Anxiety Disirders 2 Flashcards
What is anxiety?
A state of apprehension, uncertainty, and fear, often related to perceived threats.
How does anxiety differ from fear?
Anxiety is a response to an anticipated threat, while fear is a response to an actual threat.
Is anxiety ever functional or useful?
Yes, anxiety can be normal and is key to survival in evolutionary terms.
What causes persistent anxiety?
Vulnerability factors, precipitating events, and maintaining factors.
List the types of anxiety disorders.
- Panic Disorder
- Agoraphobia
- Specific Phobia
- Social Anxiety
- Generalised Anxiety Disorder (GAD)
- Obsessive Compulsive Disorder (OCD)
- Hypochondriasis or Health Anxiety
- Body Dysmorphic Disorder (BDD)
- Hoarding Disorder
- Post-Traumatic Stress Disorder (PTSD)
- Adjustment Disorder
Why does diagnosis matter?
It guides effective, evidence-based treatments tailored to specific disorders.
What are the true criteria for a panic attack?
- Peaks within 10 minutes
- Passes within 30 minutes
- At least 4 symptoms from a long list
What is a panic attack?
A specific episode of intense fear and discomfort with abrupt onset and peak within 10 minutes.
What is the lifetime prevalence of panic attacks?
3% lifetime prevalence.
What characterizes Panic Disorder?
Recurrent, unexpected panic attacks followed by persistent fear of having another attack.
What is the prevalence of Panic Disorder?
1.4%.
What is the M:F ratio for Panic Disorder?
1:2.
What are common differential diagnoses for Panic Disorder?
- Social phobia
- PTSD
- Specific phobias
- Depression
What is the DSM-5 requirement for Panic Disorder with Agoraphobia?
At least 2 of 5 specified situations must be present.
What is the treatment of choice for Panic Disorder according to NICE guidelines?
Cognitive Behavioral Therapy (CBT).
What cognitive theory explains Panic Disorder?
Individuals interpret bodily sensations in a catastrophic manner leading to panic.
What are typical fearful thoughts during a panic attack?
- I will die
- I am having a heart attack
- I will faint
- I will go crazy
What is the lifetime prevalence of specific phobias?
13.8%.
What are the DSM-5 criteria for Specific Phobia?
- Marked fear triggered by specific objects/situations
- Avoidance or enduring with anxiety
- Symptoms persist for at least 6 months
What are the main components of the aetiology of phobias?
- Behavioural conditioning
- Prepared learning
- Risk factors
What are the treatment options for phobias?
- Graded exposure
- Response prevention
- Cognitive restructuring
What are the DSM-5 criteria for Generalised Anxiety Disorder (GAD)?
- Excessive anxiety/worry for at least six months
- Difficult to control worry
- Associated with three or more symptoms
What are common symptoms of GAD?
- Restlessness
- Easily fatigued
- Difficulty concentrating
- Irritability
- Muscle tension
- Sleep disturbance
What is the duration requirement for Social Anxiety Disorder according to DSM-5?
6 months or more.
What is the typical age of onset for Social Anxiety Disorder?
Median age of onset is 13 years.
What cognitive model describes the maintenance of Social Anxiety?
Clark & Wells (1995) model focusing on internal attention and safety behaviors.
What are safety behaviors in the context of Social Anxiety?
Behaviors intended to prevent feared catastrophes but maintain anxiety.
What is the recommended first-line treatment for Social Anxiety according to NICE?
Individual CBT.
What are the three or more symptoms associated with GAD?
Restlessness, Easily fatigued, Difficulty concentrating, Irritability, Muscle tension, Sleep disturbance.
Sleep disturbance includes difficulty falling or staying asleep, or restless unsatisfactory sleep.
What causes clinically significant distress or impairment in GAD?
Anxiety, worry, or physical symptoms.
This distress can affect social, occupational, or other important areas of functioning.
What is the prevalence of GAD in the general population?
4-7%.
GAD is the most commonly found anxiety disorder in GP surgery but often presents as minor physical problems.
What is the typical onset age for GAD?
Late teens to late 20’s, occasionally sudden onset in adulthood after a stressful event.
Often seen as part of personality.
What is the male to female ratio for GAD prevalence?
2:1 in the general population.
What percentage of clients with GAD have one or more comorbid disorders?
60-90%.
Common comorbid disorders include social phobia, panic disorder, OCD, depression, dysthymia, and axis 2 disorders.
In GAD, what type of worry is more excessive and pervasive?
Worry about a range of topics, particularly about the future.
Worry topics can change frequently.
What cognitive model is associated with GAD and who created it?
Cognitive model of pathological worry (Hirsch and Mathews, 2012).
This model suggests that individuals have thinking habits that attend to threat and interpret information negatively.
What is a key clinical implication for treating GAD?
Develop more benign cognitive processes.
What are the diagnostic criteria for OCD according to DSM V?
Presence of obsessions, compulsions, or both that cause marked distress, are time-consuming, or significantly interfere with normal functioning.
Symptoms must not be attributable to physiological effects of a substance or better explained by another mental disorder.
What are obsessions in the context of OCD?
Recurrent and persistent thoughts, urges, or images that are intrusive and cause marked anxiety or distress.
What defines compulsions in OCD?
Repetitive behaviors or mental acts performed in response to an obsession or according to rigid rules.
What is the point prevalence of OCD in the general population?
1.2%.
Lifetime prevalence ranges from 0.5% to 3.5%.
What is the typical onset age for OCD?
Likely to begin before age 30.
What is the impact of OCD on social and occupational functioning?
Less likely to be married, more likely to be unemployed, greater social and occupational impairments.
What are common subtypes of OCD?
Contamination, Harm avoidance and checking, Rumination, Scrupulosity, Symmetry/ordering, Mental contamination.
What is the cognitive-behavioral understanding of obsessional thinking?
It originates from normal intrusive cognitions, but differs in interpretation focused on harm or danger.
What treatments does NICE recommend for mild OCD?
Low intensity CBT (up to 10 hours) using self-help or telephone support, group CBT.
What is the main focus of treatment for health anxiety?
Identify treatment goals and introduce a credible alternative explanation.
What is the prevalence of health anxiety in the general population?
1.5% - 4.5%.
What are the diagnostic criteria for Somatic Symptom Disorder?
One or more chronic somatic symptoms causing distress or disruption of daily life.
What is Body Dysmorphic Disorder (BDD) characterized by?
Preoccupation with perceived defects or flaws in physical appearance that are not observable to others.
What are some common repetitive behaviors in BDD?
Mirror checking, excessive grooming, skin-picking, comparing appearance with others.
What is the typical onset age for BDD?
During adolescence, mean age 16 years.
What is the suicide risk associated with BDD?
80% lifetime suicidal ideation, 25% attempted suicide.
What are the core elements of PTSD according to ICD11?
Reexperiencing, Avoidance, Hyperarousal.
What are the three core elements of PTSD?
- Reexperiencing
- Avoidance
- Hyperarousal
These elements must last for several weeks and interfere with normal functioning.
What constitutes Criterion A for PTSD according to DSM V?
Exposure to death or threatened death, serious injury, or sexual violation in one or more ways:
* Experiencing the event
* Witnessing the event
* Learning of the event occurring to a close relative or friend
* Repeated exposure to aversive details of the event
This includes experiences such as first responders collecting body parts.
What is the prevalence rate of PTSD in western community samples?
7.8%
The male to female ratio is 1:1.5.
What is the relationship between PTSD and comorbid disorders?
70 - 90% of people with PTSD meet criteria for co-morbid disorders, most commonly:
* Affective disorders
* Substance use disorders
* Anxiety disorders
In many cases, PTSD is the primary disorder.
What are some risk factors for developing PTSD?
- Low education
- Previous trauma
- Childhood adversity
- Psychiatric history
- Childhood abuse
- Family psychiatric history
Post-trauma support and life stress are also significant factors.
What are the NICE guidelines for treating PTSD?
- Trauma-focused CBT
- Eye Movement Desensitisation and Reprocessing (EMDR)
- Avoid psychologically focused debriefing
EMDR is not recommended for veterans until more research is conducted.
What are the three phases of treatment for PTSD?
- Stabilisation
- Memory Processing
- Reclaiming life
In complex PTSD, treatment may move fluidly between these phases.
What is the role of memory processing in PTSD treatment?
Without memory processing, PTSD treatment is not effective
The amygdala takes over and usual memory processing systems go offline.
What are the eight phases of EMDR treatment?
- History and treatment planning
- Preparation
- Assessment and development of target
- Desensitisation and reprocessing
- Installation of positive cognition
- Body Scan
- Debriefing
- Re-evaluation
EMDR uses bilateral stimulation during desensitisation.
What are the diagnostic criteria for Hoarding Disorder according to DSM-V?
- Difficulty discarding possessions
- Accumulation of possessions that clutter living areas
- Clinically significant distress or impairment
- Not due to a general medical condition
- Not restricted to another mental disorder
Can specify if there is excessive acquisition or insights.
What is the prevalence of hoarding disorder in the population?
Affects 2-5% of the population
This rate is twice that of OCD and four times that of bipolar disorder and schizophrenia.
What comorbid conditions are commonly associated with hoarding disorder?
- OCD: 17%
- Major depression: 57%
- Social phobia: 29%
- GAD: 28%
These figures represent community sample statistics.
What treatment approach is recommended for Hoarding Disorder?
Hoarding focused CBT
A multi-agency approach involving housing, social care, and psychology is also beneficial.
What is a significant risk associated with hoarding?
- Fire hazards
- Infestations or unhygienic conditions
- Physical dangers such as being crushed beneath the hoard
Hoarding can lead to significant stress on family dynamics.
True or False: Hoarding occurs more frequently in women than in men.
False
Research indicates that hoarding occurs more frequently in men.
What are the four components of threat perception and anxiety?
- Perceived threat.
- Perceived inability to cope with threat .
- Perceived that it will be the worst most awful thing.
- Perceived that one will be able to save them.
What were old treatments were connected disorder which are now seen as unhelpful?
Action classical conditioning of habitation or graded exposure
What is the cognitive model for anxieties that I can use for most of the exam?
Situation Thoughts, physical sensations behaviours, emotions
Explain the cognitive of GAD
Situation
Positive neutral thoughts about the situation
Then
thoughts interpreted as negative then attending to threat negatively
Learn a stream of worry
Also physical sensations such as tension and behaviours such as procrastination or reassurance seeking
What may be another power treatment for GAD
Looking thoughts like how I’m doing and powerful imagery
What is the aetiology of phobias?
Perhaps completely evolution fight or flight fear of situations
Seven years old is typically when phobias begin
Risk factors phobias include personality type such as neuroticism or cognitive type which is more negative and paying attention to threat
What is the cognitive model of phobia?
The regular hot Cross bun
What is the treatment for phobia?
Habitation Thomas experiments
What is the model?
Vicious flower by Salkovski 1998
Early childhood experiences and a critical incident lead to assumptions
These assumptions, then lead to intrusive thoughts, urges and doubts and other behaviours, which then feel good in the moment but then the urge comes back again, making it a vicious flower
What is an example of treatment for OCD?
Disputation
Theory A versus Theory B
A: a prediction is made as to what will happen and a rating is given
Then there is evidence provided for this and what it will mean
In B there is an alternative statement given and it is given a rating as well as the realistic or positive interpretation given
This is tested out
What are appropriate treatments for OCD according to a nice guidelines?
For low OCD intensity CBT or group support
For MODERATE SSRI
For severe a combination of both
For children’s CBT involving family and maybe an SSRI
Explain the cognitive model of body dysmorphia disorder by Veale
Trigger situation
Negative thoughts and appraisals about images and trying to process self as an aesthetic object
Lead safety behaviours, thoughts of ugliness, poor mood
What is nice guidelines recommend as a treatment for BDD?
Psych🧡 education about it not being vanity and CBT
SSR eyes because of it linked with 80% life and suicide ideation
Explain the cognitive model of PTSD
Cognitive processing during trauma which lead to appraisal of trauma
This lead to a traumatic memory where current then becomes traumatic
Their strategies to control threat such as avoidance
This also needs triggers
