Anxiety Flashcards
List different types of anxiety disorders and what they involve. (6)
GAD: Variety of worries, appearance, future, need perfection. Related to depression.
Panic disorder: Repeated experience of unprovoked panic attacks, intense fear.
Agoraphobia: Extreme fear and avoidance of crowds and public places.
Separation anxiety disorder: High distress with separation, tries to avoid it.
Specific phobia: Unreasonable fear.
Social anxiety: High self consciousness and fear of being perceived as foolish or stupid. (eating/performing in public).
Why is OCD not categorised with anxiety anymore?
The repetition compulsive element which lowers anxiety is distinct. It is now associated with hoarding disorder, body dysmorphia, trichotillomania.
What is associated with fear?
The urge of reassurance, and proximity to attached figures (ie parents, spouse).
What is the core feature of anxiety?
Avoidance. This can be of people, places or stimuli. The key difference betweenn disorders is the trigger for this avoidance. Anxiousness comes with expectation of threat (worry, rumination, anxious anticipation, negative thoughts).
What are physical symptoms of anxiety?
Tension headache Dizziness Periooral tingling (hyperventilation) Lump in the thorat Chest pain Abdominal pain Bowel and bladder urgency.
Comorbidity?
There is a lot of overlap between various anxiety disorders. 75% have more than one anxiety disorder.
Therefore it is important to focus on a spectrum of disorders rather than just one.
Comorbidity with Depression, Conduct disorders/ODD, ADHD.
25% younger children have additional behavioural disorder.
Epidemiology (prevalence)
Around 5% in western population.
Females>males.
Familial risk?
Anxiety and inhibited temperament runs in families. 1st degree relatives at risk.
What are the 3 groups of important neurotransmitters?
GABA. Benzidiazepenes exert effects via GABA receptor complex.
Serotinin. Mediates anxiety and fear. Neurons emerge from raphe nuclei, with median raphe providing innervation to septohippocampal system and cortex. SSRis show benefit.
Noradrenaline: Neurons arise from locus ceruleus. Serve diverse areas of brain.
Neurotransmitters that regulate mood condition and behaviour?
Norepinephrine, Dopamine and Seratonin.
Brain regions identified with fMRI?
Amygdala- abnormalities of volume. Increased response in anxiety.
Prefrontal cortex changes.
amygdala-PFC circuitry.
Risk factors?
Abuse (physical,sexual, family violence). Parental modelling and communication of fear. Parenting characteristics (overprotection, intrusiveness, negativity).
Life events, bullying, neglect and rejection.
Describe the process of anxiety assessment.
3 parts:
1: Questionnaires
2. Diagnostic interview
3. Behavioural observation
Use clinical judgement to combine information from various sources. Diagnostic interview is sometimes more appropriate.
Treatment?
CBT- may need adaptation, delivered individually or in groups.
Psychoeducation: Relaxation, Exposure to stimuli. Cognitive restructuring Parent training. Social skills
Discuss possible psychopharmacological treatments.
SSRIs: Fluoxetine, sertraline.
Combination treatment most effective (SSRI + CBT)
Outcomes more positive than teen depression.
