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anxiety disorders Flashcards

1
Q

what are the 3 models of stress

A

biomechanical ‘engineering’

medicophysiological

psychological (transactional)

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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

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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
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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

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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

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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

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7
Q

what are the 5 symptom groups in anziety

A

psychological arousal

autonomic arousal

muscle tension

hyperventilation

sleep disturbance

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8
Q

Yerkes Dodson curve

A

stress performance connection

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

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9
Q

why do we have a biological basis to stress

A

there to protect us

survival response

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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
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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

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12
Q

results of muscle tension

A

tremor

headache

muscle pain

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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

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14
Q

sleep disturbance

A

initial insomnia

frequent waking

nightmares and night terrors

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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

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16
Q

examples of dissociative symptoms

A

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

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17
Q

what are dissociative disorders associated with

A

previous experiences of trauma

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18
Q

what are somatoform disorders

A

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

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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)
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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
counselling for GAD
clear plan of management explanation and education advice re. caffeine, alcohol, exercise etc
26
relaxation training for GAD
group or individual | DVDs, tapes or clinician led
27
medication for GAD
sedatives have high risk dependency antidepressants - SSRI, TCA
28
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
29
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
30
3 clinically important syndromes in phobic anxiety disorders
specific phobias social phobia agoraphobia
31
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
32
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
33
core features of OCD
experience of recurrent obsessional thoughts and or compulsive actions
34
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
35
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
36
epidemiology of OCD
overall 1yr prevalence is 2% M=F
37
aetiological theory for OCD
genetic e.g. gene coding for 5HT receptors 5HT function abnormalities
38
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
39
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
40
PTSD | 3 key elements to reaction
hyperarousal re-experiencing phenomena avoidance of reminders
41
features of hyperarousal
persistent anxiety irritability insomnia poor concentration
42
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
43
features of avoidance in PTSD
emotional numbness cue avoidance recall difficulties diminishes interests
44
how long does PTSD take to start
usually doesn't happen straight away after the trauma can take mths-yrs before symptoms begin
45
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
46
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
47
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)
48
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
49
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

Y3 - psychiatry (27 decks)

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