Lecture Notes on Anxiety Disorders

What is Anxiety?

• An unpleasant mental state characterized by worry about future dangers or upsetting events.
• Manifests physiologically, psychologically, and behaviorally.
• Signs and Symptoms:
  • Physiological: Increased heart rate, sweating.
  • Psychological: Pessimistic thought patterns, feelings of doom.
  • Behavioral: Avoidance of specific places or situations.

The Role of Anxiety

• Anxiety can be adaptive, motivating us to take precautionary measures (e.g., improving health due to anxiety about becoming unhealthy).
• Similar to pain; both serve a practical purpose to avoid harm.
• In some individuals, anxiety becomes excessive and maladaptive, leading to anxiety disorders.

Acute vs. Chronic Anxiety

Acute Anxiety

• Immediate response to current stressors.
• Symptoms include:
  • Mnemonic: STUDENT SPHERE SEAS
    • Sweating
    • Trembling
    • Unsteadiness/Dizziness
    • Dissociation
    • Elevated heart rate
    • Nausea
    • Tingling
    • Shortness of breath
    • Fear of dying or losing control
    • Chest pain
    • Chills
    • Choking sensations
• Panic attacks display these symptoms.

Chronic Anxiety

• Persistent symptoms that are less immediate.
• Symptoms include:
  • Mnemonic: MISERABLE
    • Muscle tension
    • Irritability
    • Difficulty sleeping
    • Low energy
    • Restlessness
    • Poor attention
• Ruminative thoughts and somatic complaints are common.

Prevalence and Diagnosis of Anxiety Disorders

• Common: 10% of people meet criteria in the past year; 30% in a lifetime.
• More prevalent in women than men (2:1 ratio).
• Often begins in childhood/adolescence, typically before age 25.
• Tends to be chronic without treatment; waxing and waning severity with age.
• Lower risk of suicide compared to mood disorders, but potential for social and occupational disability.

Treatment Goals

• Focus on making anxiety a helpful signal rather than eliminating it.
• First-line treatment:
  • Cognitive Behavioral Therapy (CBT): Most effective for most anxiety disorders.
• Medications:
  • Antidepressants (SSRIs): Commonly used, less effective than CBT.
  • Benzodiazepines: Effective for acute treatment but not for chronic use due to dependency and impairment.

Specific Anxiety Disorders

Generalized Anxiety Disorder (GAD)

• Mnemonic: EEK ADS I’M MISERABLE
  • Excessive and generalized anxiety for at least 6 months.
  • Must have 3 or more symptoms from the miserable mnemonic.
• Treatment: CBT, SSRIs, Buspirone.

Panic Disorder

• Characterized by recurrent panic attacks.
• Mnemonic: SURPRISE
  • Sudden, unexpected, recurrent attacks leading to excessive anxiety.
• Treatment: CBT, SSRIs for frequency and severity reduction.

Agoraphobia

• Avoidance of places where panic attacks occurred.
• Treatment: CBT.

Specific Phobia

• Intense fear of specific objects/situations.
• Common types: Ophidiophobia (snakes), Nyctophobia (dark), Trypanophobia (needles).
• Treatment: Exposure therapy (specific form of CBT).

Social Anxiety Disorder

• Intense fear of interpersonal judgment or embarrassment.
• Treatment: CBT (first-line), SSRIs (second-line).

Summary

• Compare and contrast anxiety disorders based on constancy (constant vs episodic) and specificity (generalized vs specific).
• For those interested in learning more, consider reading "Memorable Psychiatry" for additional insights and practice questions.