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B3 CTB > Anxiety and Stress > Flashcards

Anxiety and Stress Flashcards

1
Q

What is fear?

A

Acute response to an actual stressor.

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2
Q

What is anxiety?

A

Feelings towards a perceived/potential stressor (anticipation/unease).

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3
Q

What is stress?

A

Feeling overwhelmed by current situational, environmental or perceived pressures.

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4
Q

Anxiety and stress related disorders form part of the ? (ICD-10, F40-48).

A

Neurotic, stress-related and somatoform disorders group

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5
Q

What is the key area involved in generation of fear behaviours and of learnt responses to stressors?

A

Amygdala

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6
Q

Outline what the amygdala is involved in.

A

Fear, olfaction and social recognition.

Has huge connectivity to frontal cortex, rest of limbic system, hypothalamus etc.

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7
Q

Where is the amygdala situated?

A

Medial temporal lobe, in the uncus.

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8
Q

What is the insula and where is it situated?

A

Sets the threshold for emotion.

Situated behind the folds of the lateral fissure and spans the frontal and parietal lobes.

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9
Q

What is the hippocampus involved in?

A

Learning and memory.

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10
Q

What is the cingulate gyrus involved in?

A

Pleasure responses and processing.

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11
Q

What is the hypothalamus involved in (relating to stress and anxiety)?

A

Control of autonomic output.

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12
Q

Information enters the ? of the amygdala, the integrative hub. The region producing the response is the ?

A

lateral nucleus, central nucleus

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13
Q

The central nucleus of the amygdala is divided into two regions; what are they?

A

Centrolateral and centromedial.

Centromedial nucleus controls behavioural outflow.

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14
Q

From the amygdala, where is information sent out to? (give three).

A
  • Limbic system (memory storage).
  • Hypothalamus (autonomic nervous system).
  • Motor system.
  • Basal ganglia.
  • Cerebellum.
  • Brainstem (control cardiovascular responses, respiratory responses and modulate spinal efferent fibres).
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15
Q

What is the periaqueductal grey?

A

Defence area.

Controls whether we fight, flight or freeze.

Also a key part in the pain pathway.

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16
Q

It is estimated that around ?% of the population suffers from generalised anxiety disorder.

A

5

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17
Q

The principal classification used by the ICD-10 (WHO) for anxiety related disorders:

A
  • F40 – Phobic anxiety disorders.
  • F41 – Other anxiety disorders.
  • F42 – Obsessive compulsive disorder.
  • F43 – Reaction to severe stress.
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18
Q

What do phobic anxiety disorders include? (3)

A
  • Specific phobias.
  • Agoraphobia (fear of bring in situations where escape might be difficult or that help wouldn’t be available if things went wrong).
  • Social phobias.
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19
Q

Phobic anxiety disorders are characterised by fear and anxiety in response to ?.

A

specific triggers and situations

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20
Q

What do therapies for phobic anxiety disorders target?

A

Increasing resilience and ability to cope with these anxieties, often using incremental exposure to stressors, relaxation or avoidance.

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21
Q

What is included in the ‘other anxiety disorders’ group?

A
  • Panic disorder.
  • Generalised anxiety disorder.
  • Mixed anxiety disorders.
22
Q

What are mixed anxiety disorders?

A

Disorders were anxiety is the key symptom but other disorders are present.

23
Q

What are obsessive compulsive disorders?

A

Disorders where patients experience obsessional thought patterns and exhibit ritualistic and compulsive behaviours.

These are distressing to the patient and are incredibly hard from them to overcome and cause anxiety if they are not performed.

24
Q

What is self-focussed OCD?

A

Different catregory for people displaying a milder, self-focused form of OCD, where the focus is on perfectionism and rigid adherence to routine that doesn’t reach levels requires for classification as OCD.

25
Q

What is included in the ‘Reaction to severe stress’ group?

A

Disorders associated with experiencing a significant trauma or known event.

  • Acute stress reaction.
  • PTSD.
  • Adjustment disorders.
26
Q

How are ‘Reaction to severe stress’ disorders divided?

A

By time.

  • Acute stress reaciton is immediately following the onset of an event and is linked to shock.
  • PTSD occurs at any point after the event and can result in reliving of the experience.
  • Adjustment disorders describe the inability to re-join life floowing a significant life event and can be of variable length.
27
Q

What is an anxiety disorder?

A

Abnormal and pathological fear (that an individual cannot control) and anxiety.

28
Q

List three psycholigcal symptoms of generalised anxiety disorder.

A
  • Worry (difficult to control) – could lead to decreased occupational and social functioning.
  • Interrupted sleep.
  • Poor concentration.
  • Increased sensitivity to noise.
29
Q

List three physical symptoms of generalised anxiety disorder.

A
  • Nausea.
  • Sweating.
  • Dry mouth.
  • Urinary frequency.
  • Hyperventilation (shortness of breath and dizziness).
  • Palpitations.
  • Increased heart rate.
30
Q

How is General Anxiety Disorder diagnosed?

A

Patient must have three or more of the following symptoms:

  • Restlessness or feeling on edge.
  • Easily fatigued.
  • Difficulty concentrating or mind going blank.
  • Irritability.
  • Muscle tension.
  • Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep).
31
Q

Give different types of management options for GAD.

A

Pharmacological treatments:

  • Listed on another card.

Non-pharmacological treatments:

  • CBT.
  • Thought diary.
  • Relaxation and mindfullness.
  • Hypnotherapy.
32
Q

What is selective attention?

A

Seeing only the negative features of an event.

33
Q

What is magnification?

A

Exaggerating the importance of undesirable events.

34
Q

What is overgeneralisation?

A

Drawing broad negative conclusions on the basis of a single insignificant event.

35
Q

The principal approach for managing anxiety and related disorders is ? or ?.

A

psychotherapy, behavioural therapy

36
Q

What is EMDR?

A

Eye movement desensitisation and reprogramming.

One of the first line treatments for PTSD.

Uses rhythmic eye movements in combination with talking therapies to reduce the saliency of expiernces.

37
Q

What are the classes of drugs used to treat anxiety disorders?

A
  • Antidepressants.
  • Anxiolytics/ hypnotics.
  • Antiepileptics.
  • Other drugs - symptom reduction.
38
Q

Why are benzodiazepines only prescribed in the short term?

A

They can result in dependency with long term use.

39
Q

What are the four classes of ‘effects of stress’?

A
  • Affective.

Shock, distress, anxiety, fear, depression, anger, frustration, lowered self-esteem, guilt.

  • Behavioural.

Smoking, alcohol, help-seeking delay, poor adherence, relapse, social withdrawal, illicit drugs, sexual function.

  • Cognitive.

Poor attention, errors in decision making, hypervigilance for threats, bias to interpret ambiguous events as threatening, memory loss and learning difficulty.

  • Physiological.

Activation of nervous system, hormone production, metabolic function, immune function, fatigue, disease and illness.

40
Q

Stress increases the risk of ? among the healthy and impedes ?/? among the ill.

A

illness, recovery/worsens prognosis

41
Q

What are some effects of stress on patients on the ward?

A
  • Slower wound healing.
  • More post-surgery complications.
  • Longer in-patient stay.
  • More staff time per day.
  • More analgesia use.
  • Less satisfaction with treatment.
42
Q

One of the easiest mechanisms to cope with anxiety and stress is ?.

A

avoidance of the anxiety inducing situation

43
Q

List four common approaches to improving coping skills.

A
  • Relaxation techniques, including visualisation/ imagery, progressive muscle relaxation, passive muscle relaxation, autogenetic relaxation.
  • Mindfulness.
  • Cognitive Behavioural Therapy.
  • Counselling.
  • Pharmacotherapy.
  • Self-help.
44
Q

What is the transactional model of stress?

A

Psychological model that explains the components of the behavioural and psychological response to a stressor.

Suggests stress depends on the perceived demands and the perceived ability to cope with the stressor.

45
Q

In the transactional model of stress, what are the three perspectives to understanding stress?

A
  • Stimulus – focus on the cause.
  • Response – focus on the effect.
  • Process – focus on the person-environment interaction (transaction).
46
Q

Who proposed the transactional model of stress?

A

Lazarus and Folkman, 1984.

47
Q

Coping effectiveness of stress can be: (2)

A
  • Problem-focused coping.

Individual will attempt to manage or change concrete aspects of the stressor. Mostly effective when the stressor is amenable to change.

  • Emotion-focused coping.

Attempts to remove or reduce the emotional distress. Mostly effective when the stressor cannot be changed.

48
Q

What is generalised anxiety disorder?

A

Anxiety persisting for over 6 months, which is generalised and persistent, but not restricted to any particular environment.

49
Q

What are some physical and psychological features of GAD?

A

Psychological:

  • Worry that is difficult to control.
  • Decreased occupational and social functioning.
  • Interrupted sleep.
  • Poor concentration.
  • Increased sensitivity to noise.

Physical:

  • Sweating.
  • Dry mouth.
  • Urinary frequency.
  • Hyperventilation.
  • Palpitations.
50
Q

Name drugs that are used to treat:

GAD

Specific phobias

Panic disorders

PTSD

OCD

Short-term/crises

A

GAD:

Antidepressant (SSRI) - Sertraline.

Antidepressant (SNRI) - Venlafaxine.

Antiepileptic - Pregabalin.

Specific phobias:

Antidepressant (SSRI) - Sertraline.

β-blocker - Propanolol.

Panic disorders:

Antidepressant (SSRI) - Sertraline.

Antidepressant (TCA) - Clomipramine.

PTSD:

Antidepressant (SNRI) - Venlafaxine.

Antidepressant (SSRI) - Sertraline.

Antipsychotic - Risperidone.

OCD:

Antidepressant (SSRI) - Sertraline.

Short-term/crises:

Benzodiazepine - Lorazepam.

Z-drug - Zolpidem.

51
Q

Where do stress and anxiety present in medicine?

A

The job.

The organisation.

Dealing with death.

Work-life balance.

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