Anxiety and mood disorders Flashcards
What are the key features of anxiety disorders?
Early onset (teen), 2:1 female predominance, symptoms wax and wane over lifetime Functional impairment and decreased quality of life
What are the symptoms of anxiety disorders like?
Characteristically an ordinary physiological reaction to an actual threat, but in disorders they are serving no real purpose as no threat present - we say it is a maladaptive extension of natural body responses
What is pathological anxiety?
Anxiety that is excessive, impairs function, and cannot be controlled - MALADAPTIVE, UNREALISTIC, DISPROPORTIONAL, PERSISTENT, ANTICIPATORY
What are some of the physiological, emotional, cognitive and behavioural symptoms of anxiety?
Somatic - goosebumps, increased HR, dilated pupils
Emotional - Sense of dread, terror, irritability
Cognitive - Anticipation of harm, problems concentrating, hypervigilance etc.
Behavioural - Escape, avoidance, aggression
What other psychological disorders do anxiety symptoms play a role in?
Depression - anxiety as comorbidity
Schizophrenia - anxiety when believe slipping into new episode
Drug/alcohol abuse - try to dampen symptoms of anxiety
Many anxiety disorder sufferers have more than one
What are early tendencies indicative of an anxiety disorder?
Neuroticism, negative affect, behavioural inhibition, easily anxious/depressed in presence of stressors
Interactions with parents are key e.g. if parents are anxious, or if they are pushy and the child has to try to meet their expectations
What are the 2 major characteristics of generalised anxiety disorder?
General apprehensiveness not restricted to any particular circumstance
Worry about negative events occurring in several different aspects of life
What are the symptoms of GAD like?
NOT transient - persist for several months, for more days than not during that time
This is a critical facet of diagnosis - many of the symptoms are non-specific and experienced by most people in response to stress so we need to differentiate what is a legitimate problem and what isn’t
What also needs to be clarified when diagnosing GAD?
Symptoms not being caused by a physiological condition e.g. hypothyroidism, effect of drugs on CNS, withdrawal or another mental disorder that could better account for symptoms
SYmptoms causing significant distress or significant functional impairment
What is one of the most popular models of generalised anxiety disorder?
Cognitive-behavioural model of GAD - suggests that many different factors interact to continue the cycle of anxiety
Start with a situation, and this leads to “What if..” questions which then causes worry; worry leads to negative problem orientation, anxiety and cognitive avoidance
Mood state and life events interact within this, and the overall result is often exhaustion and demoralisation
What are the key features of the biochemical basis of GAD?
In the DORSAL RAPHE NUCLEUS serotonin is produced, and this normally interacts with the BASAL GANGLIA, AMYGDALA and CORTEX, inhibiting their activity
In GAD there is serotonin hypofunction, so lack of usual inhibitory effect
Additionally, NA HYPERFUNCTION from the LOCUS COERULEUS –> excessive excitatory effect on hypothalamus (autonomic responses), thalamus and cortex
Also GABA hypofunction again reducing the inhibitory effect and producing further activation of cortex
What is panic disorder characterised by?
Unexpected panic attacks not restricted to particular stimuli/situations - attacks are DISCRETE, RECURRENT and TRANSIENT episodes of intense fear along with rapid and concurrent onset of several other symptoms
Can be a disorder in own right or associated with other anxiety-related disorders
What are some of the associated symptoms in panic disorder?
Palpitations/raised HR Sweating Nausea Shortness of breath Parasthesia (tingling) Depersonalisation Fear of losing control/dying
What is a key problem with the symptoms of panic disorder?
Easy to recognise, and fear about having attacks can actually lead to even more panic - patients need strong adaptive ways of dealing with the cognitive issue of over-perceiving the threat to themselves, to reduce the risk of attacks recurring
What is “the panic circle”?
Trigger stimulus (internal or external) Perception of threat --> apprehension/worry e.g. about panic attack or about any distressing situation --> body sensations e.g. tingling (can also be directly caused by a trigger stimulus e.g. exercise, excitement, anger, coffee etc) --> interpretation of sensations are catastrophic --> perception of threat --> apprehension or worry etc etc
What follow panic attacks?
Persistent concerns/worries for weeks afterwards, e.g. worries of recurrence or perceived negative significance e.g. think chest pain is heart attack
Worries lead to behaviours to reduce risk of recurrence e.g. only leaving home with trusted companion
What must we make sure before diagnosing panic disorder?
Symptoms aren’t due to health condition e.g. pheochromocytoma (rare adrenal gland tumour)
Symptoms not due to meds affecting CNS
Symptoms not due to withdrawal effects
Another mental health condition doesn’t account for symptoms better e.g. OCD with panic attacks
What does the Kindling model of panic disorders suggest?
Kindling is a term to describe a phenomenon wherein brain regions become primed for triggering conditions such as epilepsy but also mood disorders
Linked to neuroplasticity, where the brain learns and adapts responses to certain triggers - each bout of a mood disorder damages brain cells and nerve pathways and makes a person more susceptible to, for example, panic attacks, increasing sensitivity of hormonal response to stress
What has been suggested regarding the kindling model?
Prevention is actually a better focus - neuroplasticity is undeniable, but we can help by educating young people to identify and cope with triggers to help avoid the development of chronic mental illnesses altogether
What is the second key model for panic disorders?
The vulnerability stress-model - basic susceptibility to mental disorders, rooted in genetic makeup and early life experiences, combined with stress and life challenges, our coping skills and social support
(Biological vulnerability to hypersensitive fight/flight response) x (Tendency to engage in catastrophising cognitions about physical symptoms) –> panic attacks and hypervigilance
By addressing the factors that can be controlled e.g. coping skills and social support, we can reduce symptoms and relapses and improve the course of co-occurring disorders
Describe the biological basis of the kindling model of panic
Panic attacks –> lower threshold for chronic anxiety in limbic system, leading to more panic attacks
This lower threshold –> chronic anxiety increases likelihood of dysregulation in locus coeruleus –>poor regulation in locus coeruleus –> more panic attacks
What is the cognitive model of panic disorders?
Pay close attention to bodily sensations and misinterpret them negatively - engage in snowball catastrophic thinking, exaggerating symptoms and their consequences
What is the underlying biology of panic disorder like?
Shares some similarities with GAD - poorly regulated norepinephrine in the locus coeruleus for example, producing an excessive excitatory response
Serotonin, GABA and CCK are also involved
The brain stem fires systemically to create autonomic symptoms, the amygdala and limb system generate anticipatory anxiety and the pre-frontal cortex generates phobic avoidance
Thought to be some genetic component too, with around 10% of first degree relatives of a patient also having the disorder
What are the metabolic models of panic disorders?
Metabolic studies focus on how we PROCESS particular substances - people with panic disorder have been found to be more sensitive to certain substances than “normal” people, further supporting the biological theory and demonstrating how those with panic disorder have a different makeup to those without
What is an example of a metabolic model of panic disorder?
Panic attacks can be triggered in those with disorder by injecting LACTIC ACID (naturally produced during muscular activity)
Breathing air with elevated CO2 can also trigger attacks, as can intake of caffeine, nicotine, and alcohol
What do many panic disorder experts currently agree?
Disorder caused by a combination of factors, both chemical messengers and metabolic processes are likely involved, as are genetic and environmental factors
Biological - deficiency in serotonin and GABA receptors, amygdala and fear circuitry
Sociocultural - fewer among Asian and Hispanics, more in women
Social - anxiety-filled social environment, separation/loss
Psychological - catastrophic thoughts, conditioning etc
What is Agoraphobia?
A marked and intense fear in (or simply in anticipation of) situations in which escape is difficult or help may not be available
Individuals constantly fearful due to disproportionate sense of danger or fear if specific negative outcomes e.g. having a panic attack in public
What is a key feature of agoraphobia?
Situations that cause fear are ACTIVELY AVOIDED or only entered in specific circumstances e.g. when with someone
Home becomes a safe place and a destructive cycle forms in which avoidance of anxiety reinforces the avoidance behaviour because distress reduced (may also start to see generalisation of avoidance behaviours)
What are 4 other examples of specific phobias?
Animal type - extreme fear of dogs, cats, spiders etc
Natural environment type - extreme fear of heights, storms etc
Situational type - scared of public transport, tunnels, elevators etc
Blood-injection type - person will panic when seeing a cut
How can general phobias be defined?
Marked and excessive fear or anxiety that CONSISTENLY occurs when exposed to one or more specific triggers, OUT OF PROPORTION to actual danger present
Phobic stimulus avoided or endured with intense fear
