Anxiety Flashcards
what happens in the stress response?
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
categories of pathological anxiety disorder?
in extent (more extreme anxiety than normal) In context (anxiety in situations what don't require it)
types of anxiety disorder?
generalised anxiety disorder panic disorder agoraphobia social phobia specific phobia OCD
describe generalised anxiety disorder
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
criteria for GAD?
severe enough to be
- long lasting (most days for 6 months)
- not controllable
- causing significant distress/impaired function
clinical features of GAD?
onset usually between 20-40
chronic, fluctuating course
more common in females
90% have other psychiatric disorders
how is GAD managed?
CBT
SSRIs/SNRIs
pregabalin
benzodiazepines (Only in short term acute management)
what is CBT?
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
describe panic disorder
recurrent attacks of severe anxiety (panic) which are not restricted to any particular situation or set of circumstances and are therefore unpredictable
dominant symptoms of panic disorder?
sudden onset of palpitations chest pain choking sensation dizziness feelings of unreality can often have secondary fear of dying, losing control or going mad
what causes panic disorder?
may occur with or without agoraphobia
not due to direct physiological effects of substance/drug or medical condition
not due to another mental disorder
essential clinical features of panic disorder?
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)
biology of panic attacks?
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)
how is panic disorder managed?
CBT
SSRIs/SNRIs/Tricyclics
benzodiazepines (acutely)
3 types of phobia?
agoraphobia
social phobia
specific phobia
onset of phobias?
usually early
- agoraphobia = usually by early 30s
- other 2 = by early 20s
features of agoraphobia?
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
what is a specific phobia?
marked and persistent fear that is expressive or unreasonable, cued by the presence or anticipation of a specific object or situation
features of specific phobia?
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
how can specific phobias be managed?
behavioural therapy (exposure)
- graded exposure with systematic desensitisation
- can add in CBT
SSRI/SNRI
describe social phobia/social anxiety disorder
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
features of social phobia?
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
how is social phobia managed?
CBT
SSRI/SNRI
benzodiazepines
obsessional thoughts?
ideas, images or impulses entering mind in stereotypes way
recognised as patients own thoughts but unpleasant, resisted and ego-dystonic
compulsive acts?
repeated rituals or stereotyped behaviours not enjoyable not functional often described as neutralising recognised as pointless resistance may diminish over time
features of OCD?
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
obsessive traits vs OCD?
obsessive traits are often enjoyable or neutral
OCD = very frustrating having to do all the things they do
OCD epidemiology?
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
how is OCD managed?
CBT
- including response prevention
SSRIs/clomipramine
how do benzodiazepines work in anxiety?
enhance the effect of GABA
- GABA acts on GABA-A receptor to allow chloride ion influx leading to membrane hyperpolarization causing inhibitory postsynaptic potential
