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Danny's MD4001 CNS > 30-10-23 – Anxiety > Flashcards

30-10-23 – Anxiety Flashcards

1
Q

Learning outcomes

A
    1. Identify why patients get anxious during medical procedures
    1. Identify which post-operative outcomes pre-operative anxiety is associated with
    1. Identify the methods that can be used to help patients prepare for medical procedures with examples
    1. Discuss how psychological preparation promotes recovery from medical procedures
  • Be able to explain what Anxiety is
  • Understand the pathophysiology of Anxiety and how to diagnose it
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2
Q

What is anxiety?

What are 4 times anxiety becomes a problem?

A
  • Anxiety is an unpleasant feeling in a stressful, threatening, difficult situation
  • 4 times anxiety becomes a problem:
    1) Feelings grow
    2) Feel anxious a lot of the time
    3) No obvious reason to be anxious
    4) Negatively affects daily life
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3
Q

How do fear and anxiety compare?

What is a key differentiating feature among the Anxiety and fear-related disorders?

What are foci of apprehension?

A
  • Fear is a reaction to perceived imminent threat in the present, whereas anxiety is more future-oriented
  • A key differentiating feature among the Anxiety and fear-related disorders are disorder-specific foci of apprehension
  • The focus of apprehension is the stimulus or situation that triggers the fear or anxiety (triggers)
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4
Q

What are Anxiety and fear-related disorders characterized by?

What 4 things can Anxiety and fear-related disorders lead to?

A
  • Anxiety and fear-related disorders are characterised by excessive fear and anxiety
  • 4 things can Anxiety and fear-related disorders lead to:

1) Behavioural disturbances

2) Significant distress or significant impairment in personal, family, social, educational, occupational functioning

3) Excessive worry

4) Avoidance of stimuli

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5
Q

Describe 8 different anxiety diagnosis

A
  • 8 different anxiety diagnosis
    1) Anxiety with
    2) Depression
    3) Generalised Anxiety
    4) Social Anxiety
    5) Panic Disorder
    6) Anxiety with cognitive impairment
    7) Anxiety with learning Disability
    8) Anxiety with physical health problems Health related anxiety
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6
Q

Anxiety epidemiology.

A
  • Anxiety epidemiology.
  • Most common mental health condition
  • Frequently begin in childhood 7.3% ( 1:14 people)
  • Women:Male - 2:1 ratio
  • Country variability – USA/EU – more developed.
  • Global Burden of Disease - 6th leading cause of disability ( 15-34)
  • Detecting it more… more alarming information
  • Mental health and well-being…
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7
Q

What parts of the brain are affected in anxiety?

How does PTSD/chronic stress affect these areas of the brain?

A
  • Amygdala + Hippocampus (memory and emotions) are thought to be affected in anxiety, with Increased activity in these limbic regions
  • PTSD/chronic stress is though to reduce the size of these areas of the brain
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8
Q

Describe the HPA axis dysfunction loop (in picture)

A
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9
Q

What 4 neurotransmitters/systems are affected in anxiety?

A
  • 4 neurotransmitters/systems are affected in anxiety:

1) Serotonergic system – low

2) Noradreneric system – high

3) Gamma-aminobutyric system – dysregulation

4) Cortico-steroid regulation (leading to hippocampal reduction)

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10
Q

What are 6 associated features/conditions of anxiety?

A
  • 6 associated features/conditions of anxiety:
    1) Depression/low mood
    2) Obsessive Compulsive Disorder
    3) Post-traumatic stress disorder
    4) Addiction – alcohol
    5) Stress
    6) Insomnia
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11
Q

What are 3 other diagnoses associated with anxiety?

A
  • 3 other diagnoses associated with anxiety:
    1) Phobias
    2) Obsessive Compulsive Disorder
    3) Personality Disorders
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12
Q

What are 7 non-specific risk factors for anxiety?

A
  • 7 non-specific risk factors for anxiety:
    1) Adverse childhood experiences
    2) Abuse and neglect
    3) Physical punishment in childhood
    4) Parental history of mental health (family aggregation – why?)
    5) Overprotective/harsh parenting style
    6) Lower socio-economic status
    7) Genetic factors
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13
Q

What are 6 potential presentations for anxiety?

A
  • 6 potential presentations for anxiety:

1) History

2) Tell you in-directly/directly

3) Visible sign - agitation, different, trembling, restless, pressure of speech, emotional distress

4) Different behaviours

5) Low mood

6) Nothing

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14
Q

Describe How Generalised Anxiety Depression (GAD) can be diagnosed through GAD score.

What is specificity and sensitivity?

What is the specificity and sensitivity of GAD score?

A
  • How Generalised Anxiety Depression (GAD) can be diagnosed through GAD score:
  • The score is calculated by assigning scores of 0, 1, 2, and 3, to the response categories of ‘not at all’, ‘several days’, ‘more than half the days’, and ‘nearly every day’ adding up to a possible total of 21.
  • Scores of 5, 10, and 15 are taken as cut-off points for mild, moderate, and severe anxiety respectively.
  • The person should be asked ‘over the last 2 weeks, how often have you been bothered by any of the following problems?’:
    1) Feeling afraid, as if something awful might happen.
    2) Becoming easily annoyed or irritable.
    3) Being so restless that it is hard to sit still.
    4) Trouble relaxing.
    5) Worrying too much about different things.
    6) Not being able to stop or control worrying.
    7) Feeling nervous, anxious, or on edge.
  • Sensitivity: the ability of a test to correctly identify patients with a disease.
  • Specificity: the ability of a test to correctly identify people without the disease
  • GAD - Sensitivity of 89% and a Specificity of 82%
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15
Q

What are 3 conditions related to chronic anxiety?

A
  • 3 conditions related to chronic anxiety:
    1) Related to hypertension
    2) Cardiovasular disease
    3) Dementia
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16
Q

What are 3 important aspects of treatment of anxiety?

What are 5 non-pharmacological options for treatment of anxiety?

A
  • 3 important aspects of treatment of anxiety:
    1) Holistic Shared
    2) Decision-making
    3) Context
  • 5 non-pharmacological options for treatment of anxiety:
    1) Listening Service
    2) Distress Service
    3) Computerised Cognitive Behavioural Therapy
    4) Psychological services
    5) Community Mental Health
17
Q

What 8 things can help with well-being?

A
  • 8 things can help with well-being:
    1) Breathing exercises
    2) Exercise
    3) Fresh Air
    4) Nature
    5) Reduce Caffeine – increase cortisol/adrenaline
    6) Eat well
    7) Remain hydrated
    8) Sleep well
18
Q

What are 8 side-effects of caffeine?

A
  • 8 side-effects of caffeine:
    1) Neural Excitation
    2) Increase dopamine
    3) Mildly addictive
    4) Insomnia
    5) DiureticNervous/restless/anxious… increase HR/Bp
    6) Concentration
    7) Increase cholesterol
19
Q

What is CBT?

What is it most commonly used to treat?

Describe CBT

A
  • ‘Cognitive behavioural therapy (CBT) is a talking therapy that can help you manage your problems by changing the way you think and behave.
  • ’ It’s most commonly used to treat anxiety and depression, but can be useful for other mental and physical health problems’
  • During the sessions, you’ll work with your therapist to break down your problems into their separate parts, such as your thoughts, physical feelings and actions.
  • You and your therapist will analyse these areas to work out if they’re unrealistic or unhelpful, and to determine the effect they have on each other and on you.
  • Your therapist will then be able to help you work out how to change unhelpful thoughts and behaviours. After working out what you can change, your therapist will ask you to practise these changes in your daily life and you’ll discuss how you got on during the next session.
  • The eventual aim of therapy is to teach you to apply the skills you have learnt during treatment to your daily life.
20
Q

What are 8 aspects of CBT?

A
  • 8 Aspects of CBT:
    1) Knowledge retainment
    2) Information overload
    3) Are patients in a place to engage just now?
    4) Long term goals and treatment
    5) Trial and Error
    6) Side effects of drugs
    7) Patient wishes
    8) No rush
21
Q

What are 4 different stresses that can surround treatment?

A
  • 4 different stresses that can surround treatment:
    1) Function of procedure
    2) Procedural stress
    3) Treatment
    4) Outcome stress
22
Q

Can patients we worried about?

A
  • Patients can be worried about:
    1) Anaesthesia/being unconscious
    2) Fear of waking during surgery
    3) Pain (e.g., post-operative)
    4) Life-threatening procedures
    5) Post-operative outcome
    6) Possibility of disfigurement
    7) Threat of severe illness
    8) Outcome of test results
    9) Unfamiliarity of surroundings
    10) The ward environment
    11) Surrounded by machines
    12) Physical restriction
    13) Loss of independence
    14) Being away from home (children, job, other obligations)
23
Q

What 6 things are more likely for patients who experience high anxiety pre-operatively?

A
  • 6 things that are more likely for Patients who experience high anxiety pre-operatively:

1) Experience more pain post-operatively
* Influences type and amount of anaesthetic.

2) Use more analgesic

3) Stay in the hospital longer

4) Experience more complications
* e.g slower recovery, delayed wound healing

5) Anxiety and depression after surgery

6) Patients with > anxiety are < likely to be compliant with:
* Coughing & breathing exercises (help reduce the likelihood of pneumonia)
* Getting out of bed and moving around (help reduce phlebitis & enhance wound healing)

24
Q

What are 5 Effective approaches to increase patient sense of control?

A
  • 5 Effective approaches to increase patient sense of control:
    1) Procedural information
    2) Sensory information (how it will feel)
    3) Behavioural instruction
    4) Cognitive coping
    5) Other techniques [modelling, emotion focussed or psychotherapeutic discussion, relaxation, hypnosis]
25
Q

BENEFITS OF PSYCHOLOGICAL PREPARATION: HISTORICAL INTEREST

A
  • BENEFITS OF PSYCHOLOGICAL PREPARATION: HISTORICAL INTEREST
  • Egbert, LD, Battit, GE, Welch, CE & Bartlett, MK. (1964). The New England journal of medicine 270, 825-7
  • Pts received additional procedural information (before, during, after surgery)
  • The patients receiving this intervention:
  • Were discharged from hospital on average 2.7 days earlier
  • Required half as much pain medication as patients receiving usual care.
26
Q

Information and expectation (in picture)

A
27
Q

Preparation impact on post-operative pain

A
  • Preparation impact on post-operative pain
  • 38 studies in meta-analysis
  • Conclusion: psychological preparation may reduce post operative pain in the 1st month after surgery
28
Q

PREPARATION FOR NON-SURGICAL PROCEDURES (in picture)

A
29
Q

PREPARATION FOR NON-SURGICAL PROCEDURES e.x cancer patients

A
  • PREPARATION FOR NON-SURGICAL PROCEDURES e.x cancer patients
  • Cancer pts experience drug induced side effects such as nausea and vomiting
  • With repeated chemotherapy treatments, cancer pts can experience Anticipatory Nausea and Vomiting (ANV) before a chemotherapy treatment
    1) Classical conditioning
    2) Drug/treatment = unconditioned stimulus, produces unconditioned response nausea
  • ANV may lead pts to discontinue treatment

Danny's MD4001 CNS (60 decks)

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