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anxiety Flashcards

1
Q

physiological anxiety

A

anticipation of a stressful event
acts as a stimulus to prepare for that event
increased alertness
focus on ‘threat’

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2
Q

pathological anxiety

A

anxiety is out of proportion to threat

in some cases anxiety can exist without threat

it interferes with day to day activities, and can be very disabling

can be diverse

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3
Q

disorders related to pathological anxiety

A

generalised anxiety disorder

panic attacks

post traumatic stress disorder

phobias

OCD

Social anxiety

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4
Q

psychological symptoms of anxiety

A

fearful anticipation

cognitive disturbance

minor depressive symptoms

irritability

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5
Q

physical symptoms of anxiety

A

sympathetic arousal
-sped up heart rate
-faster breathing and hyperventilation
-sweating

hyperventilation

increase muscle tension

sleep disturbance

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6
Q

epidemiology of anxiety

A

10-20% of adults have an anxiety disorder in a year

lifetime prevalence of 20-30%

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7
Q

treatments for anxiety

A

anxiolytic drugs and psychological therapy

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8
Q

types of anxiolytic drugs

A

beta blockers
anti depressants
pregabalin
buspirone
benzodiazepines

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9
Q

how many people does generalised anxiety disorder affect

A

5% of the UK,
huge problem from health and economic perspective

2-4% of population in a year

2x as common in women

higher in middle ages, median onset of 30

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10
Q

criterion for diagnosing anxiety

A

ICD11 and DSM5

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11
Q

DSM 5 criteria

A

excessive worry and anxiety most of the time for > 6 months

worry is about a number of different things

cannot control worry

at least three of: restlessness, fatigue, poor concentration, irritable, sleep problems

symptoms result in poor functioning, cannot be managed by patient and are not due to drugs or other psychiatric conditions

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12
Q

aetiology of GAD

A

Twin studies show heritability of about 30%
-No “GAD gene” but links to serotonin and monoamine transmission genes

Risk factors
-childhood trauma
other health conditions e.g. heart attack or stroke

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13
Q

neurobiology of GAD

A

possibly due to dysfunction of the amygdala, medial prefrontal cortex and insular

involved in memory, decision making, emotional reaction, fear and threat perception

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14
Q

4 step approach to treatment of generalised anxiety disorder from NICE

A

education: may in itself improve symptoms

individual or group self CBT

drug therapy or high intensity CBT

combinations of drugs or drugs + psychological interventions
-SSRIs, SNRIs, pregabalin (BDZ only for short term use)

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15
Q

Buspirone mechanism

A

partial agonist at 5H21A receptors

5HT1A receptors found pre and post synaptically
-presynaptic: acts as inhibitory autoreceptors un serotonergic synapses, and as heteroreceptors in other synapse types

Buspirone will modulate the release of 5HT and other neurotransmitters

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16
Q

advantage of buspirone

A

doesn’t produce pronounced sedation and has relatively mild side effects

Some sources suggest there are no withdrawal effects, others suggest discontinuation syndrome

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17
Q

what is buspirone used for

A

licenced for GAD and occasionally used in other anxiety disorders

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18
Q

Compulsions

A

driven by obsessions

Repetitive, involuntary activities that are undertaken to provide temporary relief from these obsessions

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19
Q

types of intrusive/ disturbing thoughts

A

sexual thoughts
violent thoughts
thoughts of hurting themselves or other people
hygiene or contamination obsessions
obsessions around symmetry or order

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20
Q

types of compulsion

A

checking

counting

touching

arranging

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21
Q

pure obsession OCD

A

this is where most problems arise from the intrusive and disturbing thoughts

may still have some compulsions, but they are a minor part of the condition or hidden somehow

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22
Q

causes of OCD

A

Neurobiology largely unknown

Genetic (50% ish) and epigenetic (childhood trauma)

Can be triggered by atypical antipsychotics
-produce OCD in people who didn’t have it prior to taking the antipsychotic

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23
Q

trichotillomania

A

Compulsive pulling out of hair

Is sometimes combined with the eating of hair

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24
Q

dermatillomania

A

compulsive picking of the skin

25
body focused repetitive behaviours
have a distinct diagnostic category in the DSM trichotillomania dermatillomania very commonly linked with OCD , people with OCD often display these as part of their compulsions -seems to be common in people who have contamination obsessions -possible to have these conditions without actually having obsessions
26
treatment of OCD for mild impairment
Low intensity psychological interventions (<10 h) CBT inc. ERP (Exposure Response Prevention)
27
moderate impairment OCD treatment
SSRIs or more intense CBT inc. ERP
28
severe impairment OCD treatment
SSRIs and more intense CBT inc. ERP
29
ERP
exposure response prevention
30
exposure response prevention
You expose the person to what they are fearful of in a controlled way, and you gradually help them to overcome their fear Can form a part of therapy for PTSD, phobias
31
neurobiology of OCD
Neuroimaging has mostly implicated the OFC and basal ganglia. The cingulate cortex (red) has also been suggested a role, with the ACC of showing hyperactivity
32
bilateral cingulotomy
Psychosurgical technique as a practice of last resort for OCD -and a few other conditions- intractable pain, depression Involves severing connections to the cingulate cortex Is done with the aid of fMRI scans therefore is precise Is done using electrodes of gamma knife Recover is generally very quick (a few days), with relatively few people experiencing serious side effects ~40% of those who undergo this procedure to treat OCD are benefitted
33
side effect of panic attacks
physical symptoms high level of sympathetic activation, parasthesias psychological symptoms depersonalisation, derealisation, fear of loosing control or dying
34
what are panic attacks
Intense anxiety with a sudden onset Usually symptoms come on over a period of a few minutes
35
physical symptoms of panic attacks
heart pounding, accelerated heart rate, palpitations trembling sweating chest pain?
36
what is parasthesias?
pins and needles feeling
37
what disorders can panic attacks occur as a part of?
other anxiety disorders, e.g., phobias as part of a physical condition., hyperthyroidism or pheochromocytoma can sometimes provoke panic attacks
38
what is needed to be diagnosed as having a panic attack
to be diagnosed as having a panic attack you need to experience 4/13 symptoms listed on the DSM
39
what is needed to be diagnosed as having a panic attack
to be diagnosed as having a panic attack you need to experience 4/13 symptoms listed on the DSM
40
what is panic disorder
Recurrent panic attacks and A period of at least a month in which there is persistent anxiety about having a panic attack and/or Changed behaviour aimed at avoiding panic attacks e.g. avoiding social situations
41
treating mild to moderate panic disorder
low intensity psychological interventions e.g. self help, support groups
42
moderate to severe panic disorder treatments
CBT o if CBT not effective SSRI or SNRI If SSRI or SNRI not effective a tricyclic antidepressant not mentioned in NICDE guidelines: beta-blockers are sometimes used for treating anxiety and panic disorders
43
main example of a beta blocker
propranolol
44
what is the mechanism of beta blockers
B1 adrenoreceptor antagonists
45
what is the effect of beta blockers
Mask symptoms of sympathetic activation Reduce physical effects of panic attacks Will not directly treat the psychological symptoms, however may break cycle of physical symptoms making psychological symptoms worse. More useful in the short term
46
what is social anxiety disorder?
a fear of social situations
47
what is the most common anxiety disorder? What is its prevalence?
social anxiety disorder, 12%
48
criteria for social anxiety disorder
Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions, being observed, and performing in front of others The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated The social situations almost always provoke fear or anxiety. The social situations are avoided or endured with intense fear or anxiety The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. must have lasted 6+ months, cannot be explained by another condition
49
what is first recommended treatment for social anxiety?
specialised CBT recommendation for individual therapy, not group therapy
50
what treatment for social anxiety if CBT is ineffective
further CBT, SSRIs SNRIs or MAO inhibitors as a potential further treatment
51
what is PTSD
condition someone can develop following any kind of trauma
52
people who get PTSD
those who have been in combat experiences (military service) sexual assault being in a terrorist attack or involved in an incident
53
symptoms of PTSD
hypervigilance, aggression, flashbacks to the trauma, cognitive problems, intrusive thoughts and memories, and nightmares Many people find that episodes of PTSD are provoked by specific triggers that are connected (perhaps only loosely) with original trauma.
54
suicide and PTSD
These can be extremely distressing and debilitating, which is reflected in a much higher suicide rate (9.8x general population) in people with PTSD
55
neurobiology of PTSD
Seems to involve reductions in the volume of the hippocampus and prefrontal cortex The amygdala also shows abnormalities in PTSD -key structure for emotional processing and the acquisition of fear behaviours -becomes hyper-responsive and seems to result in an excessive threat responses to non-threatening stimuli changes in HPA axis -often have lower plasma cortisol levels and have a greater response to the dexamethasone suppression test than control subjects (surprise as you would expect stress to increase cortisol levels) -has been hypothesised that a low level of cortisol following a traumatic event may result in increased noradrenergic signalling both in the CNS and in the periphery -Increased release of noradrenaline by neurons originating in the locus coeruleus may result in "over-consolidation" of fearful memories about the trauma.
56
prevention of PTSD
Most people who experience a trauma will have an ‘acute stress reaction’ in the immediate aftermath However, there is often a delay before PTSD ‘properly’ establishes itself If people who experience acute stress reaction are given specialised CBT for a month following the trauma, it can: -reduce the rate at which people go on to develop PTSD -lessen symptoms of those who develop PTSD
57
treatment of PTSD
NICE does not recommend treating established PTSD with drugs Recommends treating established PTSD using specialised CBT and for non-combat trauma EMDR can be offered If patients prefer they can be offered SSRIs or SNRIs instead of CBT If PTSD has psychotic symptoms, then atypical antipsychotic drug such as risperidone might be considered
58
EDMR
Eye Movement Desensitisation and Reprocessing controversial therapy that seems to work, but no-one knows why

Drugs And The Brain (9 decks)

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