Anxiety and Stress Features Flashcards
What are the three responses to stressors?
- somatic = fight or flight
- emotional = fear, anxiety,
depression - psychological = means to cope
Emotional Responses to Stress:
anxiety is absence of stimulus
fear is presence of stimulus
Psychological Responses to Stress:
- avoidance/denial of an acute
stress can help short-term - finding a way to remove/work
through problem - finding a way to come to terms
with the problem
Maladaptive Responses:
- use of alcohol/drugs
- aggressive/exaggerated
behaviours
- deliberate self-harm
Acute Stress Reaction: Features:
- response to exceptionally stressful
events - severe symptoms of stress
reaction - usually hours-few days after
stressor - usually subside after a few days
from removal of threat - lasts less than a week after a
single event - lasts less than a month after an
ongoing situation like a war
Acute Stress Reaction: Symptoms:
- dissociative symptoms
- insomnia
- restlessness
- poor concentration
- ANS activated
- anger/anxiety/depression
- social withdrawal
Dissociative Symptoms:
- emotional numbness
- dazed
- difficulty recalling the stressful
event - depersonalisation = unreal,
detached, separated from people
by a pane of glass - derealisation - pane of glass
separating from the environment
Adjustment Disorder: Features:
- wide range of
emotional/behavioural symptoms - stressor not necessarily life
threatening - out of proportion to the stressor
- more gradual and prolonged
responses to stressful changes - lasts up to 6 months
- arises as a direct consequence of
acute stress or ongoing stressor - would not have arisen without the
stressor - response to a more mild stressor
than stressors in acute stress
reaction - lasts longer than acute stress
reaction
PTSD: Features:
- response to exceptionally
threatening or catastrophic event - threatened death/serious injury
- symptoms last for at least a month
- usually onset within days of event
but not diagnosed till 1 month - 30% recover within 3 months
- most recover within a year
- 30% chronic
PTSD: Symptoms:
- increased arousal
- dissociative symptoms
- hypervigilance/startle
- re-experiencing event
(flashbacks/nightmares) - avoiding reminders of stressful
events - maladaptive coping strategies
PTSD: Increased Arousal:
- tremor
- palpitations
- panic attacks
- restlessness
- insomnia
- anger
- poor concentration
Anxiety Flowchart:
5 general symptoms of anxiety disorders:
- psychological arousal
- autonomic arousal
- muscle tension
- hyperventilation
- sleep disturbance
Anxiety: General Symptoms: Psychological:
- fearful anticipation
- irritability
- restlessness
- poor concentration
- worry
Anxiety: General Symptoms: Autonomic Arousal:
- chest constriction
- difficulty inhaling
- palpitations
- chest discomfort
- dry mouth
- swallowing problems
- epigastric pain
- loose/frequent stool
- frequent/urgent micturition
- failure of erection
- menstrual discomfort
Anxiety: General Symptoms: Muscle Tension:
- tremor
- headaches
- aching muscles
Anxiety: General Symptoms: Hyperventilation:
- dizziness
- tingling hands and feet
- feeling breathless
Anxiety: General Symptoms: Sleep Disturbances:
- insomnia
- night terrors
Epidemiology of Anxiety Disorders:
Generalised Anxiety disorder: Overview:
- symptoms of anxiety are always
present and not restricted to a
specific set of circumstances - present for more than 6 months
Generalised Anxiety Disorders: Clinical Features:
- worry
- fearful apprehension
- headache/motor tension
- irritability
- poor concentration
- autonomic arousal
- sleep disturbances
- depersonalisatio
- low mood
- fixation with detail
- comorbidities are common (70%)
- depression, phobia, panic
GAD :Differential Diagnoses:
- other anxiety disorders
- depressive illness
- schizophrenia
- dementia
- substance misuse
- physical illness
Generalised Anxiety disorder: Risk Factors:
- M:F = 1:2 (F»)
- broad age of onset, usually
adulthood - lower household income
- unemployment
- divorce and separation
GAD: Aetiology:
- stressful events
- genetics
- early experiences: adverse
experiences, parenting styles like
overprotection or lack of
emotional warmth - cognitive theories
- neurobiological mechanisms
Panic disorder:
- recurrent panic attacks
- not in response to a phobic
stimulus - fear of another attack and worry
about implications like having a
heart attack
Panic Attack Features:
- sudden onset
- severe anxiety symptoms
- catastrophising
- hyperventilation
- lasts a few minutes
- palpitations
- choking feeling
- dizziness and faintness
- dissociation
- chest pain
- fear of dying
- fear of losing control
Panic Attacks and Hyperventilation:
- reduces CO2 in blood
- dizziness, tingling extremities,
tinnitus - weakness, faintness,
breathlessness
Panic Disorders: Aetiology:
- genetics: 7 fold increased risk in
first degree relatives - precipitating events
- traumatic early life events
Social Anxiety Disorder is a form of
phobia
Specific Phobias: Features:
- usually start in childhood
- named by adding name of
stimulus - avoid jargon
anticipatory anxiety if any chance of encountering
intense anxiety during encounter
avoidance of phobia
Bi-phasic anxiety reaction:
- initial short-lived sympathetic
arousal - parasympathetic arousal
- may result in vasovagal syncope
- feeling of disgust and repulsion
rather than pure apprehension
Blood-Injury Phobia: Differences:
- vaso-vagal syncope = parasymp
arousal as well - feeling of disgust and repulse
rather than apprehension
biphasic anxiety reaction
Specific Phobias: Aetiology:
- 1/3 = genetics
- classical conditioning: with
reinforcement of learned
behaviour after adverse
encounter, avoidance maintains
the fear and makes it hard to shift - biological preparedness
hypothesis: commonly feared
stimuli are those that have
historically threatened the survival
of the species
Social Anxiety Disorder: Features:
- inappropriate anxiety
- leads to avoidance of trigger
situations or experience of
intense anxiety - person concerned that they will
act in a way or show anxiety
symptoms that will be negatively
evaluated by others
Social Anxiety Disorder: Symptoms:
- Anticipatory anxiety
- Feeling anxious
- Blushing
- Trembling (observed writing is a
problem) - Nausea
- Relieved by alcohol in short term
(potential for abuse)
Agoraphobia:
intense fear and anxiety in situations when escape might be difficult and help may not be available
key themes: confinement, crowding, distance from home
- often begins with a panic attack
away from home - anxious cognitions about fainting
and loss of control are common - avoidance is common and leads to
maintenance
OCD: Features:
- obsessional thinking
- compulsive behaviour
- psychiatric: anxiety, depression,
depersonalisation - includes: thoughts, doubts,
impulses, ruminations - recognised as the patients own
- intrude forcibly into the mind
- unwanted; attempts are made to
resist - usually unpleasant
OCD: Obsessions vs Compulsions:
- obsession themes: contamination,
aggression, orderliness, illness,
sex, religion - compulsions are repetitive,
purposeful behaviours carried out
in a stereotyped way and are in
response to an obsession
OCD: Aetiology:
- Genetics: Monozygotic»dizygotic,
first degree relatives - Evidence of Brain Disorder:
encephalitis lethargica, associated
with chorea which affects the
caudate nucleus - neurobiological factors
- psychoanalytic and cognitive
theories
