Anxiety and Stress

Question 1

Define fear, anxiety and stress.

Answer 1

Fear – acute response to an actual stressor
Anxiety – towards a perceived/potential stressor (anticipation/unease)
Stress – feeling overwhelmed by situations, real or perceived

Question 2

What are the main classifications of anxiety and fear disorders?

Answer 2

F40 – Phobic anxiety disorders
F41 – Other anxiety disorders (GAD)
F42 - Obsessive compulsive disorder
F43 – Reaction to severe stress

Question 3

What CNS areas are involved in anxiety and fear?

Answer 3

Amygdala
Higher cognitive centres
Insula
Other limbic system areas
Association areas - frontal and parietal 
Sensory, motor and autonomic regions

Question 4

What are the inputs to the amygdala?

Answer 4

Auditory
Hormonal
Proprioceptive
Contexual
Olfactory
Visual

Question 5

What are the outputs from the amygdala?

Answer 5

Behaviour
Integration
Assimilation

Question 6

What happens if the periaqueductal gray area affected?

Answer 6

Freezing, conflict hypoalgesia

Question 7

What are the mechanisms involved in anxiety disorders?

Answer 7

Inc CNS activity
Inc neuronal synchrony
Firing freq changes
? Morphological changes
? Genetic/epigenetic changes

Question 8

What are the 2 types of treatment available for anxiety and stress related disorders?

Answer 8

1) Psychotherapy - behavioural therapy

2) Medication - Anxiolytics - only severe cases

Question 9

What types are treatments are available for psychotherapy/ behavioural therapy?

Answer 9

Conscious avoidance
relaxation courses
hypnotherapy
bibliotherapy
EMDR – eye movement desensitisation and reprocessing

Question 10

What types are medications are available for anxiety and stress related disorders?

Answer 10

Antidepressants: SSRI, SNRI, atypical
Anxiolytics - buspirone
Benzodiazepines
Antiepileptics
Other drugs: symptom reduction

Question 11

What drugs are typically prescribed for GAD?

Answer 11

SSRI Sertraline
SNRI Venlafaxine
AED Pregabalin*
Anxiolytic Buspirone

Question 12

What symptom blockers can you give for anxiety and stress related disorders?

Answer 12

β-blocker – Propanolol

Question 13

What are the symptoms of GAD?

Answer 13

Worry
Interrupted sleep
Poor concentration
Inc sensitivity to noise
Sweating
Dry mouth
Urinary freq
Hyperventilation
Palpitations

Question 14

What can you use to diagnose GAD?

Answer 14

DSM-V (Diagnostic handbook for mental health)
3 or more of following symptoms:
Restlessness or feeling keyed up or on edge
Being easily fatigued
Difficulty concentrating or mind going blank
Irritability
Muscle tension
Sleep disturbance

Question 15

What can help cope with anxiety?

Answer 15

Pharmacological treatments
Relaxation-Mindfullness
Cognitive Behavioural Therapy
Thought dairy

Question 16

What are the 4 classes of effects of stress?

Answer 16

Affective
Behavioural
Cognitive
Physiological

Question 17

What is the effects of stress on recovery? (inpatient and outpatient)

Answer 17

Inpatients - slower wound healing, longer post-surgical recovery, longer stay
Outpatient - longer recovery, less use of rehab, inc risk of co-morbidity

Question 18

What are the three perspectives to understand stress?

Answer 18

Stimulus: Focus on the cause (stressor)
Response: Focus on the effect (physiological)
Process: Focus on the person-environment interaction (transaction)

Question 19

What is General Adaptation Syndrome?

Answer 19

The stimulus feeds into the CNS which activates a response leading to physiological changes - follow 3 stages:
Alarm - fight or flight response
Resistance - body tried to return to homeostasis (can be ineffective if the alarm is continuous)
Exhaustion - depletion of resources needed to maintain the alarm response leading to disease

Question 20

What is the transactional model of stress? (name the stages)

Answer 20

1. Stimulus event (potential stressor)
2. Primary appraisal (is it relevant to me?)
3. Secondary appraisal (can i deal with the demands of the event?)
4. Coping (problem/ emotional focused?)
5. Health-related outcome (psychological or physical)

Question 21

What are the different types of coping mechanism?

Answer 21

Problem focused - Attempts to manage or change concrete aspects of the stressor
Emotion-focused - Attempts to remove or reduce the emotional distress

Question 22

What are Stress and anxiety management techniques?

Answer 22

Relaxation techniques: 
Visualisation/imagery, progressive muscles relaxation, passive muscle relaxation, autogenetic relaxation.
Mindfullness
Cognitive Behavioural Therapy
Counselling 
Pharmocotherapy
Self help