anxiety disorders Flashcards
what are the 3 models of stress
biomechanical ‘engineering’
medicophysiological
psychological (transactional)
what is the biomechanical model of stress
a model of stress that occurs when somebody’s environment is disturbed in some way by an external stress that puts a strain on them
up to a point this strain can be tolerated but if this level is exceeded, physiological and psychological damage will occur
what is the medicophysiological model of stress
general non-specific physiological reaction to a demand of any nature producing the fight or flight response
if the stressor persists there would be 3 stages of physiological activity:
- alarm reaction
- physiological adaptation to the stressor
- eventual exhaustion and burnout
what is the psychological model of stress
interaction between the individual and the environment
assumes an environmental stressor doesn’t necessarily cause the individual to feel stress
rather, their response depends on how they perceive the stressor
- an individual’s reaction to stress will depend on a balance between their cognitive processing of any perceived threat and perceived ability to cope
coping can be problem or emotion focussed
what is a problem focussed coping method in the psychological model of stress
a person attempts to influence the source of the stress to reduce/eliminate it
what is a emotion focussed coping method in the psychological model of stress
psychological or behavioural responses which attempt to reduce the -ve emotions associated w/ stress
what are the 5 symptom groups in anziety
psychological arousal
autonomic arousal
muscle tension
hyperventilation
sleep disturbance
Yerkes Dodson curve
stress performance connection
some stress is required for optimal performance but too much reduces our performance
why do we have a biological basis to stress
there to protect us
survival response
symptoms of psychological arousal
- human physiological and psychological reactions to stress producing anxiety
fearful anticipation irritability sensitivity to noise poor concentration worrying thoughts
impacts of autonomic arousal on different body systems
GI: dry mouth, difficulty swallowing, dyspepsia, nausea and wind, frequent loose motions
RESP: tight chest, difficulty inhaling
CVS: palpitations/missed beats, chest pain
GENITOURINARY: frequency/urgency, amenorrhoea/dysmnnorhoea, erectile failure
CNS: dizziness, sweating
results of muscle tension
tremor
headache
muscle pain
results of hyperventilation
CO2 deficit hypocapnia
numbness and tingling in extremities - may lead to carpopdeal spasm (frequent involuntary spasms of hands and feet caused by lower Ca levels brought about by hyperventilating)
SOB
sleep disturbance
initial insomnia
frequent waking
nightmares and night terrors
what are dissociative disorders
take the form of problems with memory, identity and emotion
can affect perception and behaviour and the person’s sense of self
symptoms can disrupt every area of functioning
examples of dissociative symptoms
the experience of detachment - someone feels outside their own body, can involve memory loss
what are dissociative disorders associated with
previous experiences of trauma
what are somatoform disorders
where a person experiences physical symptoms that can’t be explained by any underlying medical/neurological problems
difference between phobic anxiety disorders and general anxiety disorders
both have same core anxiety symptoms but:
- either occur in particular circumstances (PHOBIAS - agoraphobia, social phobia, specific phobias)
- OR occur persistently (GAD)
what is GAD
generalised anxiety disorder
persistent (several months) symptoms not confined to a situation or object
all the symptoms of human anxiety can occur (psychological arousal, autonomic arousal, muscle tension, hyperventilation, sleep disturbance)
differential diagnosis for anxiety disorders
PSYCHIATRIC CONDITIONS depression sz dementia substance misuse
PHYSICAL CONDITIONS thyrotoxicosis phaeochromocytoma hypoglycaemia asthma +/- arrhythmias
epidemiology of GAD
1yr prevalence ~4.4% in england
F>M - cultural factors and diagnosis of alcohol use may impact initial diagnosis depending on presentation
aetiology GAD
no clear line between normal anxiety and anxiety disorder - differ in extent of symptoms and duration
generally, GAD is caused by a stressor acting on a personality predisposed to the disorder by a combination of genetics and environmental influences in childhood
management of GAD
counselling
relaxation training
medication
CBT
counselling for GAD
clear plan of management
explanation and education
advice re. caffeine, alcohol, exercise etc
relaxation training for GAD
group or individual
DVDs, tapes or clinician led
medication for GAD
sedatives have high risk dependency
antidepressants - SSRI, TCA
CBT for anxiety disorders
our emotional response to a situation will depend on our cognitive processing of it
key elements: identifying errors, reprocessing and reassessing responsibility
pts tend to find this intuitively sensible
maintaining remission appears superior to drug therapy
key features of phobic anxiety disorders
same core features as GAD
only in specific circumstances
person behaves to avoid these circumstances - phobic avoidance
sufferer also experiences anxiety if there is a perceived threat of encountering the feared object/situation - anticipatory anxiety
3 clinically important syndromes in phobic anxiety disorders
specific phobias
social phobia
agoraphobia
what is social phobia
inappropriate anxiety in situation where person feels observed or could be criticised e.g. restaurant, shops, queues, public speaking
symptoms are any of the anxiety cluster but blushing and tremor predominate
usually associated w/ low self esteem and fear of criticism
management of social phobia
CBT addressing groundless fear of criticism. Challenges:
- -ve view of self
- safety barriers
- unrealistically high standards
- excessive self monitoring
education and advice
SSRIs
core features of OCD
experience of recurrent obsessional thoughts and or compulsive actions
what are obsessional thoughts
ideas, images or impulses
occurring repeatedly not willed
unpleasant and distressing - often the antithesis of personality type
- obscene, violent or senseless
recognised as the individuals own thoughts
usual key anxiety symptoms arise because of distress of the thoughts or attempts to resist them
what are compulsive acts or rituals
stereotypical behaviours repeated again and again
not enjoyable
not helpful - don’t result in useful activity
often viewed by suffered as:
- preventing harm to self/others (magical undoing)
- viewed as pointless and resisted w/ key anxiety symptoms accompanying resistance
epidemiology of OCD
overall 1yr prevalence is 2%
M=F
aetiological theory for OCD
genetic e.g. gene coding for 5HT receptors
5HT function abnormalities
management of OCD
good hx and MSE exclude treatable depressive illness
general measures - education and explanation, involve partner/family
serotonergic drugs - SSRI e.g. fluoxetine, clomipramine (TCA)
CBT - exposure and response prevention, examination of evidence to weaken convictions
psychosurgery - rare
what is PTSD
post traumatic stress disorder
delayed and/or protracted reaction to a stressor of exceptional severity (events would cause distress in anyone)
e.g. combat, natural/human caused disaster, rape, assault, torture, witnessing a traumatic event
PTSD
3 key elements to reaction
hyperarousal
re-experiencing phenomena
avoidance of reminders
features of hyperarousal
persistent anxiety
irritability
insomnia
poor concentration
features of re-experiencing phenomena
intense intrusive images
- flashbacks when awake
- nightmares during sleep
occur against the persisting background of a sense of numbness and emotional blunting
people can often feel detached from others and unresponsive to their surroundings
can also experience anhedonia
features of avoidance in PTSD
emotional numbness
cue avoidance
recall difficulties
diminishes interests
how long does PTSD take to start
usually doesn’t happen straight away after the trauma
can take mths-yrs before symptoms begin
epidemiology of PTSD
most of data comes from USA
variable cultural factors and exposure to disaster lead to a variable prevalence, 1-4% 1yr prevalence
F>M 2:1 in USA - likely due to association with sexual assailt and rape
aetiology of PTSD
NATURE OF STRESSOR
- life threatening and degree of exposure generally confers greater risk, BUT
- vulnerability factors: mood disorder, previous trauma esp as child, lack of social support, female
- protective factors: higher education and social group, good paternal relationship etc
susceptibility partly genetic
predisposing factors lower threshold but are neither necessary nor sufficient to fully explain occurence
management of PTSD
- survivors of disasters screened at 1mth
- mild symptoms - watchful waiting and review further month
- trauma focused CBT if more severe symptoms (12-16wks of treatment)
- eye movement desensitisation and reprocessing
- risk of dependence with any sedatives but patient may prefer medication (SSRI, TCA)
trauma focused CBT for PTSD
short term treatment - 12-16wks
combines trauma sensitive interventions w/ CBT strategies
includes elements of relaxation, psychoeducation, cognitive coping strategies
has also been developed for treatment of children and adolescents
how does eye movement desensitisation and reprocessing work
uses eye movements which help in processing distressing memories/beliefs
theory behind: assumes that when a traumatic/distressing experience occurs it may overwhelm normal coping mechanisms w/ the memory and associated stimuli being inadequately processed
therapy includes: patient recalls distressing images while receiving bilateral sensory input (e.g. side to side eye movements) and this helps with the processing of the stressful event
