Anxiety and related disorders Flashcards
When is anxiety abnormal?
It’s the fight or flight response.
Abnormal when out of proportion to the stressful situation, persists when stressful situation has gone.
Appears for no apparent reason when there are no stressors.
What does the Yerkes-Dodson curve suggest?
That there is an optimal arousal of stress which results in optimal performance but any less and and any more will impair performance.
What is the physiology of stress?
- HPA AXIS -> cortisol
- Direct sympathetic system
- Pro-inflammatory (cytokines)
- Reduced neurotrophin (BDNF)
How does reduced neurotrophin (BDNF) link with anxiety?
- Reduced neurotrophin (BDNF)
- Smaller hippocampus
- Reduced neuro-genesis
- Hippocampus linked with memory, emotion etc.
3 Ps
What’s important when taking a history for anxiety?
- Predisposing factors (family, personal)
- Precipitating factors (triggers)
- Perpetuating factors (what happened, response)
What are the mental symptoms of anxiety?
- Restlessness, inner tension and worry
- Fear of dread, losing control or dying
- Rumination + unable to concentrate
- Fatigue, irritable
- Derealisation + depersonalisation
Autonomic + chest/GI
What are the physical symptoms of anxiety?
AUTONOMIC: Palpations, sweating, shaking, hot flushed, dry mouth and muscular tension.
CHEST/GI: Hyperventilaton, numbness, choking, chest/abdo pain and nausea.
What criteria constitutes a diagnosis of Generalised Anxiety Disorder?
- Excessive anxiety and worry, occurring more days than not, for 6 months - worry that is difficult to control.
- Associated with 3 or more:
- > restlessness/’keyed up’/on edge
- > easily fatigued
- > difficulty concentrating or ‘mind going blank’
- > irritability
- > muscle tension
- > sleep disturbance
What are the risk factors associated with GAD?
- Low socio-economic status
- Childhood maltreatment + conduct problems
What is a phobia?
Excessive unreasonable fear, by presence or anticipation of a specific object/situation.
With/without panic attacks -> can interfere with life.
3 stages
What is classical conditioning?
Classical conditioning basically involves forming an association between two stimuli resulting in a learned response.
-
Before conditioning:
unconditioned stimulus -> unconditioned response
neutral stimulus -> no conditioned response -
During conditioning:
neutral + unconditioned stimulus -> unconditioned response -
After conditioning:
conditioned (prev neutral) stimulus -> conditioned response
What is operant conditioning?
Operant conditioning focuses on using either reinforcement or punishment to increase or decrease a behavior.
Through this process, an association is formed between the behavior and the consequences for that behavior.
In what main way are classical and operant conditioning different to each other?
Involuntary vs voluntary
Classical conditioning involves associating between an involuntary response and a stimulus, while operant conditioning is about associating between a voluntary behavior and a consequence
What is agoraphobia?
The fear of open spaces - associated with fears of dying and losing control. Fear of being alone at places where escape is difficult.
This leads to avoidance, over-dependency and bad temper/agitation.
Can be with or without panic disorder.
What is a panic attack?
Intense axiety peaking within 10 mins:
- Shortness of breath / choking
- Palpitations or chest pain
- Fear - dying, “going crazy”
- Other anxiety symptoms:
- > dizziness or faintness
- > derealisation + depersonalisation
- > hot flashes or chills, nausea or stomach distress; numbness, tingling, sweating, trembling…
What is Social Anxiety Disorder (SAD)?
Social phobias
- Fear of scrutiny by others
- Avoidance of social situations
- Blushing, hand tremors, nausea, urgency of micturition
- Low self-esteem
- Sometimes convinced non-psychological
- Can progress to panic attacks
What is the SAD (social anxiety disorder) triad?
- Fear of being focus of attention
- Fear of behaving in embarrassing manner
- Avoidance
What is the principle triad linked with PTSD?
- Hyperarousal (irriability, startle response, insomnia)
- Re-experiencing (flashback, nightmares)
- Avoidance (of reminders, detachment, numbness)
What are the ICD-10 diagnostic guidelines for PTSD?
A probable diagnosis w symptoms displaying for >6 months of trauma of exceptional severity.
DSM-IV - traumatic stressr usually involves a perceived threat to life or physical integrity and intense fear, helplessness, or horror
What are obsessions and compulsions? What disorder are they associated with?
- Obsessions - unwanted, disturbing and intrusive thoughts, images or impulses; recognised as excessive and irrational.
- Compulsions - repetitive behaviours and mental acts, neutralise obsessions and reduce emotional distress.
OBSESSIVE COMPULSIVE DISORDER
What are effects of sleep deprivation?
- Irritability, cognitive impairment, memory lapses, impaired moral judgement, severe yawning, hallucinations, symptoms like ADHD
- Impaired immune system, risk of type 2 diabetes + CVD, increased heart rate
What is the general principle of Cognitive Behavioural Therapy?
- Triad combining: thoughts, feelings, actions
- Book or internet based
- Group therapy or one-to-one
- Exposure and response prevention (ERP)
- Systemic desensitisation
- Challenge reactions to anxiety-provoking situations
- Identifying and removing safety seeking behaviours
- Proof that dysfunctional thought processes are unrealistic
