anxiety disorders Flashcards

1
Q

what are the 3 models of stress

A

biomechanical ‘engineering’

medicophysiological

psychological (transactional)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the biomechanical model of stress

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the medicophysiological model of stress

A

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:

  1. alarm reaction
  2. physiological adaptation to the stressor
  3. eventual exhaustion and burnout
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is the psychological model of stress

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is a problem focussed coping method in the psychological model of stress

A

a person attempts to influence the source of the stress to reduce/eliminate it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is a emotion focussed coping method in the psychological model of stress

A

psychological or behavioural responses which attempt to reduce the -ve emotions associated w/ stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the 5 symptom groups in anziety

A

psychological arousal

autonomic arousal

muscle tension

hyperventilation

sleep disturbance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Yerkes Dodson curve

A

stress performance connection

some stress is required for optimal performance but too much reduces our performance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

why do we have a biological basis to stress

A

there to protect us

survival response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

symptoms of psychological arousal

- human physiological and psychological reactions to stress producing anxiety

A
fearful anticipation
irritability 
sensitivity to noise
poor concentration
worrying thoughts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

impacts of autonomic arousal on different body systems

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

results of muscle tension

A

tremor

headache

muscle pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

results of hyperventilation

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

sleep disturbance

A

initial insomnia

frequent waking

nightmares and night terrors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are dissociative disorders

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

examples of dissociative symptoms

A

the experience of detachment - someone feels outside their own body, can involve memory loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are dissociative disorders associated with

A

previous experiences of trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are somatoform disorders

A

where a person experiences physical symptoms that can’t be explained by any underlying medical/neurological problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

difference between phobic anxiety disorders and general anxiety disorders

A

both have same core anxiety symptoms but:

  • either occur in particular circumstances (PHOBIAS - agoraphobia, social phobia, specific phobias)
  • OR occur persistently (GAD)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is GAD

A

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)

21
Q

differential diagnosis for anxiety disorders

A
PSYCHIATRIC CONDITIONS 
depression
sz
dementia 
substance misuse
PHYSICAL CONDITIONS
thyrotoxicosis
phaeochromocytoma 
hypoglycaemia 
asthma +/- arrhythmias
22
Q

epidemiology of GAD

A

1yr prevalence ~4.4% in england

F>M - cultural factors and diagnosis of alcohol use may impact initial diagnosis depending on presentation

23
Q

aetiology GAD

A

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

24
Q

management of GAD

A

counselling
relaxation training
medication
CBT

25
Q

counselling for GAD

A

clear plan of management
explanation and education
advice re. caffeine, alcohol, exercise etc

26
Q

relaxation training for GAD

A

group or individual

DVDs, tapes or clinician led

27
Q

medication for GAD

A

sedatives have high risk dependency

antidepressants - SSRI, TCA

28
Q

CBT for anxiety disorders

A

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

29
Q

key features of phobic anxiety disorders

A

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

30
Q

3 clinically important syndromes in phobic anxiety disorders

A

specific phobias
social phobia
agoraphobia

31
Q

what is social phobia

A

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

32
Q

management of social phobia

A

CBT addressing groundless fear of criticism. Challenges:

  • -ve view of self
  • safety barriers
  • unrealistically high standards
  • excessive self monitoring

education and advice

SSRIs

33
Q

core features of OCD

A

experience of recurrent obsessional thoughts and or compulsive actions

34
Q

what are obsessional thoughts

A

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

35
Q

what are compulsive acts or rituals

A

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

36
Q

epidemiology of OCD

A

overall 1yr prevalence is 2%

M=F

37
Q

aetiological theory for OCD

A

genetic e.g. gene coding for 5HT receptors

5HT function abnormalities

38
Q

management of OCD

A

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

39
Q

what is PTSD

A

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

40
Q

PTSD

3 key elements to reaction

A

hyperarousal
re-experiencing phenomena
avoidance of reminders

41
Q

features of hyperarousal

A

persistent anxiety
irritability
insomnia
poor concentration

42
Q

features of re-experiencing phenomena

A

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

43
Q

features of avoidance in PTSD

A

emotional numbness
cue avoidance
recall difficulties
diminishes interests

44
Q

how long does PTSD take to start

A

usually doesn’t happen straight away after the trauma

can take mths-yrs before symptoms begin

45
Q

epidemiology of PTSD

A

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

46
Q

aetiology of PTSD

A

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

47
Q

management of PTSD

A
  • 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)
48
Q

trauma focused CBT for PTSD

A

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

49
Q

how does eye movement desensitisation and reprocessing work

A

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