Anxiety Flashcards

1
Q

what happens in the stress response?

A

exposure to stress results in instantaneous and concurrent biological responses
- assess danger and organise a response
amygdala acts as emotional filter for assessing whether sensory material via the thalamus requires a stress or fear response
this is modified by later-received cortically processed signal
there are a series of responses to the stressor prior to the point at which stimulation of the adrenal gland causes the release of cortisol

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2
Q

categories of pathological anxiety disorder?

A
in extent (more extreme anxiety than normal)
In context (anxiety in situations what don't require it)
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3
Q

types of anxiety disorder?

A
generalised anxiety disorder
panic disorder
agoraphobia
social phobia
specific phobia
OCD
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4
Q

describe generalised anxiety disorder

A

anxiety that is generalised and persistent but not restricted to any particular environmental circumstances
people commonly express fear that patient or relative will soon become ill/ijured

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5
Q

criteria for GAD?

A

severe enough to be

  • long lasting (most days for 6 months)
  • not controllable
  • causing significant distress/impaired function
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6
Q

clinical features of GAD?

A

onset usually between 20-40
chronic, fluctuating course
more common in females
90% have other psychiatric disorders

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7
Q

how is GAD managed?

A

CBT
SSRIs/SNRIs
pregabalin
benzodiazepines (Only in short term acute management)

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8
Q

what is CBT?

A

based on identifying an individuals automatic thoughts, cognitive biases and schemas
helps the individual identify thoughts, assumptions, misinterpretations and behaviours that reinforce and perpetuate the anxiety

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9
Q

describe panic disorder

A

recurrent attacks of severe anxiety (panic) which are not restricted to any particular situation or set of circumstances and are therefore unpredictable

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10
Q

dominant symptoms of panic disorder?

A
sudden onset of palpitations
chest pain
choking sensation
dizziness
feelings of unreality
can often have secondary fear of dying, losing control or going mad
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11
Q

what causes panic disorder?

A

may occur with or without agoraphobia
not due to direct physiological effects of substance/drug or medical condition
not due to another mental disorder

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12
Q

essential clinical features of panic disorder?

A

50-67% have agoraphobia
onset usually late adolescence - mid 30s
chronic waxing and waning course
often have comorbid disorders (anxiety, depression, drug and alcohol misuse)

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13
Q

biology of panic attacks?

A

can be triggered in susceptible individuals by infusions of lactate (muscle activity) or by re-breathing air (increased CO2)
PET shows increased metabolism in anterior pole of temporal lobe (parahippocampal gyrus)

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14
Q

how is panic disorder managed?

A

CBT
SSRIs/SNRIs/Tricyclics
benzodiazepines (acutely)

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15
Q

3 types of phobia?

A

agoraphobia
social phobia
specific phobia

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16
Q

onset of phobias?

A

usually early

  • agoraphobia = usually by early 30s
  • other 2 = by early 20s
17
Q

features of agoraphobia?

A

fear of leaving home, entering shops/crowds/public places, travelling alone on public transport
prominent avoidance of phobic situation
some people have little anxiety as they completely avoid all phobic situations, or may use alcohol/drugs etc to cope with going out

18
Q

what is a specific phobia?

A

marked and persistent fear that is expressive or unreasonable, cued by the presence or anticipation of a specific object or situation

19
Q

features of specific phobia?

A

exposure to phobia provokes immediate anxiety response/panic attack
person recognises that fear is unreasonable
normal functioning impacted by the avoidance, anxious anticipation or distress in feared situation

20
Q

how can specific phobias be managed?

A

behavioural therapy (exposure)
- graded exposure with systematic desensitisation
- can add in CBT
SSRI/SNRI

21
Q

describe social phobia/social anxiety disorder

A

persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others
more than just being shy

22
Q

features of social phobia?

A

fears that they will act in a way (or show anxiety symptoms) that will be embarrassing and humiliating
typically occurs in relatively small social setting rather than large (football match, concerts etc)
exposure to situation will cause anxiety

23
Q

how is social phobia managed?

A

CBT
SSRI/SNRI
benzodiazepines

24
Q

obsessional thoughts?

A

ideas, images or impulses entering mind in stereotypes way

recognised as patients own thoughts but unpleasant, resisted and ego-dystonic

25
Q

compulsive acts?

A
repeated rituals or stereotyped behaviours
not enjoyable
not functional
often described as neutralising
recognised as pointless
resistance may diminish over time
26
Q

features of OCD?

A

obsessional symptoms or compulsive acts must be present most days for at least 2 weeks and be a source of distress and interference with activities

  • obsessions must be individuals own thoughts
  • no resistance
  • rituals not pleasant
  • obsessional thoughts/images/impulses must be repetitive
27
Q

obsessive traits vs OCD?

A

obsessive traits are often enjoyable or neutral

OCD = very frustrating having to do all the things they do

28
Q

OCD epidemiology?

A

gender/socioeconomic status has no effect
mean onset = 20 (bit earlier in males, bit later in females)
comorbidities (schizophrenia, tourettes etc)
familial but no gene
most have at least 1 depressive episode

29
Q

how is OCD managed?

A

CBT
- including response prevention
SSRIs/clomipramine

30
Q

how do benzodiazepines work in anxiety?

A

enhance the effect of GABA
- GABA acts on GABA-A receptor to allow chloride ion influx leading to membrane hyperpolarization causing inhibitory postsynaptic potential