Anxiety Flashcards
biological symptoms of anxiety (that you wouldnt expect)
- muscle tension or aches and pains
- feeling of choking
- palpitations
- chest pain
- nause or abdominal distress
derealization
- Psychosensory feelings of detachment or estrangement from surroundings
- Objects appear altered/unreal
depersonalization
- Parts of the body experienced as being changed, unreal, remote, automatized
- feeling that the self is distant or not reall there
what differentiates depersonalisation from psychosis
there is insight into the subjective nature
what is meta worry
worry about everything, eg worrying about worrying
what is there often a preference for in anxiety
order and routine
what are 4 symptoms in children that are indicative of anxiety
thumb sucking
nail biting
bed wetting
food fads
what is the first thing that the brain does when stimuli arrives
amygdala acts as the emotional filter to decide whether it needs a stress or fear response
later there is modification by a cortically processed signal
–> act first think later
where is the amygdala located
set of neurons in the medial temporal lobe
which system is the amygdala part of
the limbic (emotional system)
what happens when teh amygdala perceives something as dangerous
- Stimulus information sent to amygdala – stress or fear??
- Yes - distress signal to hypothalamus, which communicates with the rest of the body (so you have the energy to fight or flee)
- Hypothalamus controls ANS, activates sympathetic nervous system via adrenal glands release of adrenaline (epinephrine) into blood stream
- Then the hypothalamus activates HPA axis (hypothalamus, pituitary gland and adrenal glands). This aims to suppress the sympathetic nervous system
- If the brain continues to perceive something as dangerous, the hypothalamus releases CRH… cortisol is released from adrenal cortex.
what does acute stress do to cortisol levels then
raises them
how much cortisol and catecholamines are released due to stress
dose dependent
is release of exxcess cortisol harmful?
yes it is neurotoxic to some extent, damages the hippocampus
what must be first eliminated in the presentation of anxiety
substance misuse, medication misuse, hyperthyroidism etc
which group of symptoms are pertinent in GAD
physical symptoms! medically unexplained
what are 3 severity criteria GAD must fulfil
long lasting, most days for at least 6 months
not controllable
causing significant distress or impairment in function
is there a genetic predisposition for GAD
yes
what type of things can trigger GAD
- Stress: work, noise, hostile home
- Events: divorce, death, moving house etc.
are females or males more affected by GAD
females
management of GAD
- Symptom control: listen and reason
- Regular (non-obsessive) exercise
- Mediation
- CBT and relaxation
- pharmacotherapy
which pharmacological agents are used for GAD
SSRI/SNRI
pregabalin (anticonvulsant)
do benzodiazpines have a role in the management of anxiety
short term use, they have no long term benefits
what is the essential feature of panic disoder
recurrent attacks of severe anxiety, which are not restricted to any particular situation or set of circumstances and are therefore unpredictable
what cues panic disorder attacks
they are not restricted to a particular set of circumstances and are unpredictable!
which phobia is panic disorder often seen with
agoraphobia - 60%
where do patients with panic disorder often present to
cardiology ward, present with palpitations, chest pain, dizziness etc
what should be suspected if someone presents with panic/anxiety later in life
underlying depression
are comobridities common with panic disorder
yes - drugs, depression, alcohol, other anxiety disorders
what has been shown to trigger panic attacks in susceptible individuals
lactate build up and increased CO2 (re breathing air, hypoventilation)
which area of the brain has a role in the triggering of panic attacks
parahippocampal gyrus
management of panic attacks
CBT
SSRIs, SNRIs, TCA
when have most phobias presented by
20s - early onset
what type of behaviour do phobias lead to
avoidance behaviour, they are only anxious in specific situations
what happens to the person with a phobia if they expect to see what they are scared of
anticipatory anxiety
do patients with phobias have insight into their fear being irrational?
yes
what type of behaviour is typical of avoidance behaviour
alcohol use
getting others to do stuff for them
avodiing situation, eg online shoppingin agoraphobia
what is agoraphobia
A fairly well-defined cluster of phobias embracing fears of leaving home, entering shops, crowds and public places, or travelling alone in trains, buses or planes
what is a specific phobia
This is a marked and persistent feat that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation.
in specific phobia, does exposure to the phobic stimulus always provoke immediate anxiety response?
yes
what is the mainstay of psychotherapy for specific phobia
behavioural therapy based on graded exposure/systematic desensitisation to phobia
are people with social anxiety disorder scared of small or big groups
small groups - feat of being scrutinised/unfamiliar people
often fine in large groups as can hide
what is there a common fear of with social anxiety
micturition or defaecation
vomiting
often there is blushing or shaking
what imapct can social anxiety disorder have on soemones life
poor school performance, poor employment history
what is behavioural inhibition
a consistent tendency to react to novel situations with fear and withdrawal to safety
what is behavioural inhibition a good predictor of if seen in children
anxiety disorders
what is seen in the brain during phobia attack
increased bilateral activation of amygdala and increased rCBF to amygdala and other limbic areas
OCD: what are obsessions
stereotyped, puposeles,s words ideas or phrases that come into the mind
are the obsessions in OCD recognised as the patients own thoughts or someone elses
recognised as their own thoughts
OCD: how do the obssessive thoughts seem to the patients
unpleasant, resisted and egodystonic
OCD: what are compulsions
senseless, repeated rituals or sterotyped behaviours
not enjoyable or functional !
do patients believe there are consequences to not doing compulsions in OCD
often viewed as neutralizing - eg this wont happen if i do this
do patients resist compulsions in OCD
often they do, but if they are longstanding the patients often give up on resisting
how long must OCD symptoms be present for for diagnosis
minimum 2 weeks, this is more of a diagnosis of exclusion as they are normally present for much longer
must be present for most days a week
can obsessions be different things each time in OCD
they must be repetitive
when is peak onset of OCD in males and females
males - 14
females - 24
is depression associated with OCD
most patients experience at least one major depresive episode
is there co morbidity in COD
significant co-morbidity with schizophrenia, tourettes and other tic disorders, body dysmorphic disorder (spend a lot of time worrying about flaws in appearance), eating disorders and trichotillomania (pulling out hair).
management of OCD
CBT , response prevention
SSRI
clomipramine
what dose of SSRI is required for CBT
a higher than normal dose
