Anxiety and stress Flashcards
What is an anxiety disorder?
Abnormal and pathological fear and anxiety
What are the psychological features of Generalised Anxiety Disorder?
Difficult to control worry
Interrupted sleep
Poor concentration
Increased sensitivity to noise
What are the physiological features of Generalised Anxiety Disorder?
Sweating Dry mouth Urinary frequency Hyperventilation Palpitations
What features must be present for a diagnosis of GAD?
Excessive anxiety/ worry occurring more days than not for at least 6 months about a number of events/ activities
3+ symptoms including: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance
What impact can GAD have on daily living?
Co-morbidities with physical conditions (e.g. chronic pain)
Affects work, social interactions, relationships
Increased suicidal ideation
What factors can predispose an individual to GAD?
Combination of biological, psychological and social factors
Neural activity associated with abnormal cognitions and increased attention to threat
What treatments can be used to manage anxiety?
Pharmacological treatments
Mindfulness
CBT (establishing links between physiological and psychological changes)
Thought diary
What is selective attention?
Seeing only the negative features in events
What is magnification?
Exaggerating the importance of undesirable events
What is overgeneralisation?
Drawing broad negative conclusions on the basis of a single insignificant event
What behaviours do anxiety treatments aim to target?
Selective attention
Magnification
Overgeneralisation
What are the 4 classes of the effects of stress?
Affective
Behavioural
Cognitive
Physiological
What behaviours or emotions are affective effects of stress?
Shock Distress Anger Low self-esteem Guilt Depression Anxiety/ fear
What are the behavioural effects of anxiety?
Smoking Alcohol Help seeking delay Poor adherence Social withdrawal Illicit drugs Sexual function
What are the cognitive effects of anxiety?
Poor attention Poor decision making Hypervigilance to threats Memory loss Learning difficulties
What are the physiological effects of anxiety?
Nervous system activation Hormone production Metabolic function Immune function Fatigue Disease/ illness
How can the physiological effects of anxiety impact patients on the ward?
Poor wound healing Post-surgery complications Longer in-patient stays More staff time More analgesia use Poor adherence/ less satisfaction with treatment
How can the physiological effects of anxiety impact patients after discharge?
Longer recovery (e.g. return to work)
More service use
Less use of rehabilitation services
Increased risk of co-morbidity and early mortality
What 3 perspectives should be used to understand stress?
Stimulus (cause/ stressor)
Response (effect e.g. physiological)
Process (person-environment interaction)
What is stress?
A non-specific physiological response to a threat to one’s physical or emotional wellbeing
What are the 3 stages of a physiological response to stress?
- Alarm (fight or flight response - nervous, endocrine and immune systems activated for defence against threat)
- Resistance (conservation response initiated to return homeostasis) becomes counterproductive if alarm continues
- Exhaustion (depletion of physiological resources - collapse of adaptive responses, immune failures and disease outcomes)
What is the transactional model of stress?
A causal chain of influence involving a stimulus event and and outcome influenced by intervening processes:
- Primary appraisal (determines significance of event)
- Secondary appraisal (evaluation of available response options)
- Response (coping - cognitive and behavioural activities initiated in order to manage demands of event)
What does problem-focused coping involve?
Attempts to manage or change concrete aspects of the stressor
What does emotion-focused coping involve?
Attempts to remove or reduce the emotional distress
What is the most effective coping strategy?
Flexible (mix of problem-focused and emotion-focused coping)
Dependent on whether it is possible to change stressor
What is the difference between fear and anxiety?
Fear is an acute response to an actual stressor whilst anxiety is a response to a perceived or potential stressor (anticipation or unease)
What drug is commonly used to alleviate the physical symptoms of anxiety?
Propanolol (a Beta blocker)
Define fear
Acute response to an actual stressor - preparation for fight or flight behaviour
Define anxiety
Preparation for fight or flight behaviour in response to a perceived or potential stressor (e.g. anticipation or unease)
Define stress
A feeling of being overwhelmed by current situational, environmental or perceived pressures
Effects can be emotional (e.g. depression), psychological (e.g. irritability) and physical (raised BP, fatigue)
How are anxiety and fear disorders classified?
Generalised Anxiety Disorder (often accompanied by Depression)
Phobias (can be simple or complex) - including specific phobias, social anxiety, panic disorder and PTSD
Obsessive Compulsive Disorders (inc. body dysmorphia)
Which areas of the CNS are involved in anxiety and fear?
Amygdala
Higher cognitive centres (pre-frontal cortex)
Insula (located within the lateral fissure)
+ other limbic system areas, association areas and sensory/ motor/ autonomic regions
Which brainstem region controls defence behaviours?
Periaqueductal Gray - contains high number of opioid receptors
What non-pharmacological management is available for anxiety and fear disorders?
Psychotherapy (behavioural) including conscious avoidance, relaxation, hypnotherapy and bibliotherapy
What pharmacological options are typically used to manage GAD?
SSRIs (Sertraline)
SNRIs (Venlafaxine)
Anti-epileptics (Pregabalin)
Atypical antidepressants (Buspirone)
What is the MoA of Sertraline?
SSRI - selectively inhibits Serotonin reuptake on the presynaptic membrane increasing synaptic concentration of Serotonin in the CNS
What is the MoA of Venlafaxine?
SNRI - selectively inhibits Serotonin and Norepinephrine reuptake on the presynaptic membrane increasing synaptic concentration of 5HT and NE in the CNS
What is the MoA of Pregabalin?
AED - inhibition of voltage-gated calcium channels on the pre-synaptic membrane (thus modulating release of several excitatory NTs into the synapse)
What is the MoA of Buspirone?
Atypical - binds to 5HT 1A receptors on presynaptic membrane increasing NT levels in synaptic cleft
Suppressed serotonergic action and enhanced firing of noradrenaline and dopamine
What pharmacological options are typically used to manage specific phobias?
SSRIs (Sertraline)
Beta-blockers (Propanolol)
What is the MoA of Propanolol?
Competetively binds to beta1-adrenergic receptors inhibiting sympathetic stimulation by preventing catecholamines (norepinephrine, epinephrine, dopamine etc.) from binding - results in reduced HR, cardiac output, BP etc.
What pharmacological options are typically used to manage panic disorders?
SSRIs (Sertraline)
What pharmacological options are typically used to manage PTSD?
SNRIs (Venlafaxine)
SSRIs (Sertraline)
Antipsychotics (Risperidone)
What is the MoA of Risperidone?
2nd Gen antipsychotic - inhibition of D2 (dopaminergic) and 5HT2A (serotonergic) receptors (5HT and D2 anatagonist)
What pharmacological options are typically used to manage OCD (inc. body dysmorphia)?
SSRIs (Sertraline)
+ TCA (Clomipramine)
+ Atypicals (Buspirone)
What pharmacological options are used acutely to manage crises?
Benzodiazepines (e.g. Lorazepam)
‘Z-drug’ (Zolpidem)
