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Mental Health > Anxiety Disorders > Flashcards

Anxiety Disorders Flashcards

2
Q

Emotions are ______ or _______

A

Emotions are innate or “Hard-wired”

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3
Q

Emotion provide _________ about _________

A

Emotions provide information about a given situation

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4
Q

Emotions ________ an individual for ______

A

emotions organise an individual for action

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5
Q

Correct expression of emotion is critical for what?

A

Correct expression of emotion is critical for survival

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6
Q

What is the purpose of fear?

A

Purpose of fear is to precipitate escape from danger

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7
Q

Fear is what kind of response? When does it abates?

A

Fear is a transient response to a specific stimulus that abates after escape from the danger

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8
Q

what is the definition of anxiety?

A

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”

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9
Q

Fear and anxiety are what?

A

Fear and anxiety are distinct

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10
Q

In fear which nervous system is aroused

A

Sympathetic nervous system

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11
Q

in fear what causes a person to be more alert and focused?

A

Rush of adrenaline/epinephrine

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12
Q

describe the action tendency in fear?

A

The action tendency is to stop what the person is doing; monitor the environment vigilantly; and plan to flee or freeze (avoiding the danger)

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13
Q

what are some similarities between fear and anxiety?

A

Anticipation of danger; tense apprehensiveness; uneasiness; elevated arousal; negative affect; future orientated; accompanied by bodily sensations

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14
Q

what are some characteristics of fear that are not characteristics of anxiety?

A

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

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15
Q

what are some characteristics of anxiety that are not characteristics of fear?

A

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

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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

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17
Q

what are some peripheral manifestations of anxiety?

A

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

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18
Q

Anxiety can produce What and What? What can this impair?

A

Anxiety can produce confusion and cognitive inflexibility which can impair; concentration; new learning; recall

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19
Q

PET and MRI data confirm that which system is particular important in the aetiology of panic?

A

PET and MRI data confirm the limbic system and parahippocampal area as particularly important in the aetiology of panic.

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20
Q

what structures are involved in the bias in selective attention to threat-related stimuli?

A

Septo-hippocampus and associated structures are involved in bias in selective attention to threat related stimuli.

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21
Q

the amygdala may play a crucial role in what?

A

Amygdala may play a crucial role in the appraisal of threat

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22
Q

What neurotransmitter has been implicated in the genesis of panic?

A

Serotonin has been particularly implicated in the genesis of panic

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23
Q

what type of nerve endings are associated with panic? Where are they located?

A

Serotonergic nerve endings in the periaqueductal grey area associated with panic (unconditioned fear-fight or flight)

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24
Q

what area is associated with Anticipatory anxiety and avoidance?

A

the amygdala with anticipatory anxiety and avoidance (conditioned fear).

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25
Q

People ________ in their Proneness to? This leads to?

A

People vary in their proneness to anxiety; vulnerability leads to hyper vigilance when entering a novel or potentially intimidating environment

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26
Q

What does Hyper vigilance promote? What does it turn to if a threat is detected?

A

Hyper vigilance promotes rapid and global scanning; which turns into a narrow focus of attention if threat is detected

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27
Q

what are the characteristics of an anxious persons attention on a potential threat? It is often accompanied by?

A

Anxious person?s attention focuses narrowly and intensely on potential threat with enhanced perceptual sensitivity and even distortion.

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28
Q

Describe Selective attention

A

The narrowing of attention that occurs in response to threat; can be directed externally or internally.

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29
Q

Excessive what is the basis for abnormal behaviour and experience?

A

Excessive self focus

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30
Q

What does alcohol inhibit in terms of anxiety?

A

Alcohol inhibits self-focusing which reduces anxiety in social situations

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31
Q

what primes an individual to detect cues and threats

A

Past experiences (memory) and present beliefs prime individuals to detect cues and threats

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32
Q

high scores of what are associated with anxiety? This is know as what?

A

Temperamental vulnerability: high scores on introversion and neuroticism associated with anxiety

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33
Q

Describe Cognitive Vulnerability in terms of anxiety

A

differences in vigilance; collection and use of information; perceptual and attentional processes and judgmental biases

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34
Q

Selective attentional bias favours? Especially in ?

A

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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35
Q

what is the therapeutic task in terms of attention

A

The therapeutic task is to achieve a functional amount and to engage in accurate interpretations and retrieval

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36
Q

what is the basic description of the sympathetic system?

A

The sympathetic system enables the body to be prepared for fear; flight or fight.

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37
Q

What is the basic description of the parasympathetic system?

A

the parasympathetic system is concerned with conservation and restoration of energy

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38
Q

What are some sympathetic and parasympathetic actions of the eyes

A

Sympathetic: Dilate; Parasympathetic: Constrict

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39
Q

What are some sympathetic and parasympathetic actions of the Heart

A

Sympathetic: Increase force of contraction Parasympathetic: Decrease contraction

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40
Q

What are some sympathetic and parasympathetic actions of the Lungs

A

Sympathetic: Dilate Bronchi; Parasympathetic: Constrict Bronchi

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41
Q

What are some sympathetic and parasympathetic actions of the Stomach

A

Sympathetic: Inhibit Secretion; Parasympathetic: Stimulate Secretion;

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42
Q

What are some sympathetic and parasympathetic actions of the Bladder and Bowel

A

Sympathetic: Retention; Parasympathetic: Excitation/Expulsion

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43
Q

What are some sympathetic and parasympathetic actions of the Skin

A

Sympathetic: Constrict Vessels; Parasympathetic: Dilate Vessels

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44
Q

What are some sympathetic and parasympathetic actions of the Sweat glands

A

Sympathetic: Stimulated; Parasympathetic: inhibited

45
Q

What are some sympathetic and parasympathetic actions of the Hair

A

Sympathetic: Tensed; Parasympathetic: relaxed

46
Q

What are some sympathetic and parasympathetic actions of the Tear glands

A

Sympathetic: Inhibit Secretion ; Parasympathetic: stimulate secretion

47
Q

Does genetics play a part in anxiety disorders?

A

Yes; Twin studies have highlighted a 31-41% increased risk of anxiety disorders.

48
Q

Beck is know as the father of what?

A

cognitive behaviour therapy

49
Q

why is Avoidance an issue in anxiety disorders?

A

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

50
Q

Anxiety is a _____________ between what?

A

Anxiety is a complex interrelationship between genetics; Central nervous system mechanisms; cognitive and behavioural factors

51
Q

what are the principal categories of anxiety disorders according to the DSM?

A

Separation Anxiety Disorder; Selective Mutes; Phobic Disorders; Social Phobia; Panic Disorder; Generalised Anxiety Disorder; Substance/Medication induced anxiety; Anxiety due to medical condition

52
Q

what are some disorders that are related to anxiety disorders but are not directly classified as anxiety disorders according to the DSM-5?

A

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)

53
Q

what is the basic description of Panic Disorder?

A

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.

54
Q

How long do panic attacks last?

A

usually no more than 10 min

55
Q

Briefly describe the cognitive model of panic

A

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

56
Q

what are the general diagnostic criteria of panic disorders?

A

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).

57
Q

approx.. What percent of patients present with both panic disorder and agoraphobia?

A

Usually (Approx. 95%) patients present with Panic Disorder and Agoraphobia

58
Q

briefly describe agoraphobia

A

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)

59
Q

what is the prevalence of panic disorders? Who is more affected males or females?

A

2-3% more common in females

60
Q

what is the median age of onset of panic disorders

A

20-24 years; very unusual if onset after 45

61
Q

what are the outcomes of treatment of panic disorders?

A

6-10 years post treatment 30% full recovery; 50% improved; 20% same or worse symptoms

62
Q

describe the genetics affecting panic disorders

A

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

63
Q

describe Phobic disorders

A

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.

64
Q

in patients with phobic disorders; are they aware that they fear is irrational?

A

Yes

65
Q

what are the general diagnostic criteria of Phobic disorders?

A

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

66
Q

What are some common subtypes of Phobic disorders?

A

Situational (eg. public transport; elevators; flying); Natural Environment (eg. storms; heights; water); Blood-Injection-Injury; Animal; Others

67
Q

what is the approx.. prevalence of Phobic disorders?

A

7-9%

68
Q

who is more affected by Phobic disorders male or female? What specific Phobic is equal across genders?

A

Animal/Natural/Situational more common in females; Blood-Injection-Injury equal across genders

69
Q

phobic disorders exhibit a _____ peak

A

Bimodal (peak in childhood and mid 20s)

70
Q

when is the normal onset of phobic disorders; what other events can bring them on?

A

Onset usually in childhood; can be associated with trauma eg. Experiencing unexpected panic attack on subway

71
Q

Phobias that persist into adulthood are?

A

hobbies that persist into adulthood are unlikely to remit (without treatment)

72
Q

describe the family pattern in phobic disorders:

A

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

73
Q

what are the general diagnostic criteria of social phobia

A

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

74
Q

what is the prevalence of social phobias? What gender is more affected?

A

3-7%; lower in older adults; higher in females

75
Q

when is the onset of most social phobias? Describe the usual onset of social phobias?

A

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
Q

describe the family pattern in social phobias:

A

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.

77
Q

What is the basic definition of Generalised anxiety disorder?

A

A chronic and persistent level of anxiety and worry typically associated with all-encompassing life situations

78
Q

what are the general diagnostic criteria of Generalised anxiety disorder?

A

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

79
Q

What is the prevalence of GAD; what gender is more affected?

A

3%; it is more common in females

80
Q

in Generalised anxiety disorder most patients report feeling anxious for most there? The anxiety usually does what? What makes it worse?

A

Most report feeling anxious all their lives; anxiety usually fluctuates; worsens during times of stress

81
Q

describe the family pattern in GAD:

A

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

82
Q

in GAD Danger is often what?

A

Overestimated

83
Q

in GAD Personal resources to deal with the treat are often?

A

Underestimated

84
Q

the frequent theme of GAD is what?

A

unpredictability and uncontrollability

85
Q

briefly describe the Cognitive model of GAD:

A

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
Q

in the cognitive model of GAD Dysfunctional assumptions often revolve around?

A

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?)

87
Q

describe pathological worry:

A

according to Borkovec “conceptual; linguistic attempt to avoid future aversive events and aversive imagery?

88
Q

how is pathological worry reinforcing?

A

pathological worry is reinforcing because it provides avoidance of more threatening imagery and more distressing somatic activation

89
Q

Briefly describe Obsessive-Compulsive disorder

A

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.

90
Q

what are the general diagnostic criteria for OCD?

A

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

91
Q

in OCD is the patient aware that they compulsions are excessive and unreasonable?

A

yes

92
Q

what is the prevalence of OCD; which gender is more affected and when?

A

1.2%; females are affected at a slightly higher rate than males in adulthood; although males are more commonly affected in childhood

93
Q

in the us what is the mean age of onset of OCD? 25% of cases start by age? Onset after what age is rare?

A

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.

94
Q

In OCD who has and onset at an early age males or females?

A

Males have an earlier age at onset than females: nearly 25% of males have onset before age 10 years.

95
Q

IN OCD the onset of symptoms is usually?

A

The onset of symptoms is typically gradual; however; acute onset has also been reported.

96
Q

if OCD is left untreated it?

A

If OCD is untreated; the course is usually chronic.

97
Q

what is the basic description of Posttraumatic stress disorder?

A

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
Q

what are the general diagnostic criteria for PSTD

A

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

99
Q

PSTD is more common in what gender? Why?

A

females; more likely to be exposed to trauma (rape and violence)

100
Q

when does a diagnosis change from Acute stress disorder to PSTD

A

if symptoms last for more than 4 weeks

101
Q

Anxiety is a common comorbid condition with other psychopathology. What are they?

A

Mood disorders; Substance use disorders; Personality disorders; Depression

102
Q

_______ and ________ show significant overlap at symptom and diagnostic levels:

A

Anxiety and depression show significant overlap at symptom and diagnostic levels:

103
Q

describe Psychometrics:

A

a simple an easy to use scale for psychological symptoms

104
Q

what are some treatments of anxiety disorders?

A

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
Q

what are some dietary changes for a patient with an anxiety disorder?

A

Avoid alcohol; Where practical; avoid medications with pseudoephedrine; Avoid caffeine; Avoid illicit substances; Avoid foods with excess preservatives

106
Q

describe exposure therapy; what is essential for it (or re-traumatisation can occur)

A

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

Mental Health (7 decks)

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