Anxiety disorder- clinical picture Flashcards
Normal response to a stressor
- Amygdala detects sensory information indicating danger—> stimulates the hypothalamus
- Hypothalamus stimulates the sympathetic NS—> stimulates release of NA from the adrenal medulla
- NA–> Tachycardia, hypertension, bronchial dilation, sweating, hyperventilation
GAD
- Clinical presentation
Persistent features that are not restricted or strongly presenting before certain circumstances
- Worry
- Headache
- Motor tension
- Autonomic hyperactivity [sweating, dry mouth etc]
Psychological GAD symptoms
Fearful anticipation of things
Irritability
Sensitivity to noise
Restlessness
Poor concentration
Thoughts of worry
GI symptoms of GAD
Dry mouth
Difficultly swallowing
Epigastric discomfort
Frequent wind
Respiratory symptoms of GAD
Hyperventilation
Tight chest
Difficulty inhaling
Cardiovascular symptoms of GAD
Chest pain
Palpitations
Feeling of ‘missed beats’
Genitourinary symptoms of GAD
Urinary urgency/ frequency
Dysmenorrhea
Amenorrhea
Erectile failure
Neuromuscular symptoms of GAD
Tremors
Trembling
Paraesthesia
Tinnitus
Dizziness
Headaches
GAD presentation in primary care
Presents a lot more than in general population
- Lifetime prevalence [8-9%]
- 3x more in GP
Also contains very high co-morbidity
- 70%
Genetics of GAD
5x increase in 1st degree relatives
Genetic factors have a modest role
- Monozygotic twins show no difference with dizygotic twins
Neurobiological mechanism of GAD
No clear studies related to humans
Abnormal APA axis
Possible role of serotonin–> Benefits from SSRIs
GABA agonists are effect–> Possible GABA mechanism
NA pathways possibly implicated
Psychological etiology of GAD
Stressful and traumatic life events= increases risk of developing GAD
Just one very negative event= 3x risk
Parenting effects on GAD
Disruption in early attachment–> anxious apprehension and dependency
- Withdrawal and depression can occur when disruption is severe
Overprotection + lack of warmth and responsiveness
- Can lead to anxiety
Endocrine differential diagnosis of panic disorders
Hypoglycaemia
Phaeocromocytoma–> neuroendocrine tumor of adrenal medulla
Carcinoid–> slow growing neuroendocrine tumour
Cardiovascular differential diagnosis of panic disorders
Arrhythmias
Respiratory differential diagnosis of panic disorders
Asthma
Neurological differential diagnosis of panic disorders
Seizures
Agoraphobia
- Clinical presentations
Fear and avoidances of places that may induce panic
- Specific context
- Example: in crowds, away from the house
Can present with panic attacks and general anxiety
Panic epidemiology
Panic attacks
- 7-9% of population
Panic disorder
- 1.5-2.5% lifetime prevalence
Peak onsets:
15-25, 45-54
Risks
- Living in city
- Broke relationship
- Less educated
- Previous abuse
- Being female
Panic genetic predisposition
Increase risk in first degree relatives
- 7x
Moderate inheritability
Biological model
- Panic
Panic attack triggered by activation of locus coeruleus–> Release of NA
SSRI are effective [though SRT studies are contradictory]
GABA agonists are effective
Pentagastrin and CCK seen to cause panic attacks
Specific phobias
Inappropriate anxiety in the presence of one or more particular objects/ situations
Aetiology of phobia
- Biological preparedness
- Objects that historically threatened the survival of an organism is feared. - Previous unresolved unconscious conflict
- Classical condition–> Fear is learned in association with negative symptoms
Autonomic response to blood/injury phobia
Vasovagal syncope:
- Sigh of blood/ needles= initial tachycardia and hypertension
- Then blood pressure and heart rate drops–> Decrease cerebral artery blood flow
Social phobias
Inappropriate anxiety when a person is observed or scrutinised
Epidemiology of social phobia
- Lifetime risk
- GP presentation
- Co-morbidity
- Onset
- Sex
Lifetime risk
- 2.4-13.3
GP
- Can be as high as 7%
Co-morbidity
- 81% meet another psychiatric disorder at one point
Peaks
- before 5
- 11-15
- Unusual after 30
Sex
- Women more than men
Aetiology of social phobia
Genetic and environmental
- Monozygotic> dizygotic twins
