| Generalized anxiety disorder | Higher | Higher | Higher | Same | Higher |
| Specific phobias | Higher | Higher | Higher | Higher | Lower |
| Agoraphobia | Higher | Higher | Same | Same | Higher |
| Social anxiety disorder | Higher | Higher | Higher | Lower | Lower |
| Panic disorder | Higher | Higher | Same | Same | Lower |
| Obsessive-compulsive disorder | Same | Higher | Same | Same | Lower |
Biological Basis of Anxiety Disorders
ANXIETY DISORDERS ARE ASSOCIATED WITH BIOLOGICAL CHANGES
- Brain Imaging Abnormalities
- Autonomic Activation
- Neuroendocrine Changes
- Early Bio-behavioral Changes
Amygdala and Fear Response
Amygdala Lateral Nucleus
- Creates link between conditioned and unconditioned stimulus
- Exposure to subsequent relevant stimulus, activates
Central Nucleus: (coordinates fear response)
- periaqueductal gray region - freezing or immobility
- lateral hypothalamus - autonomic responses
- paraventricular hypothalamus – neuroendocrine
Brain Circuitry of Fear and Coping
Shift From Passive Fear to Active Coping in the Brain LeDoux J and Gorman J Am J Psychiatry 158:1953-1955, December 2001
Key Takeaways for Anxiety Disorders
WHAT TO REMEMBER ABOUT ANXIETY DISORDERS
- Common and debilitating conditions
- Often co-occur with other medical and psychiatric conditions
- Characterized by
- prominent somatic symptoms
- catastrophic misinterpretations
- escape and avoidance behaviors
WHAT TO REMEMBER ABOUT ANXIETY DISORDERS
- Avoidance
- Can prevent help-seeking
- Inhibits reporting of symptoms
- Highly treatable
- Medication, especially serotonin active antidepressants
- Cognitive behavioral treatment