Anxiety disorders Flashcards
Describe biomechanical model of stress
Biomechanical stress occurs when something in someone’s environment changes and puts a strain on them.Up to a point this strain can be tolerated but beyond this physical and psychological damage will occur. This could be a major personal event, an event that affects a whole community or just a daily hassle.
Describe Medicophysiological stress model
Medicophysiological reaction is a general non-specific physiological reaction to anything producing the fight or flight response.If this stressor persists then there are 3 stages of physiological activity: first would be an alarm reaction, second would be physiological adaptation to the stressor and then eventually exhaustion or burnout.
Describe Psychological (Transactional) model of stress
A dynamic model of stress. This assumes there is an interaction between the individual and the environment. It suggests that the environmental stressor does not nesscarily cause the individual to feel stress but rather their response depends on how they perceive the stressor. The person assesses what the stressor means to them personally. They could decide it is irrelevant to them, something positive or a stress.
The person then assesses their ability to cope with the stressor.
Stress occurs when there is an imbalance between the perceived demand and the person’s ability to cope.
What are the different types of coping mechanisms?
Problem focussed- efforts are directed towards modifying stressor e.g. prepartion, studying or interview practice
Emotion focussed- modify emotional reaction, mental defence mechanisms e.g. denial, relaxation training. or taking a sedative drug
It is best to use a combination of these two types.
What are symptoms of anxiety?
Psychological arousal; Fearful anticipation Irritability Sensitivity to noise Poor concentration Worrying thoughts
Autonomic arousal:
gastrointestinal- dry mouth, swallowing difficulties, dyspepsia (painful/disturbed digestion), nausea, flatulance, frequent loose stools
respiratory- tight chest, difficulty inhaling
cardiovascular- palpitations/missed beats, chest pain
gentiourinary- frequency/urgency of micturation, amenorrhea/dysmenorrhoea, erectile faliure
CNS- dizziness and sweating
Muscle tension- tremor, headache, muscle pain
Hyperventilation- causing CO2 deficit (hypocapnia), numbness in extremities, carpopedal spasm (due to low Calcium), breathlessness
Sleep distrubance- inital insomnia, frequent waking, nightmares and night terrors
How does ICD-10 categorise anxiety disorders?
Phobic anxeity disorders (with or without panic disorder)- includes social phobias
Other anxeity disorders (e.g. GAD, mixed with depression, panic disorder)
Obsessive-compulsive disorder (OCD)
Reaction to severe stress and adjustment disorders
Post-traumatic stress disorder
Adjustment disorders
Dissociative conversion disorders
What is the differences between GAD and phobic anxiety disorders?
They have the same core symptoms but occur at different times
GAD - occurs persistently over several months (at least) not confined to a situation or object
Phobic disorders- occur in specific circumstances e.g. agrophobia - fear of leaving home and going to public places, so symtpoms and panic attacks occur when this happens or is going to happen
What is the epidemology of GAD?
4.4% one year prevelence rate in England.
More common in women than men
Can present with something like alcohol dependance which they may use as a coping mechanism.
How is GAD managed?
Counselling- includes explaination, education, advice reguarding caffiene, alcohol, exercise ect and plan of management
Relaxation training
Medication
Cognitive Behavioural Therapy (CBT)
What medication is used to treat GAD?
SSRI’s (selective seratonin reuptake inhibitors- a category of antidepressant) e.g. sertraline , fluoxetine, citalopram
TCA’s (tricyclic antidepressants) e.g. amitiptyline, clomipramine
What is CBT?
Our emotional response to a situation depedns on how we cognitively process it. CBT helps to identify errors, reprocess and reassess situations.
It is vetter at maintaining remission then drug treatment is.
What are phobic aniety disorders?
Same symptoms/features as GAD but only occur in specific circumstances.
Person tries to avoid these circumstances “phobic avoidance”.
Sufferer will also experience anxiety if there is a perceived threat of encountering the feared object or situation -“anticipatory anxiety”
There are 3 types of syndrome:
Specific phobia- e.g. flying, clowns, heights ect
Social Phobia- fear of social interactions, due to embrassement, judgement ect, can get all symptoms of anxiety but blushing and tremor predominate
Agoraphobia- fear of enviroment that is perceived as unsafe e.g. open spaces, public transport or anwhere where there is no easy way to escape.
How can anxiety e.g. social phobia be managed?
CBT
Medication e.g. SSRI’s
What is OCD?
Consists of two components:
Obessive thoughts- unpleasent and unwanted ideas, images or impulses that occur repeatedly. They are recognised as the individuals own thoughts although they are involuntary. Anxiety arises due to the distressing nature of the thoughts or attempts to resist.
and
Compulsive Acts or rituals- behaviours repeated again and again. They are not helpful or enjoyable. They are often viewed as either:
~ preventing some harm to self or others “magic undoing”
or
~ viewed as pointless and resisted which causes anxiety
(even if seen as pointless it can be difficult to stop due to the anxiety it causes)
How is OCD managed?
Education
Involoving family
Serotonergic drugs - as OCD is though to be to do with the recptors of 5HT/ seratonin which is a monoamine neurotransmitter.
~ SSRI’s e.g. fluoxetine
~ clomipramine- a TCA
CBT- exposure and repsonse prevention
Psychosurgery- only done in rare cases that are resistent to other treatments.
