PSYC 3340 Anxiety Disorders PDF

ANXIETY & TIC DISORDERS PSYC 3340  TERMINOLOGY Somatic: physical symptoms associated with distress (e.g., having a stomachache if you are anxious) Fear Core features of anxiety: Nervousness Avoidance  DEVELOPMENTAL COU...

ANXIETY & TIC DISORDERS PSYC 3340  TERMINOLOGY Somatic: physical symptoms associated with distress (e.g., having a stomachache if you are anxious) Fear Core features of anxiety: Nervousness Avoidance  DEVELOPMENTAL COURSE Fears common in children Fears decrease with age Content of fear changes with age Females report more fears than males DEVELOPMENTAL COURSE Anxiety is an internal experience and in adults primarily based on patient report In children, we integrate behavior observations Fear may present as crying, clinging to caregiver May present as somatic symptoms Headaches, stomachaches, etc. https://www.verywellfamily.com/tips-to-ease-back-to-school-anxiety-  Cause clinically GENERAL significant distress or CRITERIA impairment in FOR functioning MOST ANXIETY Not better explained by another disorder DISORDERS (psych, medical) or substance use SPECIFIC PHOBIAS Fear or anxiety about something specific This almost always results in immediate fear or anxiety Out of proportion to actual danger and sociocultural context Persistent and last 6 months or more Specifiers (can have more than one): Animal Natural environment Blood-injection-injury Situational Other (e.g., choking, vomiting, sounds, costumed characters  SPECIFIC PHOBIAS 3 Components: Behavioral Physiological Cognitive Most often emerge before age 7 Remission rates higher in children than in adults Despite high rates, relatively few seek treatment One of the most common anxiety disorders SEPARATION Symptoms (3 or more) ANXIETY Excessive distress when anticipating or separating from caregivers/attachment figures DISORDER Worrying about something bad happening to caregiver Worrying about experiencing something bad that results in separation Reluctance or refusal to go places because of fear of separation Reluctance or refusal to sleep away from home Nightmare about separation Physical symptoms (somatic) Persistent: 4 weeks in children and 6 months in adults Can occur at any age but typically before puberty, with average age around 7 SELECTIVE MUTISM Consistent failure to speak in social situations in which there is an expectation for speaking DESPITE speaking in other situations Disturbance interferes with educational, occupational, or social functioning Persists for at least 1 month Does not include first month of school Not attributable to communication disorder or lack of knowledge of verbal communication Rarest anxiety disorder (.03-.2%) Usually emerges around time when child starts school SOCIAL ANXIETY DISORDER (SOCIAL PHOBIA) Anxiety out of proportion Fear or anxiety about one of more social to actual threat or situation that involves evaluation/scrutiny danger In children, can include peer settings Persistent for 6 or more Fears that they will be negatively months evaluated Specifier: performance Social situations almost always provokes only anxiety or fear Tends to be more In children, may be expressed common in older behaviorally children and adolescents Situation avoided or endured with intense Most common after distress specific phobia PANIC DISORDER Recurrent and unexpected panic attacks. Fear and discomfort which reaches a peak within minutes and includes four of the symptoms on the right: At least one attack followed by 1 month of one or both: Persistent concern or worry about panic attacks Maladaptive change in behavior related to attacks Lower rates in children and starts increasing in adolescents, with average age of onset usually in adults AGORAPHOBIA Fear in 2/5 of the following: Using public transportation Being in open spaces Being in enclosed places Standing in line or being in a crowds Being outside of home alone Fears or avoid these situations because it might be hard to leave or get help Situations almost always produce fear/anxiety Actively avoided, need another person with them, or are endured with distress Fear out of proportion to situation and sociocultural context 6 months or more GENERALIZED ANXIETY DISORDER Only one (not three) needed for children https://psychscenehub.com/psychpedia/generalised-anxiety-disorder-  Race and Ethnicity Black Adolescents: evidence of more OCD symptom FACTORS White Females: more social anxiety and panic Socioeconomic Status Lower family income is related to higher rates of anxiety Gender NCSA- females > males, but inconsistent in literature Age Age stability of anxiety symptoms Content changes GAD and SAD peak in adolescence  Genetics Neurobiology Likely interaction between genetics Amygdala (short term responses) and environment Bed nucleus of stria terminals (more F-HTT gene x low social support related long term responses) to higher level of behavioral inhibition Hippocampus & Prefrontal cortex in childhood in mothers (controls amygdala by inhibiting response) Striatum (more active in behaviorally inhibited adolescents) Cortisol: stress hormone released by ETIOLOGY hypothalamic-pituitary-adrenocortical (HPA) axis  ETIOLOGY Temperament: disposition & behavioral inhibition (behavior and physiology) Tripartite Model Positive Affectivity (low=depression) Negative Affectivity (high=anxiety) Physiological Hyperarousal (=anxiety) Cognitive and Learning Influences Selective attention & hypervigilance Interpretation bias Family Temperament and attachment Parental behaviors Cultural Variations Self-report vs. somatic symptoms Girls more frequently diagnosed across cultural groups https://www.therapistaid.com/worksheets/what-is- EXPOSURE EXPOSURE https://www.youtube.com/watch?v= 2z-ZGt_vD5A COGNITIVE BEHAVIORAL THERAPY https://www.alapsych.com/behavior-therapy/ DIALECTICAL BEHAVIOR THERAPY Progressive Muscle Relaxation Coping Skills ANXIETY MEDICATIONS https://www.sprouthealthgroup.com/treatments/anti-anxiety- meds/  OBSESSIVE COMPULSIVE DISORDER (OCD) https://slideplayer.com/slide/7558329/ https://mosaictreecounseling.com/obsessive-compulsive-disorder-ocd/ PREVALENCE 1-2.3% in children (increases to 1.9-3.3 in adults) More stable when onset is in adulthood, but still fairly stable in childhood Overall relatively equal gender ratios Slightly higher in males in childhood Slightly higher in females in adulthood Females more likely to have contamination/cleaning symptoms Males more likely to have sexual-religious or aggressive symptoms Similar across cultures  ETIOLOGY: NEUROBIOLOGY Evolution: Dysregulation in mechanisms related to threat detection and attachment Biological: Cortical-Striatal-Thalamic-Cortical; response inhibition and planning Trouble inhibiting thoughts and acts Genetics: Strong genetic component (12% incidence with immediate family members) Additive genetic factors + nonshared environmental factors and interactions Neurobiology: Glutamate is excitatory neurotransmitter “Coincidence detector” Serotonin dysfunction (which is why SSRIs work well) Frontal-Striatal-Thalamic  Behavioral: two-factor conditioning 1. neutral event becomes aversive due to association through ETIOLOGY classical conditioning 2. event or stimulus is avoided to decrease anxiety Cognitive Behavioral Models: intrusion thoughts lead to maladaptive interpretations of intrusions. Trauma Dysfunctional Beliefs Perfectionism/intolerance of uncertainty Over importance of thoughts and need to control thoughts Inflated sense of responsibility and overestimation of threat TIC DISORDERS Tourette’s Disorder Multiple motor and one of Persistent (Chronic) Motor or Vocal Tic Disorder more vocal tics present at Single or multiple motor or vocal tics some time, though don’t (not both) Tics for at least one year (may wax have to be at the same and wane) time Onset before 18 Never met criteria for Tourette’s Tics for at least one year Specifiers: Motor tics only (may wax and wane) Vocal tics only Onset before 18 Provision tic disorder Single or multiple motor/vocal tics  PREVALENCE Used to be considered rare, now some evidence that up to 20% of children may have transient tics (textbook notes between 2-10%) Prevalence may decrease in adolescence and adulthood Simple motor- 5-7 Simple vocal- 8-9 Complex tics – 11 or 12 Tourettes:.1-1% Tics: 1-2% Extremely high comorbidity with ADHD Also often comorbid with OCD, anxiety, mood concerns, learning disabilities, disruptive behavior ETIOLOGY Strong genetic component/heritability (concordance of about 50% in dizygotic twins) Complex neurobiological underpinnings, but associated with cortical-subcortical circuit dysregulation Aberrant striatal nerves that lead to dysregulation of cortical motor areas Reduced volume of caudate nucleus in basal ganglia Related to response inhibition and cognitive motor control Dopamine activity  Medications that decrease dopamine (atypical antipsychotics like haloperidol and risperidone) MEDICATION Botox injections & MEDICAL ADHD medications (can increase concentration, but for some make tics worse) TREATMENT Anxiety meds like clonidine and guanfacine can control behavioral symptoms Antidepressants: control anxiety and OCD Antiseizure meds like topiramate for Tourette’s  TIC TREATMENT Tics are neurological but sensitive to environment in which they occur Trains patient to be more aware of tics Comprehensive Behavioral Trains patients to do competing behaviors when they feel the urge to tic Intervention for Tics (CBIT) Making changes to day-to-day activities to reduce tic triggers Habit-Reversal Therapy Teach competing response  TREATMENT https://youtu.be/4_qquZsL bYY https://youtu.be/2eyz2suG eeg About CBIT | The Tourette CBIT Foundation