Anxiety Flashcards
What is the stress response?
Exposure to stress results in instantaneous and concurrent biological responses to asses the danger and organise an appropriate response
What is the role of the amygdala in the stress response?
Acts as the emotional filter to assess if sensory material via thalamus requires a stress/fear response, then goes to cortex for decision
Describe what happens chemically in the stress response.
Acute stress causes dose-dependent increase in catelcholamines and cortisol
Cortisol acts to mediate and shut down the stress response through negative feedback acting on the pituitary, hypothalamus, hippocampus and amygdala
What sites of the brain are responsible for stimulation of cortisol release?
Hypothalamus
Pituitary
Hippocampus
Amygdala
List 7 types of anxiety disorder
Generalised anxiety disorder Panic disorder Agoraphobia Social phobia Specific phobia OCD PTSD
Describe GAD
Generalised, persistent, free-floating - not specific to environmental circumstances
Describe presentation of GAD
Typically presents with physical symptoms
Restlessness/on edge
Irritability
Easily fatigued
Mind blank
Muscle tension
Sleep disturbance
Fear that something bad is going to happen
Lasts almost every day for approx. 6 months
What is typical age of onset of GAD
20-40
WHat is female to male ratio of GAD
2:1 F:M
50% of GAD are co-morbid with other psychiatric disorders. True/false?
False - 90% co-morbid
What is management of GAD?
CBT
SSRIs/SNRIs
Pregabalin
Benzodiazepines (short term only for acute anxiety)
What is CBT based on and how does it help the individual?
Based on identifying individuals automatic thoughts, cognitive biases and schemas
Help the individual identify thoughts, assumptions, misinterpretations and behaviours that perpetuate the anxiety
What is panic disorder?
Recurrent attacks of severe anxiety or panic which are not restricted to any particular situation so are unpredictable
What are dominant symptoms of panic disorder?
Sudden onset physical symptoms e.g. palpitations, chest pain, choking sensations, dizziness
Feelings of unreality
Secondary fear of dying, losing control or going mad
GAD and panic disorder can be due to the direct physiological effects of a substance or medical condition e.g. hyperthyroidism or caffeine. True/false?
False - they are NOT due to these
Approximately what percentage of patients with panic disorder have agoraphobia?
50-70%
What is typical age of onset of panic disorder?
Adolescence - mid 30s
WHat is usual course of panic disorder?
Chronic - fluctuates
Lifetime prevalence of GAD is approx. 3%/9% and lifetime prevalence of panic disorder is approx. 3%/9%.
GAD - 9%
Panic disorder - 3%
The following are what kind of symptoms of anxiety?
Sweating, hot flushes, cold chills Trembling Muscle tension Numbness/tingling Dizzy/faint Dry mouth Feeling of choking Lump in throat Difficulty breathing Palpitations Chest pain Nausea/abdominal distress
Physical/biological symptoms
The following are what kind of symptoms of anxiety?
Fear of losing control/going crazy Feeling on edge Difficulty concentrating Derealisation Depersonalisation Hyper vigilance Racing thoughts Meta-worry (worrying about worrying) Health anxiety Beliefs about needing to worry Preference for order and routine
Cognitive symptoms
The following are what kind of symptoms of anxiety?
Avoidance Exaggerated response to minor surprises Difficulty in getting to sleep Excessive use of alcohol/drugs Restlessness Irritability Checking behaviours
Behavioural symptoms
What type of anxiety disorder has higher prevalence in cardiology clinic than in general population?
Panic disorder
What are two mechanisms of inducing panic attacks that people with panic disorder are more susceptible to panic attacks with?
Infusing lactate
Re-breathing CO2
Where in the brain shows increased metabolism on PET scan during a panic attack?
In parahippocampal gyrus in the anterior pole of the temporal lobe
What is the treatment for panic disorder?
CBT
SSRIs/SNRIs/Tricyclics
Benzodiazepines for short term
What are the 3 types of phobias?
Agoraphobia
Social phobias
Specific phobias
What are the approximate ages of onset for agoraphobia and social and specific phobias?
Agoraphobia - most by 20s and early 30s
Social and specific phobias - most by early adolescence and early 20s
In phobias the patient recognises their fear as rational. True/false?
False - patient can recognise their fear is irrational
What is agoraphobia?
Fear of being around people, in busy places, open places etc.
Agoraphobia is strongly linked to avoidance. It can be primary but is more often secondary to other pathology like panic disorder or depression. True/false?
True
What is the name of this anxiety disorder:
Marked and persistent fear that is excessive/unreasonable cued by presence or anticipation of a specific object or situation
Specific phobia
What is the treatment of specific phobias?
Behavioural therapy - exposure grade/systematic desensitisation
Maybe CBT
SSRIs/SNRIs if required
What is social phobia?
Persistent fear of one or more social situations
Fear of possible scrutiny, embarrassment and humiliation
Often occurs in relatively small social settings
What are common social anxiety symptoms?
Blushing
Shaking
Fear of vomiting
Urgency/fear of micturition or defaecation
What changes in the brain are there in social phobia/anxiety that are normalised on successful treatment?
Increased bilateral activation of the amygdala & increased regional cerebral blood flow to amygdala
Which phobia can often present in toddlers/pre-school children?
Social phobia
What is the treatment for social phobia?
CBT
SSRIs/SNRIs
Benzodiazepines (short term)
How long must symptoms be present are for OCD diagnosis?
Obsessional Symptoms and compulsive acts must be present most days for at least 2 weeks
What is the mean age of onset of OCD? And specific peak ages for males and females?
Mean: 20
Males: 13-15
Females: 24-25
60-90% of patients with OCD experience at least 1 major depressive episode. True/false?
True
OCD does not tend to occur with other psychiatric disorders such as schizophrenia, Tourette’s, body dystrophic disorder, eating disorders, trichtillomania. True or false?
False - high co-morbidity
OCD thoughts are unpleasant, resisted and ego-dystonic. What does this mean?
Ego-dystonic means not in line with patients values/beliefs
What is the treatment for OCD?
CBT
SSRIs/Clomipramine (TCA)
What is the mechanism of action of benzodiazepines?
Binds to GABA-A receptor (inhibitory receptor) and enhances the effect of GABA. When GABA binds to GABA-A receptor the ion channel allows chloride ion influx, membrane hyperpolarises and this results in inhibitory postsynaptic action - basically stops neuronal excitability and benzos help that
What problems are associated with benzodiazepines particularly if used over 2 weeks?
Sedation and psychomotor impairment Withdrawal problems Dependency and abuse Alcohol interaction Can worse co-morbid depression
