anti-anxiety medications

ValiumLibriumXanaxKlonopin

Also used for sleeping pills &

anti-seizure meds

benzodiazepines

anti-anxiety medications

“SSRIs”

ProzacPaxilZoloftCelexa

selective serotonin reuptake inhibitors

antidepressants

biological contributions

• polygenic trait of neuroticism**

• neurochemicals (GABA, NE, 5HT, CRH)

**comorbidity

generalized anxiety disorder

• 6 mo+ of uncontrollable worry to many issues

• 3+ of:

restlessness, fatigue, poor concentration,

irritable, muscle tension, sleep probs

• distress or impairment

CRITERIA

generalized anxiety disorder

• prevalence 3%

• 2:1 sex ratio

• onset 17-31 yrs (but most “always been this way”)

• prognosis: chronic

panic attack

inappropriate fear response

CRITERIA

4+ of:

heart palpitations, sweating, shaking, short of breath, choking, chest pain, nausea, dizzy, derealization/depersonalizaiton, fear of losing control, fear of dying, chills/heat, numbness/tingling

panic attack

cued – conditioned to external cues

uncued – conditioned to interoceptive cues

situationally predisposed

panic disorder

CRITERIA

• recurrent panic attacks

• 1+ for 1 mo+:

- concern about future attacks or consequences

- sig behavioral change (avoidance of external or internal cues)

panic disorder

• prevalence 3%• 2:1 sex ratio• relatives 8x more likely concordant

COGNITIVE-BEHAVIORAL THERAPY• cued: systematic desensitization• uncued: induce interoceptive sensations + cognitive restructuring of perceived control

agoraphobia

CRITERIA

anxiety about situations where:

- hard to access help

- escape difficult/embarrassing

specific phobia

CRITERIA

• 6+ mo persistent, excessive, irrational fear of an object of situation

• anxiety/fear on exposure

• avoided or endured w/ intense anxiety

• insight that phobia is irrational

specific phobia

• 9% prevalence

• 4:1 sex ratio

• prognosis: chronic

ETIOLOGY

-direct or vicarious trauma experience

-conditioning from panic attack

- information transmission

TREATMENT

systematic desensitization

social phobia

CRITERIA

• fear of social/performance situations

• anxiety/fear upon exposure

• insight that fear is irrational

• avoidance behavior impairs functioning

social phobia

• 7% prevalence

• 1: 1.4 sex ratio

CAUSE

prepared learning or, neuroticism/inhibition, conditioned direct exp

TREATMENT

exposure & cognitive therapy

OCD

CRITERIA

• recurrent & persistent thoughts/images

• associated behaviors compelled to perform

• insight to irrational “

• distress, consumes 1+ hr/day, or impairs functioning

ocd

obsessionsrepetitive, unwelcome thoughts

compulsionsrepetitive, almost irresistible action

• germs

• something bad will happen

• symmetry

• religion

• #s

• washing

• counting

• checking

• touching

• rituals

OCD

• 1% prevalence

• sex ratio?

• onset: childhood-30’s

• prognosis: chronic

TREATMENTS

• SSRIs, exposure + response prevention

ocdorbital frontal PFCbasal gangliacingulate

abnormal activation decreases after psychotherapy or anxiolytics