ANXIETY Flashcards
performance anxiety relationship
yerkes-dodson law
The interalated components of anxiety
- thoughts of having apprehensive, nervouse or frightened
2. the awareness of a physical reactio to anxiery (autonomic or peripheral anxiety)
anxiety patterns of pathology
1 Generalised (free floating) anxiery - mild/moderate lasting hours days around normal life events 2 Paroxysmal anxiety- abrupt onset and stron autonomic sx - can be on background of GAD but phobias most common
Physical sx of anxiety
- tachycardia
- palpitations
- htn
- sob
- chest pain/discomfort
- choking sensation
- tremors/shaking
- muscle tension
- dry mouth
- sweating
- cold/skin
- N&V
- Diarrhoea
- abdominal discomfort
- dizziness/syncope
- mydrias
Anxiety hx
- onset
- severity
- duration (general or paroxysmal)
- to specific threat or spontaneously?
- only in context of pre-existing medical or mental health condition
DDX
Anxiety diorders
-phobic disorders (agoraphobia, social phobia, specific phobia)
Non situational anxiery disorder
- GAD
- Panic Disorder
Reaction to stess or OCD
Other psychiatric conditions
-65% of patients with anxiett gave deppressive sx
anxiety secondary to general medical conditon or psychiatricx substance
Phobic disorders
agoraphobia
-crowded spaces - particularly if cannot escape in context of panic disorder
Social phobia
-fear of scrutiny in general but can be specific (e.g public speaking)
Specific phobia
- situational (flying, elevators)
- natural environmental (heights, storms, water)
- blood injection/injury: seeing blood or injury (bradycardia!)
- animal
GAD ICD-10
excessive worry on minor matters and apprehensive most days for 6/12
1) apprehension
2) motor tension (restless, fidgetting, tension headaches, inability to relax)
3) autonomic overactivity
Panic disorder
NOT restricted to situation or object
- anticipatory anxiety is anxiety about having panic attacks and can lead to agoraphobia
other psychiatric conditions
cause second anxiety with focus in (brackets)
- eating disorder (gaining weight)
- somatisization disorder (having many physical complaints)
- hypochondriacal disorder (having serious illness)
- delusional beliefs in paranoid schizophrenia (fear of being poisened or killed)
- deppression (gait or worthlessness)
- OCD (when having obsessional thought and resisting compulsion)
- personality disorder (seperation or abandoment, or being rejected or inadequated
- ADHD (restless and unable to concentrate
- autism spectrum disorder (unable to understand others)
- delirium/dementia (not understanding what is going on)
- anxiery and depression closly related
anxiety medical conditions
causing dyspnoea
- CCF
- PE
- COPD
- pulmonary disease
- asthma
causing increased sympatheitc outflow
- hypoglycaemia
- phaeochromocytoima
causing pain
-malignancies
Other
- cerebral trauma
- cushings disease
- hyperthyroidism
- temporal lobe epilepsyt
- vitamin deficiencies
substances
intoxications
- alcohol
- amphetamines
- caffeine
- cannabis
- cocaine
- hallucinogens
- inhalants
- ketamine
- NPS
- phencyclidine
withdrawal
- alcohol
- benzodiazepams
- caffeine
- cocaine
- Gamma-hydroxybutyrate/ gamma-butyrolactone
- nicotine
- other sedatives and hypnotics
- opiates
SE of prescribed
- ADDs (SSRIs in first 2 weeks and rapid discontinuation particularly of paroxetine or venlafaxine)
- corticosteroids
- sympathomimetics
- Thyroid hormones
- compound analgesics
- containing caffeine
- anticholinergics
- antipsychotics (akathisia)
anxiety hx questions
- do you sometimes wake up feeling anxiousand dreading the day (any form of anxiety)
- do you worry excessivly about minor matters on most days of the week? (generalised)
- have you ever been so frightened that your heart was pounding and you thought you might die? (panic attack)
- do you avoid leaving the house alone becuase you are afraid of having a panic attack or being in situations (like crowded shop/train) from which escape would be difficult/embarrassing? (agoraphobia)
- do you get anxious in social situations like speaking in front of people (social phobia)
- do some things or situations make you scared? . . . . do you avoid them? (specific phobia)
epidemiology
overall anxiety 12-17% 1 year prevelence prevelence % and f:m GAD = 3% AND 2-3:1 pANIC DISORDER = 4% AND 2-3:1 social phobia = 4% and 1:1 specific phobia = 4% and 2:1 PTSD =4% and2:1 OCD = 2% and 1:1
onset most is childhood/adolescence with panic disorder and bit later and ptsd anytime
generally more wommen except social and OCD whcih is equal
aetiology
30-50% heritability with considerable genetic overlap with anxiety
panic disorder and ocd most heritable
-GABA, serotonin and NA most associated
-OCD with caudate nucleus damage
-amygdala hyperactivation in PTSD and other anxiety
- significant traumatic life event needed for PTSD but only 10-30% will develop
- CBT suggests thuought patterns (innapropriate) lead to overestimation of dangers
- pavlovian relationship with some phobias eg car crash
