Anxiety Disorders Flashcards
2
Q
Emotions are ______ or _______
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Emotions are innate or “Hard-wired”
3
Q
Emotion provide _________ about _________
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Emotions provide information about a given situation
4
Q
Emotions ________ an individual for ______
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emotions organise an individual for action
5
Q
Correct expression of emotion is critical for what?
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Correct expression of emotion is critical for survival
6
Q
What is the purpose of fear?
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Purpose of fear is to precipitate escape from danger
7
Q
Fear is what kind of response? When does it abates?
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Fear is a transient response to a specific stimulus that abates after escape from the danger
8
Q
what is the definition of anxiety?
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There is no clear definition; but in the book Anxiety by Rachman he put forward this definition “a feeling of uneasy suspense; tense anticipation of a threatening but obscure event”
9
Q
Fear and anxiety are what?
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Fear and anxiety are distinct
10
Q
In fear which nervous system is aroused
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Sympathetic nervous system
11
Q
in fear what causes a person to be more alert and focused?
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Rush of adrenaline/epinephrine
12
Q
describe the action tendency in fear?
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The action tendency is to stop what the person is doing; monitor the environment vigilantly; and plan to flee or freeze (avoiding the danger)
13
Q
what are some similarities between fear and anxiety?
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Anticipation of danger; tense apprehensiveness; uneasiness; elevated arousal; negative affect; future orientated; accompanied by bodily sensations
14
Q
what are some characteristics of fear that are not characteristics of anxiety?
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Fear has a specific focus of threat; there is an understandable connection between the treat and the fear; fear is usually episodic; Fear declines with the removal of the treat; fear causes a bodily sensation of an emergency; fear has a rational quality
15
Q
what are some characteristics of anxiety that are not characteristics of fear?
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In anxiety the source of the anxiety is elusive; there is an uncertain connection between the source of anxiety and the anxiety; the anxiety is prolonged and causes a pervasive uneasiness; the anxiety does not have clear borders; anxiety causes a heightened vigilance; anxiety cause bodily sensations of vigilance; anxiety has a very puzzling quality
16
Q
Anxiety may be a primary presenting symptom of what medical conditions?
A
Hypoglycaemia; Cerebral trauma; Febrile illness; chronic infection; Migraine; Premenstrual Syndrome; Epilepsy; Withdrawal from alcohol and other substances; Thyroid dysfunction; Pituitary dysfunction; B12; B3 Deficiency
17
Q
what are some peripheral manifestations of anxiety?
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Diarrhoea; Dizziness and light-headedness; Hyperhidrosis (excess sweating); Hyperreflexia (twitching); Hypertension; Palpitations; Pupillary mydriasis; Restlessness (eg. pacing); Syncope (fainting); Tachycardia (increased heart rate); Tingling in the extremities; Tremors; Upset stomach (?butterflies?); Urinary frequency or hesitancy or urgency
18
Q
Anxiety can produce What and What? What can this impair?
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Anxiety can produce confusion and cognitive inflexibility which can impair; concentration; new learning; recall
19
Q
PET and MRI data confirm that which system is particular important in the aetiology of panic?
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PET and MRI data confirm the limbic system and parahippocampal area as particularly important in the aetiology of panic.
20
Q
what structures are involved in the bias in selective attention to threat-related stimuli?
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Septo-hippocampus and associated structures are involved in bias in selective attention to threat related stimuli.
21
Q
the amygdala may play a crucial role in what?
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Amygdala may play a crucial role in the appraisal of threat
22
Q
What neurotransmitter has been implicated in the genesis of panic?
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Serotonin has been particularly implicated in the genesis of panic
23
Q
what type of nerve endings are associated with panic? Where are they located?
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Serotonergic nerve endings in the periaqueductal grey area associated with panic (unconditioned fear-fight or flight)
24
Q
what area is associated with Anticipatory anxiety and avoidance?
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the amygdala with anticipatory anxiety and avoidance (conditioned fear).
25
Q
People ________ in their Proneness to? This leads to?
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People vary in their proneness to anxiety; vulnerability leads to hyper vigilance when entering a novel or potentially intimidating environment
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What does Hyper vigilance promote? What does it turn to if a threat is detected?
Hyper vigilance promotes rapid and global scanning; which turns into a narrow focus of attention if threat is detected
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what are the characteristics of an anxious persons attention on a potential threat? It is often accompanied by?
Anxious person?s attention focuses narrowly and intensely on potential threat with enhanced perceptual sensitivity and even distortion.
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Describe Selective attention
The narrowing of attention that occurs in response to threat; can be directed externally or internally.
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Excessive what is the basis for abnormal behaviour and experience?
Excessive self focus
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What does alcohol inhibit in terms of anxiety?
Alcohol inhibits self-focusing which reduces anxiety in social situations
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what primes an individual to detect cues and threats
Past experiences (memory) and present beliefs prime individuals to detect cues and threats
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high scores of what are associated with anxiety? This is know as what?
Temperamental vulnerability: high scores on introversion and neuroticism associated with anxiety
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Describe Cognitive Vulnerability in terms of anxiety
differences in vigilance; collection and use of information; perceptual and attentional processes and judgmental biases
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Selective attentional bias favours? Especially in ?
Selective attentional bias favours detection of threats especially in unfamiliar circumstances or where there is a history of threat or danger
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what is the therapeutic task in terms of attention
The therapeutic task is to achieve a functional amount and to engage in accurate interpretations and retrieval
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what is the basic description of the sympathetic system?
The sympathetic system enables the body to be prepared for fear; flight or fight.
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What is the basic description of the parasympathetic system?
the parasympathetic system is concerned with conservation and restoration of energy
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What are some sympathetic and parasympathetic actions of the eyes
Sympathetic: Dilate; Parasympathetic: Constrict
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What are some sympathetic and parasympathetic actions of the Heart
Sympathetic: Increase force of contraction Parasympathetic: Decrease contraction
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What are some sympathetic and parasympathetic actions of the Lungs
Sympathetic: Dilate Bronchi; Parasympathetic: Constrict Bronchi
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What are some sympathetic and parasympathetic actions of the Stomach
Sympathetic: Inhibit Secretion; Parasympathetic: Stimulate Secretion;
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What are some sympathetic and parasympathetic actions of the Bladder and Bowel
Sympathetic: Retention; Parasympathetic: Excitation/Expulsion
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What are some sympathetic and parasympathetic actions of the Skin
Sympathetic: Constrict Vessels; Parasympathetic: Dilate Vessels
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What are some sympathetic and parasympathetic actions of the Sweat glands
Sympathetic: Stimulated; Parasympathetic: inhibited
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What are some sympathetic and parasympathetic actions of the Hair
Sympathetic: Tensed; Parasympathetic: relaxed
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What are some sympathetic and parasympathetic actions of the Tear glands
Sympathetic: Inhibit Secretion ; Parasympathetic: stimulate secretion
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Does genetics play a part in anxiety disorders?
Yes; Twin studies have highlighted a 31-41% increased risk of anxiety disorders.
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Beck is know as the father of what?
cognitive behaviour therapy
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why is Avoidance an issue in anxiety disorders?
Initially relief from avoiding a feared situation is reinforcing; however in the longer term avoidance strengthens the belief in the inherent danger of a feared situation and blocks experience of disconfirming evidence thus maintaining the anxiety
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Anxiety is a _____________ between what?
Anxiety is a complex interrelationship between genetics; Central nervous system mechanisms; cognitive and behavioural factors
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what are the principal categories of anxiety disorders according to the DSM?
Separation Anxiety Disorder; Selective Mutes; Phobic Disorders; Social Phobia; Panic Disorder; Generalised Anxiety Disorder; Substance/Medication induced anxiety; Anxiety due to medical condition
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what are some disorders that are related to anxiety disorders but are not directly classified as anxiety disorders according to the DSM-5?
Obsessive-Compulsive and related disorders (Body Dimorphic Disorder; Hoarding Disorder; Trichotillomania; Excoriation Disorder and others) ;Trauma and Stress related disorders (PTSD; Acute Stress Disorder; Adjustment disorder)
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what is the basic description of Panic Disorder?
The sudden and unexpected onset of a range of acute symptoms such as heart palpitation; chest pain; chocking; dizziness; sweating; ect (sympathetic nervous system arousal) resulting in feelings of loss of control; going mad or even impending death; often resulting in the urge to escape. These attacks usually last no more than 10 min.
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How long do panic attacks last?
usually no more than 10 min
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Briefly describe the cognitive model of panic
Individuals experience panic attacks due to a chronic misinterpretation of bodily symptoms; the misinterpretation triggers an anxious response as the body focuses of the internal danger. The patent typical avoids the situation that leads to this; thus reinforcing the anxiety
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what are the general diagnostic criteria of panic disorders?
Recurrent unexpected panic attacks; at least one panic attacks has been followed by persistent concern; worry and/or changes in behaviour. The attacks are not due to a medical condition or substance use and it is not accounted for better by any other anxiety disorder as panic attacks pervade across the spectrum of anxiety disorders (eg. PSTD).
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approx.. What percent of patients present with both panic disorder and agoraphobia?
Usually (Approx. 95%) patients present with Panic Disorder and Agoraphobia
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briefly describe agoraphobia
Agoraphobia is anxiety about being in places or situations from which escape might be difficult in the event of a panic attack or panic-like symptoms. These situations are avoided by the patient or else endured with marked distress. (REMEMBER IT IS NOT A STAND ALONE DIAGNOSIS)
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what is the prevalence of panic disorders? Who is more affected males or females?
2-3% more common in females
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what is the median age of onset of panic disorders
20-24 years; very unusual if onset after 45
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what are the outcomes of treatment of panic disorders?
6-10 years post treatment 30% full recovery; 50% improved; 20% same or worse symptoms
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describe the genetics affecting panic disorders
There is an increased risk for panic disorder among offspring of parents with anxiety; depressive; and bipolar disorders. Respiratory disturbance; such as asthma; is associated with panic disorder; in terms of past history; comorbidity; and family history
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describe Phobic disorders
Disrupting; fear-driven avoidance; proportionally inconsistent to the danger posed by the object or situation. Individuals have a significant degree of insight into the
inconsistent nature of these fears.
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in patients with phobic disorders; are they aware that they fear is irrational?
Yes
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what are the general diagnostic criteria of Phobic disorders?
Marked; persistent fear that is excessive or unreasonable; Exposure to phobic stimulus provokes immediate response; Recognition fear is unreasonable; Phobic situation(s) avoided or endured with intense anxiety; Avoidance or anxiety significantly impacts on functionality of individual; If < 18 years; duration > 6 mths
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What are some common subtypes of Phobic disorders?
Situational (eg. public transport; elevators; flying); Natural Environment (eg. storms; heights; water); Blood-Injection-Injury; Animal; Others
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what is the approx.. prevalence of Phobic disorders?
7-9%
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who is more affected by Phobic disorders male or female? What specific Phobic is equal across genders?
Animal/Natural/Situational more common in females; Blood-Injection-Injury equal across genders
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phobic disorders exhibit a _____ peak
Bimodal (peak in childhood and mid 20s)
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when is the normal onset of phobic disorders; what other events can bring them on?
Onset usually in childhood; can be associated with trauma eg. Experiencing unexpected panic attack on subway
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Phobias that persist into adulthood are?
hobbies that persist into adulthood are unlikely to remit (without treatment)
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describe the family pattern in phobic disorders:
There may be a genetic susceptibility to a certain category of specific phobia (e.g.; an individual with a first-degree relative with a specific phobia of animals is significantly more likely to have the same specific phobia than any other category of phobia
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what are the general diagnostic criteria of social phobia
Marked; persistent fear of social or performance situations where exposure to unfamiliar people or scrutiny is possible; Exposure to social stimulus provokes immediate response; often a Panic Attack; Social situation/performance avoided or endured with intense anxiety (including use of restaurants and public toilets); Avoidance or anxiety significantly impacts on functionality of individual; If < 18 years; duration > 6 mths
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what is the prevalence of social phobias? What gender is more affected?
3-7%; lower in older adults; higher in females
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when is the onset of most social phobias? Describe the usual onset of social phobias?
normal onset is mid teens: Onset- frequently stressful/humiliating experience(being bullied; vomiting during a public speech) but may be insidious onset; Usually lifelong; attenuate in severity
76
describe the family pattern in social phobias:
First-degree relatives have a two to six times greater chance of having social anxiety disorder; and liability to the disorder involves the interplay of disorder-specific (e.g.; fear of negative evaluation) and nonspecific (e.g.; neuroticism) genetic factors.
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What is the basic definition of Generalised anxiety disorder?
A chronic and persistent level of anxiety and worry typically associated with all-encompassing life situations
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what are the general diagnostic criteria of Generalised anxiety disorder?
Excessive anxiety and worry about a number of events or activities occurring more days than not for at least 6 months; Difficulty in controlling worry; Experience 3 (or more) of the following: (Restlessness/on edge; Easily fatigued; Difficulty concentrating; Irritability; Muscle tension; Sleep disturbance); Anxiety; worry of physical symptoms cause significant functional problems
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What is the prevalence of GAD; what gender is more affected?
3%; it is more common in females
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in Generalised anxiety disorder most patients report feeling anxious for most there? The anxiety usually does what? What makes it worse?
Most report feeling anxious all their lives; anxiety usually fluctuates; worsens during times of stress
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describe the family pattern in GAD:
One-third of the risk of experiencing GAD is genetic; and these genetic factors overlap with the risk of neuroticism and are shared with other anxiety and mood disorders; particularly major depressive disorder
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in GAD Danger is often what?
Overestimated
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in GAD Personal resources to deal with the treat are often?
Underestimated
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the frequent theme of GAD is what?
unpredictability and uncontrollability
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briefly describe the Cognitive model of GAD:
it is not events per se but expectations and interpretations that are responsible for negative emotional states (eg.; Situation: Husband late home from work. Cognitions: Is he caught in the traffic vs. Is he dead in an accident?)
86
in the cognitive model of GAD Dysfunctional assumptions often revolve around?
acceptance (?I always have to please others?); competence (?I cannot cope?); responsibility (?I am mainly responsible for ?how things turn out?); control (?I have to be in control all the time?)
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describe pathological worry:
according to Borkovec "conceptual; linguistic attempt to avoid future aversive events and aversive imagery?
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how is pathological worry reinforcing?
pathological worry is reinforcing because it provides avoidance of more threatening imagery and more distressing somatic activation
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Briefly describe Obsessive-Compulsive disorder
Recurrent obsessions (intrusive and recurring thoughts and images) and/or compulsions (irresistible impulse to repeat some ritualistic act over and over again) causing significant impairment or distress.
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what are the general diagnostic criteria for OCD?
Presence of obsessions (pervasive and intrusive thoughts; impulses; images) and/or compulsions (repetitive behaviours or mental acts that must be applied rigidly); The person must realise that the obsession and/or compulsions are excessive and unreasonable; The obsessions and/or compulsions cause marked distress; are time consuming (>1hour/day); or significantly interfere with day-to-day functioning
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in OCD is the patient aware that they compulsions are excessive and unreasonable?
yes
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what is the prevalence of OCD; which gender is more affected and when?
1.2%; females are affected at a slightly higher rate than males in adulthood; although males are more commonly affected in childhood
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in the us what is the mean age of onset of OCD? 25% of cases start by age? Onset after what age is rare?
In the US; the mean age at onset of OCD is 19.5 years; and 25% of cases start by age 14 years. Onset after age 35 years is unusual but does occur.
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In OCD who has and onset at an early age males or females?
Males have an earlier age at onset than females: nearly 25% of males have onset before age 10 years.
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IN OCD the onset of symptoms is usually?
The onset of symptoms is typically gradual; however; acute onset has also been reported.
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if OCD is left untreated it?
If OCD is untreated; the course is usually chronic.
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what is the basic description of Posttraumatic stress disorder?
A traumatic event (such as rape; natural disaster; seeing someone maimed or killed; combat) brings in its aftermath difficulties including (but not restricted to) disturbed sleep; flash-backs; poor concentration/memory; anxiety; and sometimes emotional numbing.
98
what are the general diagnostic criteria for PSTD
The person has been exposed to a traumatic event; The traumatic event is persistently re-experienced in at least one of the following ways: Recurrent/intrusive recollection of the event; Recurrent/distressing dreams of the event; Feelings that the event is taking place again; Intense psychological distress upon exposure to cues that symbolise event; Physiological reactivity upon exposure to cues that symbolise event; Some of the following features: Efforts to avoid thoughts; feelings; conversations; activities; or people associated with trauma; Inability to recall important information associated with trauma; diminished interest in activities or others; blunted affect and sense of
foreshortened future; Difficulty in sleeping; anger outbursts; poor concentration; hyper vigilance and exaggerated startle response; > 1 month of symptoms and impacts significantly on functioning
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PSTD is more common in what gender? Why?
females; more likely to be exposed to trauma (rape and violence)
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when does a diagnosis change from Acute stress disorder to PSTD
if symptoms last for more than 4 weeks
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Anxiety is a common comorbid condition with other psychopathology. What are they?
Mood disorders; Substance use disorders; Personality disorders; Depression
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_______ and ________ show significant overlap at symptom and diagnostic levels:
Anxiety and depression show significant overlap at symptom and diagnostic levels:
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describe Psychometrics:
a simple an easy to use scale for psychological symptoms
104
what are some treatments of anxiety disorders?
Muscle Relaxation; Breathing Training; Mindfulness meditation(soothes sympathetic nervous system arousal); Exposure with Response Prevention; Systematic Desensitisation(challenges tendency to avoid); Cognitive-Behavioural Therapy (challenges unhelpful thoughts);Pharmacological Treatments; Diet
105
what are some dietary changes for a patient with an anxiety disorder?
Avoid alcohol; Where practical; avoid medications with pseudoephedrine; Avoid caffeine; Avoid illicit substances; Avoid foods with excess preservatives
106
describe exposure therapy; what is essential for it (or re-traumatisation can occur)
Exposing patients to identical or similar stimuli he or she fears in a gradual manner (e.g.; look at pictures of frogs ?holding a live frog; recalling memories of abuse/images of
accident/combat zone); Strong rapport with therapist is essential or re-traumatising can occur
