Anxiety and stress Flashcards
type I trauma?
single incident trauma
type II trauma?
repetitive trauma
conveys higher risk of PTSD
what is tonic immobility
inescapable threat leads to involuntary state of profound but reversible motor inhibition
what is neuroception
neural circuit decision to determine if people/situations are safe or dangerous
takes part without conscious awareness
risk factors for post traumatic reactions - traumatic factors
man made over natural disaster prolonged exposure percieved threat to life personally relevant multiple death/mutilation or grotesque scenes
risk factors for post traumatic reactions - patient factors
severe acute stress reaction FHx or personal hx serious injury loss normal function extreme of age transgenerational events past experience trauma
risk factors for post traumatic reactions - environmental factors
lack of support ongoing stress reactions of others finance social/economic disadvantage displacement
normal reactions to trauam?
numb, shock, denial fear depression or elation guilt anger insomnia hopeless avoidance intrusive experience hyperarousal
psychological reactions post trauma
alcohol, drug dependence acute stress disorder PTSD depression grief panic attack and agoraphobia brief hypomania specific phobias
symptoms of PTSD
nightmares flashbacks avoidance of thoughts or feelings amnesia of trauma negative affect exaggerated blame sleep disturbance concentration difficulty irritability risky behaviour
how long do PTSD symptoms need to be present o be diagnostic
> 1m
What is complex PTSD and what other symptoms does it have besides the core
negative self concept
emotional dysregulation
chronic interpersonal difficulties
psychological therapies of PTSD
CBT
EMDR
for complex, stabilisation and safety and psychoeducation, trauma therapy
what may be the use of prazosin
sleep and nightmares
medication for PTSD
acute phase
AD - SSRI/venlafaxine for depressive features
low dose risperidone or antipsychotic for hyperarousal
describe the bodys response to stress exposure
amygdala acts to assess whether sensory material via thalamus needs stress/fear response
modified by cortical signal
acute stress releases catecholamines and cortisol
physical symptoms anxiety
sweating, hot flushes, chills trembling/shaking muscle tension, aches, pain numbness or tingling dizzy or unsteady, faint dry mouth globus fear of choking dyspnoea chest pain palpitaitons tachycardia nausea or abdominal distress
behavioural symptoms anxiety
avoidance of situations exaggerated response to minor surprises excess alcohol/drugs restless irritable checking behaviours seeking reassurance difficulty sleeping
cognitive symptoms anxiety
feeling on edge fear of losing control difficulty concentrating meta worry racing thoughts health anxiety preference for order/routine
what is GAD and
persistent and general anxiety, free floating and not restricted to any topic
>6m and impaired function
managing GAD?
CBT
SSRI/SNRI
Pregabalin
BZDs
what is panic disorder
recurrent attacks of severe anxiety and panic
may or may not occur with agoraphobia
not due to other physiological effects or psychological conditions
Management of panic disorder
CBT
SSRI/SNRI
what is agoraphobia and its features
irrational fear and phobia of leaving home, entering shops or crowds/public places
others do shopping, internet/late night shopping
what is social phobia
irrational phobia of social situations in which person is exposed to unfamiliar people or scrutiny
often small social settings
how may social anxiety in adolescents be seen
poor school performance
poor employment
school refusal
behavioural inhibition
management of social phobia
CBT
SSRI/SNRI
what is specific phobia and some examples/features
irrational phobia or an object/situation
flying, heights, spiders, blood
immediate anxiety response recognised as irrational
management of specific phobia
desensitisation
CBT
SSRI/SNRI if needed
what is OCD
recurring obsessive thoughts or compulsive acts
what are obsessional thoughts and examples
ideas, images, or impulses entering mind in a sterotyped way recognised as own pt thoughts unpleasant, resisted, ego-dystonic contamination symmetry fear of harm sexual thoughts violence/aggression
what are compulsions and examples
repeated rituals/sterotypes
not enjoyable/functional/pointless
checking, cleaning, symmetry, hoarding, counting
managing OCD
CBT and response prevention
SSRI or consider clomipramine 2nd line
side effects BZD
sedation, psychomotor impairment discontinuation and withdrawal dependence and abuse alcohol interaction can worsen co-morbid depression
