Anxiety Flashcards
What are the physical symptoms of anxiety?
Sweating, hot flushes, cold chills, trembling or shaking
Muscle tension, aches/pain, numbness or tingling
Dizziness, unsteadiness, palpitations or racing heart
Dry mouth, feeling of choking, globus or dysphagia
Difficulty breathing, chest pain or nausea
What are the cognitive symptoms of anxiety?
Fear of losing control or dying
Feeling on edge or tense and hypervigilance
Difficulty in concentrating or racing thoughts
Feeling that objects are unreal and depersonalisation
Metaworry and health anxiety
Beliefs about importance of worry
Preference for order and routine
What are the behavioural symptoms of anxiety?
Avoidance of certain situations Exaggerated response to minor surprises Difficulty sleeping due to worry Excessive use of alcohol or drugs Restlessness and inability to relax Persistent irritability Seek reassurance and checking behaviours
What does exposure to stress result in?
Instantaneous and concurrent biological responses
What does the amygdala act as?
Emotional filter of brain for assessing whether sensory material via thalamus requires stress response
What does acute stress lead to?
Dose-dependent increase in catecholamines and cortisol
What acts to mediate the stress response?
Cortisol = acts on pituitary, hypothalamus, hippocampus and amygdala via negative feedback
What are some examples of anxiety disorders?
Generalised anxiety disorder, panic disorder, agoraphobia, social phobia, specific phobia
What is generalised anxiety disorder?
Anxiety that is generalised and persistent but not restricted to particular environmental circumstances
What are the symptoms of generalised anxiety disorder?
Persistent nervousness, trembling, muscular tension, sweating, lightheadedness, palpitations, epigastric discomfort
What are some features of generalised anxiety disorder?
Express fears that they or a relative will shortly become ill or have an accident
Must be long lasting = most days for at least 6 months
Must be uncontrollable and causing significant upset
How common is generalised anxiety disorder?
Lifetime prevalence of 9%
Twice as common in women
Typical onset between age 20-40
How common are comorbidities with generalised anxiety disorder?
90% of cases are comorbid with other psychiatric disorders
How is generalised anxiety disorder treated?
CBT, SSRIs or SNRIs, pregabalin, benzodiazepines for short term
What is panic disorder?
Recurrent attacks of severe anxiety not restricted to any particular situation and are therefore unpredictable
What are the symptoms of panic disorder?
Sudden onset palpitations, chest pain, choking sensation, dizziness, depersonalisation or derealisation
What are some secondary fears that occur in panic disorder?
Secondary fear of dying, losing control or going mad
How common is agoraphobia in panic disorder?
50-67% of panic disorder patients will have agoraphobia
How common is panic disorder?
Lifetime prevalence of 2-3%
Typical onset in late adolescence to mid 30s
Not due to direct physiological effects of substance or medical condition
What are some comorbidities of panic disorder?
Other anxiety disorders, depression and substance misuse
What can trigger panic disorder in susceptible individuals?
Infusions of lactate or rebreathing air
What does a PET scan of patients with panic disorder show?
Increased metabolism in the anterior pole of the temporal lobe
What are some treatments for panic disorder?
CBT, SSRIs or SNRIs, tricyclics, benzodiazepines for short term
When do phobias present?
Typically early onset
Agoraphobia = 50% presented by 20s and 75% by early 30s
Social/specific phobia = 80% presented by early adolescence and 75% by early 20s
What are some features of phobias?
Fear is recognised by patient as being irrational
Typified by avoidance and anticipatory anxiety
What is agoraphobia?
Fairly well-defined cluster of phobias embracing fears of leaving home, entering shops, crowds and travelling alone
What are some features of agoraphobia?
Avoidance of phobic situation often prominent
May be primary or, more often, secondary to other disorder
Often involve other people, alcohol or technology to avoid anxiety
What are specific phobias?
Marked and persistent fear that is excessive/unreasonable = cued by presence or anticipation of specific thing
What does exposure to the phobic stimulus in a person with a specific phobia cause?
Provokes immediate anxiety response
What are some features of specific phobias?
Phobic situation is avoided or else endured with intense anxiety = normal functioning impaired by avoidance or distress of feared situation
What are the treatments for specific phobias?
Graded exposure behavioural therapy, CBT and SSRIs or SNRIs if needed
What is social anxiety disorder?
Persistent fear of social/performance situations in which the person is exposed to unfamiliar people or to possible scrutiny
What are some features of social anxiety disorder?
Person fears they will act in a way seen as embarrassing
Typically occurs in relatively small social settings
Exposure to feared situation provokes anxiety
What are some symptoms of social anxiety disorder?
Blushing, shaking, fear of vomiting, urgency and fear of micturition or defaecation
What can social anxiety disorder result in?
Poor school performance and poor employment history
What is social anxiety disorder linked to?
Behavioural inhibition = tendency to react to novel situations by avoidance and withdrawl to safety
What effect does social anxiety disorder have on the amygdala?
Increased bilateral activation of amygdala
Increased rCBF to amygdala
What are the treatments for social anxiety disorder?
CBT, SSRIs or SNRIs, benzodiazepines in short term
What is OCD?
Recurrent obsessional thoughts and/or compulsive acts
What are obsessional thoughts?
Ideas or impulses entering mind in stereotyped way = recognised as patient’s own thoughts, unpleasant and egodystonic
What are compulsive acts?
Repeated rituals or stereotyped behaviours = not enjoyable or functional, often viewed as neutralising, recognised as pointless
What is the criteria for OCD?
Symptoms must be present most days for at least 2 weeks and be source of distress/interference with life
Obsessions must be individuals own thoughts
Resistance must be present
Obsessions must be repetitive
What are some common obsessions?
Contamination from germs, fear of harm, excessive concern with order or symmetry
What are some common compulsions?
Checking, cleaning, repeating acts, special words repeated in set manner
What is the average age of onset for OCD?
Mean age of onset is 20
Peak in men is age 13-15
Peak in women is age 24-25
How common is depression in OCD?
60-90% of OCD patients experience at least 1 major depressive episode
What are some significant comorbidities of OCD?
Schizophrenia, Tourette’s and other tic disorders, body dysmorphic disorder, eating disorders, trichtillomania
What is the treatment of OCD?
CBT including response prevention
SSRIs or clomipramine
What kind of receptors is the GABA-A receptor?
Inhibitory inotropic receptor = in presence of GABA the ion channel allows Cl- influx causing meme=brane depolarisation and results in inhibitory postsynaptic potential
What effect do benzodiazepines have?
Enhance the effect of GABA
What effect do agonists of the benzodiazepine site produce?
Cause relaxation and have anticonvulsant effect = antagonists have opposite effect
What are the benefits of benzodiazepines?
Rapid action, well tolerated and efficacious
What are the drawbacks of using benzodiazepines?
Side effects occur if used for more than 2 weeks = sedation and psychomotor impairment, withdrawl problems, dependency and abuse, alcohol interaction
What effect can benzodiazepines have on comorbid depression when treating anxiety disorders?
May worsen the depression
