NEUR 3594 Exam 1 - Anxiety and Trauma 1

What are the anxiety disorders classified by the DSM5

Generalized anxiety disorder, panic disorders, selective mutism, separation anxiety disorder, agoraphobia, social anxiety disorder, specific phobia

What are the trauma and stress disorders classified by the DSM5

Post traumatic stress disorder

How many individuals do anxiety disorders affect in a 12 month period

About 1 in 8

How many individuals do anxiety disorders affect over a lifetime

About 1 in 5

Are anxiety disorders more common in males or females

Females (except OCD)

When do most anxiety disorders begin

In early life

What is true about anxiety disorders comorbidity

Highly comorbid with MDD

What is period prevalence

Proportion of a population that has the characteristic at any point during a given period

What is lifetime prevalence

Proportion of a population that has had the characteristic at any point in their life

What are some of the personal burdens of anxiety

Family, financial, physical health and work performance

What is fear

An acute response to real or perceived imminent threat (relieved by removal of threat)

What is anxiety

Chronic and sustained fear response without identifiable or predictable threat

Are fear and anxiety responses adaptive or maladaptive

Often adaptive, but become maladaptive when they are excessive, overgeneralized, or significantly interfere with functioning and well being

What are the key characteristics of anxiety and trauma related disorders

Heightened fear, elevated emotional reactivity, dysfunctional defense learning, and disrupted emotional regulation

How is neurocircuitry of fear and anxiety conserved across species

Well conserved

What is state anxiety

Adaptive emotional and arousal response to anxiogenic (stressful) stimulus

What is trait anxiety

Overall anxious disposition of the animal, in which anxiety is maladaptive, persistent and pathological

What is the three component model of anxiety

Potential stressors (failures, losses, etc) are perceived as a threat, which then can cause either a bodily effect or negative thoughts, and from there can create ineffective behavior (avoidance, escape, etc)

Who came up with the biomedical approach to stress

Hans Selye (founder of stress research)

What is stress from the biomedical perspective

A stressor is any stimulus that perturbs the physiological and psychological integrity of an organism

What is allostasis in the biomedical perspective of stress

Process of achieving stability through change (mechanisms for life sustaining functions)

What is the modern definition for stress response

A physiological reaction that occurs in response to a real or perceived harmful threat. Results from coordinated action of the ANS, CNS and endocrine system

What is the modern stress diagram

Appraisal (how dangerous is this), predictability (did I know this could happen), and controllability (can I do something to stop this) lead to the stress response or termination of stress response

What are some of the physiological reactions that occur during stress response

Decrease saliva production, digestion, food movement. Increased heart rate, pupil dilation, and breathing

What are the 3 main domains of stress

Type, duration (acute or chronic), and severity (mild to severe)

What are the three types of stress

Physical, psychological, and social

What is an example of physical stress

Acute (injury, emergency, exhaustion) and chronic (illness, altitude change, temperature change)

What are examples of psychological stress

School/ career, grief/ loss, financial and personal conflict

What are examples of social stress

Social isolation, bullying, digital world stress

What is the valence of stress

The inverted U nature of stress (need some stress to avoid boredom, but too much stress [distress] causes burnout and impaired focus). We want to be in eustress where the stress motivates focused attention and emotional regulation

What is trauma

An extreme/ overwhelming threat experience with potential for lasting effect

What is said to be the difference between stress and trauma

Stress should have the ability to cope, where trauma leads to a developed psychopathology

What are the key features of separation anxiety disorder

Excessive, developmental inappropriate fear of separation from attachment figures. Worry about harm to attachment figure and reluctance to leave. May experience nightmares or physical symptoms

What is the duration of separation anxiety disorder

4 or more weeks in a child and 6 or more months in an adult

What is the onset for separation anxiety disorder

Onset in childhood or de novo in adulthood

What are the key features of selective mutism

Consistent failure to speak in certain social situation despite speaking elsewhere. Interferes with academic and social function. It is not due to language unfamiliarity

What is the duration of selective mutism

1 month or more (beyond the first month of school)

What is the onset of selective mutism

Exclusively in childhood

What are the key features of agoraphobia

Fear of situations where escape/ help may be difficult. Often linked to panic but can occur without. It is persistent, disabling, and has low spontaneous recovery

What is the duration of agoraphobia

Persistent

What are the key features of panic disorder

Recurrent panic attacks (abrupt, peak within minutes, 4 or more symptoms). Concern about having more panic attacks or behavioral change (avoiding certain situations and visiting ER)

What is the onset of panic disorder

Between late adolescence and mid 30s

What are they key features of specific phobia

Excessive, disproportionate fear/avoidance of specific object/situation (animal, environment, situational, etc)

What is the duration of specific phobia

6 months or more

What is the onset of specific phobias

Childhood or mid adolescence

What are the key features of social anxiety disorders

Fear of social/ performance situations due to fear of negative evaluation, embarrassment, rejection, offending others. Avoid these situations

What is the duration of social anxiety disorder

Persistent

What is the onset of social anxiety disorder

By late teens (can be insidious or abrupt)

What is the performance only specifier of social anxiety disorder

Fear limited to performance (public speaking). Later onset and stronger physiology

What are the key features of generalized anxiety disorder

Excessive worry about multiple domains, 3 or more symptoms: restlessness, fatigue, poor concentration, irritability, muscle tension, sleep disturbances

What is the duration of generalized anxiety disorder

6 or more months

What is the onset for generalized anxiety disorder

Childhood or adolescent onset accounts for half, adult is other half

What are the key features of other anxiety disorders

Can be due to another medical condition (direct physiological cause). Substance or medication induced. Other specified/ unspecified (atypical, insufficient info)

How do culture related diagnostics impact disorder diagnosis

Can complicate or mask symptoms of anxiety

What is the format of the Beck Anxiety Inventory (BAI)

21 item self report

What is the primary focus of the Beck Anxiety Inventory (BAI)

Primarily somatic and cognitive anxiety symptoms

What is the age range for the Beck Anxiety Inventory (BAI)

Primarily older adolescents and adults

What are the strengths of the Beck Anxiety Inventory (BAI)

Emphasizes anxiety symptoms with relatively less overlap with depression, quick (5-10 mins)

What are the limitations of the Beck Anxiety Inventory (BAI)

Does not diagnose or reliably differentiate specific anxiety disorders, heavily weighted towards somatic symptoms

What is the format of the Generalized Anxiety Disorder 7 (GAD-7)

7 item self report

What is the primary focus of the Generalized Anxiety Disorder 7 (GAD-7)

Core symptoms of generalized anxiety disorder

What is the age range of the Generalized Anxiety Disorder 7 (GAD-7)

Adolescents and adults, extensively validated in adults

What are the strengths of the Generalized Anxiety Disorder 7 (GAD-7)

Very brief, widely validated, useful for screening and monitoring symptom severity

What are the limitations of the Generalized Anxiety Disorder 7 (GAD-7)

Developed primarily for GAD, may not adequately capture other anxiety disorders

What is the format for the Hamilton Anxiety Rating Scale (HAM-A)

14 item clinician rated

What is the primary focus of the Hamilton Anxiety Rating Scale (HAM-A)

Psychic (psychological) and somatic anxiety symptoms

What is the age range of the Hamilton Anxiety Rating Scale (HAM-A)

Primarily adults

What are the strengths of the Hamilton Anxiety Rating Scale (HAM-A)

Long established clinician rated measure for assessing anxiety severity and monitoring treatment response

What are the limitations of the Hamilton Anxiety Rating Scale (HAM-A)

Requires clinician administration, somatic items can overlap with conditions, and scoring can be subjective

What are the key features of post traumatic stress disorder

Follows trauma, re-experiencing, avoidance, arousal, negative mood/ cognition

What are the DSM5 criteria of post traumatic stress disorder

A1: traumatic event defined in greater detail

A2: emotional response REMOVED

4 factor model: B (intrusion), C( avoidance), D (negative mood/cognition), E (arousal)

What is the duration for PTSD

1 month or more

What are the subtypes of PTSD

Preschool: developmentally sensitive criteria for young children

Dissociative: Depersonalization/ derealization, common after severe childhood trauma

What tools can be used to assess PTSD

CAPS-5 (clinician gold standard) and PCL-5 (self report)

What are the key features of acute stress disorder

Occurs within days of trauma, symptoms across mood, dissociation, avoidance, arousal

What are the DSM5 criteria for acute stress disorder

A1: trauma exposure required

Must meet 9 of 14 symptoms across domains (avoidance, arousal, negative mood/ cognition), focus on dissociation is reduced

What is ASD duration

3 days to 1 month

What assessment tool can be used for ASD

CAPS-5 and PCL-5