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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 psychological model of stress?

A

An individual’s reaction will depend on a balance between their cognitive processing of the threat and perceived ability to cope

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3
Q

What are the types of coping?

A
  • Problem focussed
  • Emotion focussed
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4
Q

What is problem focussed coping?

A

where efforts are directed toward modifying stressor
- preparation, studying or interview practice

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5
Q

What is emotion focussed coping?

A

where efforts focussed on modifying emotional reaction

  • mental defence mechanisms (eg denial)
  • relaxation training
  • sedative drug
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6
Q

How are our physiological and psychological reactions to stress elicited?

A

stressor leads to release of corticotropin releasing hormone:
- adrenal gland: adrenocorticotropic released –> glucocorticoid, noradrenaline and adrenaline

  • peripheral blood: prolactin & growth hormone released –> cytokines
  • lymph node: hardwiring sympathetic innervation
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7
Q

What are the symptoms groups of the fight or flight response?

A
  • psychological arousal
  • autonomic arousal
  • muscle tension
  • hyperventilation
  • sleep disturbance
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8
Q

What is the Yerkes Dodson curve of stress performance connection?

A

As stress increases so too does performance until stress becomes too much and performance declines

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9
Q

What psychological arousal can be produced by stress?

A

anxiety symptoms

  • fearful anticipation
  • irritability
  • sensitivity to noise
  • poor concentration
  • worrying thoughts
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10
Q

what autonomic arousal can be produced by stress?

A

GI: dry mouth, swallowing difficulties, dyspepsia, nausea and wind, frequent loose motions

resp: chest tightness, difficulty inhaling
cardio: palpitations, chest pain
urinary: frequency/urgency of micturition, amernorrhoea/dysmenorrhoea, erectile failure

CNS: dizziness, sweating

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11
Q

How can muscle tension associated with stress manifest?

A
  • tremor
  • headache
  • muscle pain
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12
Q

How can hyperventilation associated with stress manifest?

A
  • causing CO2 deficit hypocapnia
  • numbness tingling in extremeities may lead to carpopedal spasm
  • breathlessness
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13
Q

How can sleep disturbance associated with stress manifest?

A
  • Initial insomnia
  • Frequent waking
  • Nightmares and night terrors
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14
Q

How are anxiety disorders characterised?

A

ICD10 F40-F48

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15
Q

how do phobias and GAD differ?

A

same core anxiety symptoms

  • phobias occur in particular circumstances
  • GAD occurs persistently
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16
Q

what symptoms are associated with GAD?

A

symptoms of human anxiety

  • psychological arousal
  • autonomic arousal
  • muscle tension
  • hyperventilation
  • sleep disturbance

persistent; not confined to a situation or object

17
Q

What is the differential diagnosis for anxiety disorder?

A

psychiatric conditions

  • depression
  • schizophrenia
  • dementia
  • substance misuse

physical conditions

  • thyrotoxicosis
  • phaeochromoctoma
  • hypoglycaemia
  • asthma
  • arrhythmias
18
Q

What is the epidemiology of GAD?

A
  • one year prevalence around 4.4% in England
  • W>M
19
Q

what is the difference between anxiety and GAD

A
  • no clear line
  • differ in extent and duration of symptoms
20
Q

What is the aetiology of GAD?

A

stressor acting on a personality predisposed to the disorder by a combination of childhood:

  • genetic factors
  • environmental influences
21
Q

how are GAD managed?

A
  • counselling
  • relaxation training
  • medication
  • cognitive behavioural therapy
22
Q

how is CBT used in anxiety disorders?

A

our emotional response to a situation will depend on our cognitive processing of it

  • identifying errors, reprocessing and reassessing responsibility
  • maintaining remission appears superior to drug therapy
23
Q

what symptoms are associated with phobic anxiety disorders?

A

symptoms of human anxiety

  • psychological arousal
  • autonomic arousal
  • muscle tension
  • hyperventilation
  • sleep disturbance

occur in specific circumstances only

24
Q

What are the 3 clinically important phobic anxiety syndromes?

A
  • specific phobias
  • social phobia
  • agoraphobia
25
Q

what is social phobia?

A

inappropriate anxiety in situation where person feels observed or could be criticised (eg restaurants, shops or any queues, public speaking)

symptoms: blushing, tremor, anxiety symptoms

26
Q

how is social phobia managed?

A
  • cognitive behavioural therapy: addressing the groundless fear of criticism
  • counselling: education and advice
  • medication: SSRI antidepressants
27
Q

What are the core features of OCD?

A
  • recurrent obsessional thoughts
  • compulsive acts
28
Q

What are the features of obsessional thoughts associated with OCD?

A
  • ideas, images or impulses
  • occurring repeatedly
  • unpleasant and distressing
  • key anxiety symptoms accompanying resistance
29
Q

What are the features of compulsive acts or rituals associated with OCD?

A
  • stereotypical behaviours repeated again and again
  • not enjoyable or helpful
  • often viewed by sufferer as preventing some harm to self or others
  • key anxiety symptoms accompanying resistance
30
Q

What is the epidemiology of OCD?

A
  • overall one year prevalence is 2%
  • M = W
31
Q

What are the aetiological theories for OCD?

A
  • genetics (gene coding for 5HT receptors)
  • 5HT function abnormalities
32
Q

How is OCD managed?

A
  • education and explanation: involve partner/family
  • medications: serotonergic drugs (SSRI eg fluoxetine), clomipramine
  • cognitive behavioural therapy (CBT)
  • psychosurgery
33
Q

What is PTSD?

A

delayed and or protracted reaction to a stressor of exceptional severity
- combat, natural or human-caused disaster, rape, assault, torture

34
Q

What are the 3 key elements to PTSD reaction?

A
  • Hyperarousal
  • Re-experiencing phenomena
  • Avoidance of reminders
35
Q

What is the epidemiology of PTSD?

A
  • 1-4% one year prevalence
  • W>M
36
Q

What is the aetiology of PTSD?

A
  • nature of stressor: life threatening and degree of exposure generally confers greater risk
  • susceptibility partly genetic
37
Q

What vulnerability and protective factors influence the nature of a stressor in PTSD?

A

vulnerability factors

  • mood disorder
  • previous trauma especially as child
  • lack of social support
  • female

protective factors

  • higher education and social group
  • good paternal relationship
38
Q

What model describes how you need some stress to perform at best?

A

Yerkes Dodson curve

39
Q

what is the management of PTSD

A

Survivors of disasters screened at 1 month

  • mild symptoms: watchful waiting and review 1 month on
  • severe symptoms: trauma focused CBT, eye movement desensitisation and reprocessing (EDMR)
  • medication: SSRI or TCA

psychiatry (23 decks)

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