Anxiety Flashcards
Anxiety is persistent => general anxiety
OR
Anxiety is episodic, regularly triggered by a cue => phobia
OR
Anxiety is episodic without a regular trigger => panic disorder
*Patient with one anxiety disorder may develop another
INFO CARD
What is generalised anxiety disorder (GAD)?
GAD => persistent, chronic general anxiety
More common in women
Physical symptoms of GAD:
GI: => Dry mouth => Difficulty in swallowing => Epigastric discomfort => Aerophagy (swallowing air) => Diarrhoea
Respiratory: => Feeling of chest contraction/tightness => Difficulty inhaling => Over-breathing => Choking
Cardiology:
=> Palpitations
=> Awareness of missed beats
=> Chest pain
Physical symptoms of GAD:
GU:
=> Increased frequency
=> Failure of erection/loss of libido
CNS: => Fatigue => Blurred vision => Dizziness => Sensitivity to bright light/noise => Headache => Sleep disturbance => Trembling
Mixed anxiety and depressive disorder => most common mood disorder in primary care
=> equal elements of depression and anxiety
INFO CARD
What is a panic disorder?
Repeated sudden attacks of overwhelming anxiety accompanied by severe physical symptoms related to:
=> hyperventilation
AND
=> sympathetic nervous system over-activation i.e. palpitations, tremor, restlessness and sweating
People with panic attack have catastrophic illness belief that they are going to die => fear, terror and impending doom
What are the clinical features of panic disorder?
=> fear, terror and impending doom
=> dyspnoea
=> palpitations
=> chest pain or discomfort
=> suffocating sensation
=> dizziness
=> paraesthesia in hands and feet or perioral
=> Sweating
=> carpopedal spasms
What causes hyperventilation in anxiety?
Over-breathing leads to a decrease in PaCO2 and an increase in arterial pH, causing relative hypocalcaemia
How do you manage panic attacks?
Explanation and reassurance
Patient trained in relaxation techniques and slow, controlled breathing
Patient asked to breathe into a closed paper bag
What are phobic (anxiety) disorders?
Phobia is an abnormal, intense fear triggered by a stimulus
=> stimulus is predictable + usually of no concern
=> leads to avoidance of stimulus
=> can be disabling
=> treatable with behaviour therapy
=> e.g. agoraphobia, claustrophobia, social phobia
What is the aetiology underlying phobias?
=> Caused by classical conditioning i.e. fear and avoidance becomes conditioned to a previous benign stimulus e.g. a lift or after an emotional shock e.g. being stuck in a lift
=> In children, phobias arise via imagined threats i.e. ghost stories
Phobias affects which group of people more?
Women > men [2:1]
Phobias aggregate in family - genetic factors
Phobias:
- Agoraphobia:
=> direct translation ‘fear of marketplace’
=> fear of being away from home, with travelling, walking down the road and going to supermarket
=> most disabling, patients don’t leave their rooms - Social phobia:
=> fear & avoidance of social situations i.e. crowds, strangers, parties and meetings
=> Public speaking = worst nightmare
Phobias:
- Simple phobias:
=> Arachnophobia (phobia of spiders) most common in esp in women
=> Other common phobias = insects, bats, dogs, snakes, heights, thunderstorms and the dark
=> Children phobic about dark, ghosts and burglars the most but most grow out of it
Phobias:
- Agoraphobia:
=> direct translation ‘fear of marketplace’
=> fear of being away from home, with travelling, walking down the road and going to supermarket
=> most disabling, patients don’t leave their rooms
- Social phobia:
=> fear & avoidance of social situations i.e. crowds, strangers, parties and meetings
=> Public speaking = worst nightmare
Phobias:
- Simple phobias:
=> Arachnophobia (phobia of spiders) most common in esp in women
=> Other common phobias = insects, bats, dogs, snakes, heights, thunderstorms and the dark
=> Children phobic about dark, ghosts and burglars the most but most grow out of it
In people with brief episodes, discussion with a doctor about their anxiety and its precipitant is enough.
What is the psychological management of anxiety disorders?
- Relaxation techniques:
=> Effective in mild to moderate anxiety
=> Complementary techniques i.e. meditation, yoga
=> Conventional relaxation training by slowing down rate of breathing, muscle relaxation and mental imagery - Anxiety management training (2 stages):
=> 1st Stage: verbal cues & mental imagery to arouse anxiety and demonstrate the link with symptoms
=> 2nd Stage: training to reduce this anxiety by relaxation, distraction and reassuring self-statements - Behaviour therapies:
=> Change behaviours thus change symptoms assoc. with phobia
=> Graded exposure or ‘systematic den-sensitisation’
=> Identify and rate phobias in a hierarchy of worsening fears
=> Then practice exposure to the least fearful stimulus until no fear is felt
What is the psychological management of panic attacks?
CBT => treatment of choice for GAD and panic attacks
=> Therapist and patient identify mental cues i.e. thoughts and memories that subtly provokes exacerbations of anxiety or panic attacks
