anxiety disorders 1 Flashcards
define anxiety
Anxiety is a normal response to threat or danger
and part of the usual human experience
when does anxiety become a problem?
Anxiety becomes a mental health problem if the
response is exaggerated, lasts more than three
weeks and interferes with daily life.
how is anxiety characterised?
Anxiety is characterised by worry and agitation,
often accompanied by physical symptoms such as
rapid breathing and a fast heartbeat or hot and cold
sweats.
what are the somatic symptoms of anxiety?
Goosebumps emerge Muscles tense Heart rate increases Respiration accelerates Respiration deepens Peripheral blood vessels dilate Liver releases carbohydrates Bronchioles widen Pupils dilate Perspiration increases Adrenaline is secreted Stomach acid is inhibited Salivation decreases
what are the emotional symptoms of anxiety?
Sense of dread
Terror
Restlessness
Irritability
what are the cognitive symptoms of anxiety?
Anticipation of harm Exaggerating of danger Problems in concentrating Hypervigilance Worried, ruminative thinking Fear of losing control Fear of dying Sense of unreality
what are the behavioural symptoms of anxiety?
Escape Avoidance Aggression Freezing Decreased appetitive responding Increased aversive responding
how is GAD characterised?
Characterized by excessive and inappropriate
worrying that is persistent (lasting some months in
ICD-10, six months or longer in DSM- 5) and not
restricted to particular circumstances.
what are the symptoms of GAD?
Patients have physical anxiety symptoms and key
psychological symptoms
what can GAD become comorbid with?
Can be comorbid with major depression (but not
arise solely in its context), panic disorder, phobic
anxiety disorders and OCD
how is panic disorder charactersed?
Characterized by recurrent unexpected surges of
severe anxiety (‘panic attacks’), with varying
degrees of anticipatory anxiety between attacks
what are panic attacks?
• Panic attacks are discrete periods of intense fear or
discomfort, accompanied by at least four physical or
psychological anxiety symptoms.
• Typically panic attacks reach their peak within ten
minutes and last around 30–45 minutes.
around 2/3 patients develop agoraphobia with panic disorder, what is this?
defined as fear in places or
situations from which escape might be difficult or in
which help might not be available, in the event of
having a panic attack.
give an example of agoraphobia
These situations include being in a crowd, being
outside the home or using public transport (two
situations required in ICD-10): they are either
avoided or endured with significant personal
distress (avoidance at some stage is required for
ICD-10 diagnosis).
how is social phobia characterised?
Characterized by a marked, persistent and
unreasonable fear of being observed or evaluated
negatively by other people, in social or performance
situations, associated with physical and
psychological anxiety symptoms.
what is specific phobia?
Specific, simple or isolated phobia is
characterized by excessive or unreasonable
fear of (and restricted to) single people,
animals, objects, or situations (for example,
flying, dentists, seeing blood, etc.) which are
either avoided or are endured with
significant personal distress (avoidance must
be prominent for ICD-10 diagnosis).
how is PTSD characterised?
Characterized by a history of exposure to trauma
(actual or threatened death, serious injury, or threats
to the physical integrity of the self or others) with a
response of intense fear, helplessness or horror: with
the later development of re-experiencing symptoms
(intrusive recollections, flashbacks or dreams),
avoidance symptoms (for example efforts to avoid
activities or thoughts associated with the trauma),and
hyper-arousal symptoms (including disturbed sleep,
hypervigilance and an exaggerated startle response).
what is the time limit for diagnosing PTSD?
Must usually be within six months of the exposure to
trauma for an ICD-10 diagnosis.
how is OCD characterised?
Characterized by recurrent obsessional
ruminations, images or impulses, and/or
recurrent physical or mental rituals, which are
distressing, time-consuming and cause
interference with social and occupational
function.
what are the common OCD obsessions?
Common obsessions relate to contamination,
accidents, and religious or sexual matters:
common rituals include washing, checking,
cleaning, counting and touching.
what is step 1?
Following assessment and diagnosis of GAD:
• provide education about GAD and options for
treatment
• monitor symptoms and functioning (known as active
monitoring).
• Discuss the use of over-the-counter medications and
preparations
what is step 2?
Low-intensity psychological
interventions
• For people with GAD that has not improved after
education and active monitoring in step 1, offer one
or more of the following, guided by the person’s
preference:
• individual non-facilitated self-help*
• individual guided self-help
• psychoeducational groups
what is step 3?
high intensity treatment
• an individual high-intensity psychological intervention
using either CBT or applied relaxation or drug
treatment using a selective serotonin reuptake
inhibitor (consider offering sertraline first because it is
the most cost-effective drug)*
what should you not offer for high intensity treatment?
Do not offer antipsychotics for GAD in primary care.
• Do not offer benzodiazepines except as a short-term
crisis measure.
what if a person has an indaequate response to step 3?
- A high-intensity psychological intervention, thenoffer a drug treatment
- Drug treatment, then offer either a high-intensitypsychological intervention or an alternative drugtreatment.
- If a person’s GAD has partially responded to drugtreatment, consider offering a high-intensitypsychological intervention in addition to drugtreatment.
when should you refer to step 4?
- A risk of self-harm or suicide or
- Significant comorbidity or
- Self-neglect or
- An inadequate response to step 3 interventions.
what is step 4?
- Consider offering combinations of treatment:
- psychological and drug treatments or
- combinations of antidepressants or
- augmentation of antidepressants with other drugs.
what is the biological basis for anxiety?
• Decreased 5-HT neurotransmission
• Overactivity of the NA systems
• Deficient inhibition of the GABA interneurons with
reduced sensitivity to postsynaptic GABAA receptors
• Excessive activity of glutamate neurons at NMDA
receptors in the amygdala responsible for fear
conditioning
• Super sensitivity of receptors for peptide
neurotransmitters such as cholecystokinin and
neuropeptide Y.
• Increased evidence for central role of brain derived
neurotropic factor (BDNF) in modulating neural plasticity
in anxiety state
