Anxiety Flashcards
Outline General Anxiety Disorder (GAD) and some disorders it includes
Abnormal and pathological fear and anxiety - one of a range of anxiety disorders including panic disorder, PTSD, OCD, social phobia, specific phobias, acute stress disorder, body dystrophic disorders
What are the psychological and physical features of GAD?
Psychological: worry, interrupted sleep, poor concentration, increased sensitivity to noise
Physical: sweating, dry mouth, urinary frequency, hyperventilation, dizziness, palpitations
Outline the DSM-IV diagnosis of GAD
Excessive anxiety and worry occurring more days than not, for at least 6 months about a number of events or activities
What are predispositions to GAD?
Biopsychosocial factors, social environment, perceived control
Define stress and what are the 4 ways it can be classed
Stress = feeling overwhelmed by situations, real or perceived (an inability to cope)
Affective - shock, distress, anxiety, fear
Behavioural - smoking, alcohol, social withdrawal, help seeking delay
Cognitive - poor attention, memory loss, hypervigilance
Physiological - activation of NS, cortisol production, fatigue, illness
Define fear and which brain areas are involved
Fear = acute response to an actual stressor
Involves amygdala and other limbic areas (insula cortex, PAG)
What are the two main ways people cope with stress?
Problem-focused coping: attempts to manage the aspects of the stressor, most effective when the stressor is amenable to change
Emotion-focused coping: attempts to remove or reduce the emotional distress, most effective when the stressor can’t be changed
What are the treatments for GAD?
Psychotherapy: CBT, counselling, relaxation courses, hypnotherapy, conscious avoidance
Medication: Propranolol (B-blocker for physical symptoms), SSRI (Sertraline), SNRI (Venlafaxine) or Risperidone/Amitryptiline (antipsychotic)
What are the 6 symptoms that anxiety/worry are associated with for a diagnosis? How many must you have?
3 or more out of the 6: Restlessness Easily fatigued Difficulty concentrating Irritability Muscle tension Sleep disturbance
What are 3 features of coping with anxiety?
Magnification - exaggerating the importance of undesired events
Overgeneralisation - drawing broad negative conclusions on the basis of a single insignificant event
Selective attention - seeing only the negative features of an event
What are 3 perspectives to understanding stress?
Stimulus
Response
Process
What are the 3 stages of physiological stress response?
Alarm - SNS, endocrine and immune systems activated
Resistance - conservation response initiated to return homeostasis
Exhaustion - depletion of physiological resources; immune failures and disease outcomes
What’re the physiological effects of stress in-patients vs those discharged
Inpatients: slower wound healing, longer stay, more staff time, more analgesia use, poor adherence to medication, more post-surgery complications
Discharged: longer recovery/return to work, more service use, less use of rehab services, increased risk of comorbidity/early mortality
What’s the transactional model of stress?
Causal chain of influence Stimulus event (stressor) -> primary appraisal -> secondary appraisal -> response/coping -> health related outcome
What’re the definitions of fear, anxiety and stress?
Fear - acute response to an actual stressor
Anxiety - towards a perceived or potential stressor
Stress - feeling overwhelmed by situations, real or perceived
What CNS areas are involved in anxiety and fear?
Amygdala PFC Insula (threshold for emotions) Limbic system areas Association areas - frontal and parietal
Where is the insula cortex located?
Behind lateral/sylvian fissure (spearing frontal and parietal lobes)
Which brainstem region controls defence behaviours and what types of receptor dominate here?
PAG - opioid receptors (relevant to analgesia too as increases descending inhibition to SC)
What mechanisms might there be in brain areas producing anxiety/stress behaviours?
Increased CNS activity
Increased neuronal synchrony
Changes in firing frequency, morphological changes, genetic/epigenetic changes
What can psychotherapy do to neurones?
New learning Overwrite/depress old learning Alter brain activity frequencies Desensitising MRI shows altered activity
What’s GAD-7 and how is it scored?
Rapid screening tool for clinical anxiety
Mild anxiety = score 5-9
Moderate = score 10-14
Severe = >15
What are the 7 questions in GAD-7?
How often in the past 2 weeks…
Feeling nervous/anxious Unable to stop worrying Worrying about different things Trouble relaxing Being so restless its hard to sit still Easily annoyed/irritable Afraid something awful might happen
