Anxiety disorder Study Guide

📖 Core Concepts Anxiety vs. Fear – Anxiety: internal, vague, uncontrollable state; Fear: response to a specific, identifiable external threat. Diagnostic Threshold – Symptoms ≥ 6 months, more days than not, causing marked functional impairment. First‑line Treatment – Cognitive‑behavioral therapy (CBT) ± selective serotonin reuptake inhibitor (SSRI) or serotonin‑norepinephrine reuptake inhibitor (SNRI). Prevalence – 30 % of adults will experience an anxiety disorder in a lifetime; current global point prevalence ≈ 4 %. Risk Factors – Childhood abuse, low self‑esteem, certain endocrine/metabolic disorders, stimulant or depressant substances, family environment. 📌 Must Remember GAD: chronic excessive worry ≥ 6 months + ≥ 3 physical/cognitive symptoms (e.g., restlessness, muscle tension). Specific Phobia: intense, persistent fear of a particular object/situation; prevalence 5‑12 %. Panic Disorder: recurrent unexpected panic attacks + persistent concern about future attacks or behavior change. Agoraphobia: fear of places where escape is difficult; often comorbid with panic disorder. Social Anxiety Disorder: fear of negative evaluation; 7 % of U.S. adults. PTSD: trauma‑exposed, symptoms > 1 month (re‑experiencing, avoidance, hyperarousal). Screening Tools – GAD‑7 (sensitivity 57‑94 %, specificity 82‑88 % for GAD). Medication Hierarchy – 1️⃣ SSRIs/SNRIs → 2️⃣ Benzodiazepines (short‑term) → 3️⃣ Buspirone / Pregabalin (if non‑responsive). Relapse Prevention – Continue medication ≥ 1 year after remission; taper slowly; maintain psychotherapy. 🔄 Key Processes Clinical Evaluation Positive screen → Full interview → Assess duration, impairment, avoidance, medical mimics → DSM‑5 criteria → Diagnosis. CBT for Anxiety Psychoeducation → Cognitive restructuring → Exposure (in‑vivo or imaginal) → Homework & relapse‑prevention plan. Medication Initiation Start SSRI/SNRI at low dose → Titrate over 2‑4 weeks → Monitor side effects (sexual dysfunction, GI upset) → Assess response at 6‑8 weeks. Panic‑Agoraphobia Cycle (simplified) Anticipatory anxiety → Panic attack → Fear of future attacks → Avoidance → Agoraphobic restriction → Heightened anxiety. 🔍 Key Comparisons Anxiety vs. Fear – Anxiety: internal, no clear trigger vs. Fear: reaction to identifiable danger. GAD vs. Panic Disorder – GAD: chronic worry about many domains; Panic: discrete, sudden attacks, fear of future attacks. SSRI vs. Benzodiazepine – SSRI: long‑term, disease‑modifying, delayed onset; Benzodiazepine: rapid relief, high dependence risk, short‑term only. Specific Phobia vs. Social Anxiety – Phobia: object/situation‑specific, physical panic response; Social: fear of evaluation, social‑performance symptoms. CBT vs. Exposure‑Only – CBT: includes cognition work + exposure; Exposure: focuses solely on habituation to feared stimulus. ⚠️ Common Misunderstandings “All anxiety is normal” – Normal worry is brief, context‑bound; anxiety disorders are persistent, impairing, and often without clear trigger. “Benzodiazepines are harmless short‑term fixes” – Even brief courses increase risk of dependence, falls, and motor‑vehicle accidents. “Medication alone cures anxiety” – Relapse rates are high without concurrent psychotherapy or lifestyle changes. “Children can’t have anxiety disorders” – 10‑20 % develop a full disorder before age 18; presentations may mimic physical ailments. 🧠 Mental Models / Intuition “Threat‑Detection Alarm” Model – Anxiety is an over‑active alarm system that flags non‑threats; treatment = recalibrating the sensor (CBT) and quieting the alarm (meds). “Avoidance‑Reinforcement Loop” – Avoiding a feared situation removes immediate anxiety → reinforces avoidance → expands fear network. Break the loop with graded exposure. 🚩 Exceptions & Edge Cases Medical Mimics – Hyperthyroidism, hypoglycemia, cardiac arrhythmias can produce panic‑like symptoms; always rule out before labeling primary anxiety. Substance‑Induced Anxiety – Caffeine, cocaine, cannabis withdrawal may mimic or exacerbate anxiety; treat underlying use disorder first. Children’s Presentation – May show somatic complaints (headaches, abdominal pain) rather than verbal worry. 📍 When to Use Which Mild‑moderate GAD → Begin CBT (internet‑supported acceptable). Severe GAD or comorbid depression → SSRI/SNRI + CBT. Acute panic attacks → Short‑term benzodiazepine for crisis; transition to CBT + SSRI for long‑term control. Specific Phobia → Exposure‑based therapy (systematic desensitization, in‑vivo exposure). Social Anxiety with performance component → SSRI + CBT with exposure to social situations. Pregnant or substance‑use patients → Favor CBT and non‑sedating meds (buspirone) over benzodiazepines. 👀 Patterns to Recognize “Physical symptom cluster + worry about health” → Consider generalized anxiety rather than isolated somatic disorder. “Sudden onset after trauma + flashbacks” → Flag PTSD; look for avoidance and hypervigilance. “Fear of leaving home + panic history” → Agoraphobia likely secondary to panic disorder. “Excessive worry about separation + early childhood onset” → Separation anxiety disorder. 🗂️ Exam Traps Distractor: “Fear of a specific object = GAD.” – GAD is generalized worry; specific object fear = Specific Phobia. Choice: “Benzodiazepines are first‑line for all anxiety disorders.” – Only short‑term, second‑line; SSRIs/SNRIs are first‑line. Option: “Anxiety must last > 1 month to be diagnosed.” – True for PTSD; anxiety disorders require ≥ 6 months. Answer: “GAD prevalence is higher in men.” – Actually higher in females (5.2 % vs. 2.8 %). Misleading stem: “Rapid heartbeat after caffeine is always panic disorder.” – Must rule out substance‑induced anxiety; consider caffeine effect. --- Use this guide for quick, focused review right before your exam. Good luck!