anxiety Flashcards
what is anxiety and what are the physical and psychological symptoms? what nervous system is activated and the neurotransmitter associated?
Anxiety is characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure. It’s a part of the body’s natural response to stress or perceived threats, activating the “fight or flight” response that prepares us to act in potentially dangerous situations. Anxiety can be mild, causing unease or nervousness, or it can be severe, leading to intense fear or panic attacks.
physical:
-increased blood pressure
-sweating
-shortness of breath
-tachycardia (irregularly increased heart rate)
-dry mouth
-hyperventilation
Psychological symptoms:
-feeling of dread
-difficulty concentrating
-insomnia
-hypervigilance (increased alertness)
butterflies
-fear
Sympathetic nervous system and adrenaline and noradrenaline is causing this
what is the Yerkes-Dodson curve? also, add an example of one of the main reinforced behaviors to reduce anxiety using the fear of mice example and OCD and washing.
The Yerkes-Dodson law is a model of the relationship between stress and task performance. It proposes that you reach your peak level of performance with an intermediate level of stress, or arousal. Too little or too much arousal/anxiety results in poorer performance.
mice
-This person has a fear of mice and this their anxiety level over time.
Some into contact with the stimulus their anxiety increases and then they run away, and their anxiety levels decrease.
Reinforcing escape behaviour, they will always escape the behaviour because they know it will cause a reduction in anxiety
Apply this to OCD:
Stimulus – is the obsession like hand washing.
Escape would be the compulsion – continuingly washing your hands.
That will reduce that anxiety and reinforces the compulsions
give some examples of anxiety disorders
panic disorder
PTSD
OCD
social phobia
generalised anxiety disorder
what are the ICD-10 criteria for generalized anxiety disorder
To be diagnosed with generalised anxiety disorder (GAD) as per the ICD-10 criteria, a person must consistently feel intense anxiety more often than not, extending over several weeks and typically lasting for six months or more. This type of anxiety is widespread and persistent, not limited to or primarily focused on any specific environmental situations. For a diagnosis, individuals must exhibit a range of symptoms across various categories, including:
Autonomic Arousal Symptoms: Examples include heart palpitations, excessive sweating, shaking, and dryness of the mouth.
Chest and Abdominal Symptoms: These might involve difficulties in breathing, pains in the chest, sensations of choking, or discomfort in the stomach area.
Psychological Symptoms: Feelings of constant worry, an inability to relax, general nervousness, and quick irritability are key signs.
General Symptoms: Symptoms such as dizziness, a tingling sensation in the hands or feet, and feelings of being lightheaded are common.
Non-specific Symptoms: These include an overreactive startle response, trouble focusing, and issues with sleeping patterns.
The diagnosis hinges on these symptoms significantly affecting the individual’s ability to function daily, indicating a broad impact across both physical and psychological aspects of their life.
what are the clinical features of GAD? what is the epidemiology of this disorder? and what are the increased and decreased risks?
should not be a feature of another disorder but there is normally comorbidity with other conditions such as depression (67%) or any psychiatric disorder (96%)
life time prevalence for an individual of getting anxiety is 5.7%
increased risk: female, middle-aged and low income
decreased risk: african american, asian, hispanic, and have high socioeconomic status
is the criteria accurate and valid for diagnosis of anxiety
Validity -> accurate diagnosis, make sure it is anxiety and nothing else.
DMS 3, 4, 5 – included in all of these.
-fair reliability – does clinician a and b diagnose the patient with anxiety. Do they all agree?
-highly comorbid- can separate it out from other conditions
what is the etiology of GAD?
genetics - 5x more prevalent in first-degree relatives
Biological Factors
*Genetics: Anxiety disorders can run in families, suggesting a genetic component. Specific genes associated with anxiety have been studied, but anxiety is likely influenced by many genes, each contributing a small effect.
*Brain Chemistry: Imbalances in neurotransmitters, chemicals in the brain that transmit signals, can contribute to anxiety disorders. Neurotransmitters like serotonin, dopamine, and gamma-aminobutyric acid (GABA) play roles in mood regulation and anxiety.
Decreased levels of GABA, as GABA inhibits CNS irritability.
Serotonin
Typically Associated with Decreased Levels in Anxiety: Serotonin is often linked to mood regulation, and lower levels or imbalances in serotonin are commonly associated with anxiety disorders. Many anti-anxiety and antidepressant medications work by increasing serotonin levels or enhancing its activity in the brain, suggesting that boosting serotonin can alleviate anxiety symptoms.
Dopamine
Complex Role, Can Be Both Increased or Decreased: Dopamine’s role in anxiety is more complex and less straightforward than serotonin’s. Dopamine is associated with the brain’s reward system, motivation, and pleasure. In some cases, anxiety disorders might be linked to decreased dopamine activity, affecting reward and motivation pathways. However, increased dopamine activity can also contribute to anxiety symptoms, particularly in situations where dopamine’s role in alertness and stress response is considered. The specific relationship between dopamine and anxiety might vary depending on the type of anxiety disorder and individual differences.
*Brain Structure: The structure and function of certain areas of the brain, such as the amygdala (which processes fear) reduced activity in the amygdala - MRI of children and adolescents with GAD showed volume increases. and the prefrontal cortex (which regulates the response to fear), can influence susceptibility to anxiety.
Neurological diseases such as huntington’s.
Hypoglycemia
Thyroid dysfunction
Psychological Factors
*Personality Traits: Certain personality traits, such as being prone to perfectionism or having a tendency towards negative thinking, can increase the risk of developing anxiety disorders.
*Trauma and Stressful Life Events: Experiencing trauma, such as abuse, the death of a loved one, or significant life changes, can trigger anxiety disorders. Chronic stress or exposure to stressful environments can also elevate the risk. Insecure attachment type
*Learned Behaviors: Anxiety can be learned from family members or through experiences, especially if a person observes others responding to situations with fear or anxiety.
psychological vulnerability - such as diminished sense of control, they feel like they don’t have control (external locus of control)
Environmental Factors
*Social and Cultural Factors: Cultural expectations, societal pressures, or conflicts can contribute to the development of anxiety disorders. Social factors, including relationships with family, friends, and peers, play a role as well.
*Substance Use: The use of or withdrawal from certain substances, including caffeine, alcohol, nicotine, and drugs, can trigger or exacerbate anxiety symptoms.
Alcohol and drug withdrawal
Vitamin b12 deficiency.
Noradrenergic Nervous System
Function and Anxiety: The noradrenergic system is involved in the body’s “fight or flight” response, which is activated under stress. It uses norepinephrine (noradrenaline) as a neurotransmitter to communicate between neurons. This system regulates arousal, alertness, and responses to stress.
Imbalance and Impact: Imbalances in norepinephrine levels and noradrenergic system activity can contribute to anxiety. An overactive noradrenergic system can lead to heightened stress responses, resulting in increased anxiety levels. This can make individuals more sensitive to stressors and more likely to experience anxiety disorders.
Target for Treatment: Medications that target the noradrenergic system, such as certain antidepressants and anti-anxiety drugs, can be effective in treating anxiety disorders. These medications can help regulate norepinephrine levels, reducing symptoms of anxiety
what are the course and prognosis and treatment/management?
course is chronic, symptoms may diminish, as the patient gets older.
-with time secondary depression may occur, this is not uncommon if the condition is left untreated.
-with treatment prognosis is good, over 70% of patients improve with pharmacological therapy, best when combined with psychotherapy
CBT is the main treatment.
Benzodiazepines -> good at stopping panic attacks and anxiety. it works by binding to GABA A receptor and is fast acting, has anxiolytic properties to calm the individual down alleviating anxiety symptoms.
Disadvantage of these -> regular use can use to withdrawal symptoms therefore can only be used short-term. Long term use leads to cognitive problems.
So should be used in short term.
Next – high doses of SSRIs and SNRIs. They are pretty effective.
Pregabalin- reduces glutamate release to have a greater GABA inhibitory effect on the brain and body, thus alleviating anxious symptoms
-psychoeducation
-relaxation techniques
-Flooding therapy is a behavioural exposure therapy technique wherein the patient learns to associate feelings of relaxation with the fear-inducing stimulus. The patient is exposed directly and rather abruptly to the fear-inducing stimuli while at the same time employing relaxation techniques designed to lower levels of anxiety.
