Anxiety Flashcards
what acts as the emotional filter of the brain for assessing whether sensory material via the thalamus requires a stress or fear response
amygdala
acute stress leads to dose-dependent increase in what
catecholamines and cortisol
_____ acts to mediate and shut down the stress response
cortisol
through negative feedback, cortisol acts on what
pituitary
hypothalamus
hippocampus
amygdala
acute stress _____ cortisol levels
increases
what is an automatic though
thought that pops into your head throughout the day
what is a schema
a deep rooted unconditional belief that stems from childhood experience. they shape assumptions and automatic thoughts
what is GAD
anxiety that is not restricted to, or strongly predominating in any particular environment - free floating
what makes anxiety qualify as GAD
long lasting (most days for 6 months) not controllable causing significant distress/impairment in function
what is the typical age of onset of GAD
20-40
what is the course of GAD
chronic and fluctuating
is GAD more common in women or men
women
__% are co-morbid with other psychiatric disorders
90
what is the first line treatment of GAD
CBT
what pharmacological methods can be used to treat GAD
SSRI - sertraline
SNRI - venlafaxine
pregabalin
Benzodiazepines (ST only)
what investigations would be done for GAD
ECG
PFTs
TFTs
FBC
when do problems with benzos arise
if used over 2 weeks
what kind of problems arise with benzos
sedation and psychomotor impairment
withdrawal problems
can worsen depression
nausea and headache
how do you treat an overdose of benzodiazepines
flumazenil
what kind of withdrawal symptoms are seen with benzos
rebound anxiety
insomnia
irritability
delirium
how do benzos work
enhance the effect of GABA –> sedation, muscle relaxation, anticonvulsant effects, reduced anxiety
GABA channels allow __ influx
Cl-
what is panic disorder
recurrent attacks of severe anxiety which are not restricted to any particular situation or set of circumstances and so attacks are unpredictable
what are s/s of panic disorder
sudden onset of palpitations, chest pain, choking sensation, dizziness, unreality
when does a panic attack peak
10 minutes, lasts up to 45 mins
most patients with PD also have
agoraphobia
what is agoraphobia
fear and avoidance of places and situations that might cause you to panic and make you feel trapped, helpless or embarrassed e.g. big crowds, public transport
what is the typical age onset of PD
late adolescence to mid 30s
what is the typical course of PD
waxing and waning
chronic
PD is often comorbid with
other anxiety disorders, depression, drug and alcohol misuse
what is the first line treatment in PD
CBT (+ graded exposure of agoraphobia)
what are some pharmacological options for treating PD
SSRI
SNRI - venlafaxine
TCA - imipramine, clomipramine
benzo - short term only - acute
what are the 3 types of phobia
agoraphobia
social phobia
specific phobia
phobias are typically late/early onset
early
with phobias, is the fear recognised as irrational?
yes
phobias are typified by
avoidance and anticipatory anxiety
what does agoraphobia entail
fears of leaving home, entering shops, crowds, public places, travelling alone
- avoidance is prominent
agoraphobia may be second to conditions such as
panic disorder
depression
people with agoraphobia often use ___ to get over anxiety
alcohol
what is specific phobia
marked and persistent fear that is excessive or unreasonable cued by the presence or anticipation of a specific object or situation
what is the treatment of specific phobia
behavioural therapy - graded exposure
CBT if necessary
SSRI/SNRI if required
what is social phobia
persistent fear of one or more social or performance situation in which the person is exposed to unfamiliar people or possible scrutiny by others
social phobia tends to occur in ____ social situations
small
what is the treatment of social phobia
CBT
SSRI/SNRI
benzo
what is OCD
recurrent obsessional thoughts and/or compulsive acts
in anxiety there is increased bilateral activation and increased CBF of the
amygdala
what are obsessional thoughts
ideas images or impulses entering the mind in stereotyped way
how would you describe the nature of the obsessional thoughts in OCD
unpleasant, resisted and ego-dystonic
what are compulsive acts in OCD
repeated rituals or stereotyped behaviours that are not enjoyable or functional - pointless
carrying out the compulsive act is assoc with
reduced anxiety
neutralising behaviour
what is needed for diagnosis of OCD
obsessional thoughts 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 the persons own thoughts
- resistance must be present
- rituals are not pleasant
- must be repetitive
what are some common obsessions
fear of germs
fear of harm
obsession with order/symmetry
obsession with body
what are some common compulsions
checking
cleaning / washing
repeating words
collecting
what is the mean onset of OCD
20
what is the peak onset of OCD for males
13-15
what is the peak onset of OCD for females
24-25
60-90% of OCD experience one ________ episode
major depressive
OCD has significant co-morbidity with
schizophrenia tourettes/tic disorders body dysmorphic disorder eating disorders trichotillomania
what is trichotillomania
compulsive desire to pull out hair
what is the treatment of OCD
CBT - including response prevention
SSRI
clomipramine
