Anxiety Flashcards
How is pathological and ‘normal’ anxiety distinguished?
How are anxiety disorders basically classified?
Autonomy: No or minimal environmental trigger
Intensity: exceeds patient’s capacity to bear discomfort
Duration: symptoms persist
Behaviour: anxiety threatens functioning and people engage in avoidance/ safety behaviours
Remember that anxiety is a cycle where thoughts, emotions, behaviours and physical symptoms interact.
Constant: GAD or Episodic. Episodic- PTSD, Phobias, Panic attacks, OCD
What is an obsession? What is the ddx for a patient presenting with obsessions?
Reccurent, unpleasant (diff OCPersonalityDisorder) intrusive thought/ image that is the patient’s own thought (not thought insertion) and cannot be prevented. The patient recognizes the thought as irrational and the thought/image causes distress.
Ddx: OCD, OCPD, Psychosis/ Schizophrenia, Depression - e.g. postnatal: thoughts to harm baby, Brain Tumour.
What is somatization disorder?
When a patient presents with physical symptoms lasting 2 years or longer from at least 2 different systems but no physical cause can be identified. The patients are not reassured by medical test results/ doctors. These symptoms cause significant distress- they are real but no basis can be found.
Their prognosis is good if they are willing to consider the possibility of a psych explanation.
What is a phobia? What is their epidemiology? How are they treated?
8% Fear of a specific object/ thing that results in panic and avoidance
They can be treated with Exposure and Response Prevention T/ Desensitization T: 1 day therapy in which you gradually increase their exposure to their phobia at each step waiting for them to habituate (ie. for their level of anxiety to decrease)
What is PTSD? What is it’s epidemiology?
3.6%
Some time elapses following a significant traumatic event for these symptoms to arise (weeks-months but less than 6m usually). Characterized by flashbacks, nightmares- disturbing sleep, Hypervigilance e.g. v triggered by/ sensitive to innocent sounds, Avoidance behaviours, numbing and disengagement.
What is generalized anxiety disorder? How does it differ from panic disorder? What are their respective epidemiologies?
GAD- a “free-floating” constant feeling of anxiety that is not linked to any particular situation and includes both generalized psychological symptoms (diff concentrating, nervousness) and somatic/ physical symptoms i.e. motor tension, apprehension and autonomic overactivity. Occurs on most days lasting several weeks-months at a time. Patients may feel paralyzed by fear and engage in avoidance behaviours bc of fears for the future. Epi- 2.8%
Panic Disorder- A specific disorder (panic attacks occur in lots of disorders) in which there are recurrent attacks of severe intense anxiety. They are not related to a specific stimulus- unpredictable. Symptoms- sudden crescendo of severe anxiety associated w intense awareness of threatening bodily sensations e.g. can’t breathe, palpitations. Common to feel loss of touch w/ reality and therefore associate w/ catastrophic cognitions- thoughts might die/ going mad. Patient makes hurried exit and they avoid further visits to this place. If frequent attacks patients may fear leaving home/ being alone. Usually expect sev attacks/month in circumstances w/ no identifiable danger that is not elicited by a specific circumstance.
These usually last for up to 10 minutes and between episodes the patient is usually fairly asymptomatic. 1.7%
What is the Presentation of an anxiety disorder?
- Psychological arousal: irritability, poor concentration, restless, worrying thoughts, fearful anticipation, sensitivity to noise
- Sleep disturbance: insomnia, nightmares
- muscles: tension, tremor, aches
- Autonomic arousal: dry mouth, hyperventilation, palpitations, sweating, freq/urgent micturation, diarrhea, chest discomfort, diff breathing
- Others: dizziness, tingling (conseq hyperventilation)
what is agoraphobia?
marked fear and avoidance of at least 2 of the following: public spaces, traveling alone, traveling away from home, crowds, where there is no clear immediate exit point.
Symptoms are related to such situations/ thought of facing such circumstances. Avoidance is the cardinal feature.
Panic disorder may or may not co-occur.
Psychological and autonomic symptoms are manifestations of anxiety and not secondary to e.g. delusions/ depression.
Describe social phobia.
Marked fear and avoidance of being the focus of attention, of embarrassment or humiliation. Symptoms are specific to encounter with or thought of social situations and include: blushing, sweating, fear of vomitting + fear/ urge to micturate.
Psychological, behav and autonomic symptoms are manifestations of anxiety and not secondary to e.g. delusions/ depression.
What are the tx options for PTSD?
- EMDR: eye movement desensitization retraining
- Trauma-focused CBT to break cycle of avoidance that is similar to phobia confrontation therapy
- (2nd line tx): SSRIs, TCAs
What is a compulsion?
action comes from the self (i.e. not controlled externally) that is purposeless/ unnecessary but the patient feels a subjective urge to perform
How is generalized anxiety disorder treated?
- Reassurance
- CBT and other psychotherapies
- medications- SSRIs
- Diazepam in the acute stages but only for very limited time due to the risk of dependence
How would you describe Panic Attacks to a patient in lay terms?
A small gland in our bodies produce a chemical called Adrenaline that tells our body to prepare for Fight or Flight. This is an automatic function of our bodies to a perceived threat that helps us to respond appropriately. This chemical causes our heart to beat faster, to breath faster, to sweat, to feel anxious. When you have noticed these changes in your body and you have thought they were caused by a heart attack, this has made you worry, which has increased your body’s production of this chemical which has led to an even more intense heart rate etc. Once our body’s store of this chemical are used up (around 30m) the panic attack finishes and we return to normal until the next attack. Anxiety is cyclical- anxiety causes these symptoms which increases your anxiety which increases your symptoms.
What is OCD? What are some of the questions to ask a patient presenting with OCD?
person has obsessions i.e. intrusive thoughts/images that are the patient’s own, these thoughts/ images are overvalued but are distressing for the patient (even though they understand that they are irrational) and the patient cannot despite their attempts push the thought/ image from their mind. These obsessions induce anxiety and compulsions (primitive psychodynamic defense mechanisms), are used to alleviate anxiety to allow them to resume functioning. These behaviours often take the form of checking, washing, counting in response to fears of contamination, fears of failure etc. These compulsions are reinforced by the relief patient experiences by doing these rituals. These rituals are purposeless/ unneccessary but the patient feels a subjective urge to complete them.
- What are the thoughts that compel these rituals
- Frequency of the rituals/ How long do the rituals help for- as time passes, relief lasts for less and less time
What is the tx for OCD?
- Exposure response prevention
- CBT: show the patient that they can challenge their obsessions. e.g. therapist says I have had a thought I will die in an RTA, I will also write this down on paper to show you that this is a thought and I am not afraid of it happening.
