Anxiety Flashcards
what are the biological (physical) symptoms of anxiety
Sweating, hot flushes or cold chills
Trembling or shaking
Muscle tension or aches and pains
Numbness or tingling sensations
Feeling dizzy, unsteady, faint or lightheaded
Dry mouth (not due to medication or dehydration)
Feeling of choking
A sensation of a lump in the throat, or difficulty in swallowing
Difficulty breathing
Palpitations or pounding heart, or accelerated heart rate
Chest pain or discomfort
Nausea or abdominal distress (e.g. churning in stomach)
(autonomic overstimulation)
what are cognitive symptoms of anxiety
Fear of losing control, “going crazy or dying
Feeling keyed up, on edge or mentally tense.
Difficulty in concentrating, “mind going blank”
Feeling that objects are unreal - derealization
Feeling that the self is distant or “not really here” -depersonalisation
Hypervigilance (internal and external)
Racing thoughts
Meta-worry (worry about everything, worrying about worrying)
Health anxiety
Beliefs about the importance of worry
Preference for order and routine
what are the pathological cognitive symptoms of anxiety
Feeling that objects are unreal - derealization
Feeling that the self is distant or “not really here” -depersonalisation
Meta-worry (worry about everything, worrying about worrying)
what are the behavioural symptoms
Avoidance of certain situations
Exaggerated response to minor surprises or being startled
Difficulty in getting to sleep because of worrying
Excessive use of alcohol/drugs (prescription or “recreational”)
Restlessness and inability to relax
Persistent irritability
Seek reassurance from family/GP
Checking behaviours
what is the stress reponse
exposure to stress:
Amygdala acts as the emotional filter of the brain for assessing whether sensory material via the thalamus requires a stress or fear response (milliseconds)
this is modified by later-received cortically processed signal (i.e., act first, think later!)
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
describe cortisols role in the stress response
acute stress leads to dose-dependent increase in catecholamines and cortisol
cortisol acts as to mediate (& shut down) the stress response
through negative feedback it acts on the pituitary, hypothalamus, hippocampus and amygdala
these sites are responsible for the stimulation of cortisol release
acute stress therefore increases cortisol levels
when is anxiety pathological
in extent- more extreme than normal
in context- not normally anxiety provoking situations
if it causes significant distress and impairment of social/ occupational/ other function
name the 6 types of anxiety disorders
Generalised Anxiety Disorder Panic Disorder Agoraphobia Social Phobia Specific Phobia Obsessive Compulsive Disorder
what is generalised anxiety disorder
anxiety that is generalised and persistent, not restricted to/ sronger in particular circumstances
is free floating
what are the dominant symptoms of generalised anxiety disorder
(variable)
persistent nervousness, trembling, muscular tensions, sweating, lightheadedness, palpitations, dizziness, and epigastric discomfort. Fears that the patient or a relative will shortly become ill or have an accident are often expressed
what does generalised anxiety disorder need to be to be diagnosed
severe enough to:
be present on most days for at least 6 months
not controllable
cause significant distress/ impairment in function
what is generalised anxiety disorder typically associated with
restlessness/ feeling keyed up or on edge
easily fatigued
difficulty concentrating/ mind going blank
irritability
muscle tension
sleep disturbance
what is the typical age of onset of GAD
20-40
who gets GAD
2:1 F:M
associated with disability, medically unexplained physical symptoms, and overutilisation of health care services and resources
what is the usual course of GAD
chronic, fluctuating
what is usually co morbid with GAD
90% have other psychiatric disorders, e.g. depression, substance abuse, other anxiety disorders
what is the treatment for GAD
Cognitive Behavioural Therapy – treatment of choice
SSRIs / SNRIs – reasonable (Duloxetine, venlafaxine)
Pregabalin – long term anxiety disorder
Benzodiazepines (short term only)
how does CBT work
identifying an individual’s automatic thoughts, cognitive biases and schemas
Help the individual identify thoughts, assumptions, misinterpretations and behaviours that reinforce and perpetuate the anxiety
what is panic disorder
is recurrent attacks of severe anxiety (panic), which are not restricted to any particular situation or set of circumstances and are therefore unpredictable, happen at any time
what are the dominant features of panic disorder
sudden onset of palpitations, chest pain, choking sensations, dizziness, and feelings of unreality (depersonalization or derealization). There is often also a secondary fear of dying, losing control, or going mad
what condition does panic disorder often occur with
agoraphobia
what do you need to exclude in a diagnosis of panic disorder
not due to drug or other conditions (e.g. caffeine, hyperthyroidism)
is not caused by another mental disorder (e.g. panic can occur due to a depressive episode)
who gets panic disorder and what is its course
Lifetime prevalence between 2-3%
Typical onset late adolescence to mid-30’s
50-67% also have Agoraphobia
Usual course is chronic - waxing and waning
10 year follow-up - 1/3 unchanged or worse, 1/3 modest improvement, 1/3 well
what can be co morbid with panic disorder
other anxiety disorders (esp agoraphobia), depression, drug & alcohol misuse
what is the biology of panic attacks
can be trigger in those susceptible by infusion of lactate (by product of muscular activity)
or by re breathing air (increased CO2)
increased metabolism in anterior pole of temporal love (parahippocampal gyrus)
what is the treatment for panic disorder
cognitive behavioural therapy
SSRIs/SNRIs/ tricyclics
benzodiazepines (short term only)
what are the three types of phobia
agoraphobia
social phobia
specific phobia
