Anxiety disorders

Question 1

etiology of anxiety disorders

Answer 1

1. biological
   - the limbic system and the prefrontal cortex especially the amygdala are important re modulating fear and anxiety
   - those with anxiety show heightened responsiveness in these areas which responds to treatment
   - neurotransmitters = noradrenalin, serotonin, dopamine, GABA
   - sympathetic nervous system mediates many of the symptoms
   - medical conditions: cardiac, respiratory, endocrine, drug abuse and withdrawl
   - genetic factors : re inheriting risk for anxiety and resilience and personality factors
   - psychiatric illness and co-morbidities
2. psychological
   - childhood trauma/ abuse/ neglect
   - traumatic events in adult life/ stress build-up/medical illness
   - personality factors, coping style and ability to manage/ tolerate stress
3. social
   - childhood factors - family makeup/ finances
   - social supports: friendships/accomodation/ occupation/ finances

Question 2

epidemiology of anxiety disorder

Answer 2

1. up to 1/3 of people will be affected by an anxiety disorder during their lifetime
2. they tend to follow a chronic course
3. prevalence falls slightly with older age
4. highly co-morbid with other anxiety disorders and other mental disorder
5. mostly treated in primary care or psychiatric OPD

Question 3

what are the commonest anxiety disorders?

Answer 3

• specific phobias
• social phobias
• panic disorder
• GAD
• agoraphobia

Question 4

Yerkes-Dodson law

Answer 4

looks at the optimal arousal/stress for functioning. too much and too little stress can impair functioning

Question 5

what the 3 major groupings of anxiety disorders ?

Answer 5

1. anxiety and fear-related disorders
2. obsessive compulsive and related disorders
3. disorders specifically associated with stress

Question 6

what disorders are included in the anxiety or fear-related disorders?

Answer 6

1. generalized anxiety disorder
2. panic disorder
3. agoraphobia
4. specific phobia
5. social anxiety disorder

Question 7

what disorders are included in the obsessive-compulsive and related disorders?

Answer 7

1. obsessive-compulsive disorder
2. body dysmorphic disorder
3. hypochondriasis
4. hoarding disorder

Question 8

what disorders are included in disorders specifically associated with stress?

Answer 8

1. PTSD
2. Complex post traumatic stress disorder
3. prolonged grief disorder
4. adjustment disorder

Question 9

discuss anxiety and fear disorders.

Answer 9

• excessive fear (imminent present threat) and anxiety (anticipated future threat)
• +/- trigger = focus of the apprehension
• symptoms (and psychopathology)
• behavioural disturbance (avoidance and safety behaviours)
• impairment in social, educational, occupation and other areas of functioning
• not caused by organic disease or any other psychiatric disorder

Question 10

what are safety behaviours ?

Answer 10

• behaviours designed to reduce anxiety - common in all anxiety presentations
• common and subtle
• E.g staying quiet in social situations in social anxiety disorder, going out with a companion in agoraphobia, going to bed when feeling anxious, compulsive behaviours, having a Xanax in your bag “just in case”
• they stop us from directly testing our fears and perpetuate the false belief that our thoughts are facts
• can be useful in early treatment but can also interfere with treatment

Question 11

example of safety behaviours cycle

Answer 11

Question 12

discuss obsessive- compulsive and related disorders?

Answer 12

• repetitive cognitive phenomena (intrusive thoughts, obsessions, preoccupations) and/or repetitive behaviours
• resulting in significant distress
• impairment in social, educational, occupational and other areas of functioning
• not caused by organic disease or any other psychiatric disorder

Question 13

discuss disorders specifically associated with stress?

Answer 13

• exposure to an identifiable stress/ traumatic event or a series of such events
• the nature, pattern and duration of the symptoms arise specifically in response to this stressor
• stressful events may be within the normal range of life experiences or may be well outside it and of an extremely horrific and or threatening nature
• resulting in significant distress
• impairment in social, educational, and other areas of functioning
• not caused by organic disease or any other psychiatric disorder

Question 14

symptoms of anxiety disorders

Answer 14

1. psychological/ thoughts
   - though content
   - situational aspect
2. psychological/ emotions
   - fear
   - dread
   - anxiety
3. physical/ motor
   - restlessness
   - muscular tension
   - fatigue
   - shortness of breath
   - palpitations
   - abdominal discomfort/ diarrhea
   - urinary frequency
   - tingling of the extremities
4. behavioural
   - avoidance
   - safety behaviours

Question 15

what is the cognitive triangle

Answer 15

• relationship between thoughts, feelings and behaviours

Question 16

simple phobias

Answer 16

Question 17

agoraphobia

Answer 17

Question 18

Social anxiety disorder SAD

Answer 18

Question 19

Panic disorder

Answer 19

Question 20

generalized anxiety disorder

Answer 20

Question 21

Obsessive compulsive disorder

Answer 21

Question 22

body dysmorphic disorder

Answer 22

Question 23

hypochondriasis

Answer 23

Question 24

PTSD

Answer 24

Question 25

complex - cPTSD

Answer 25

Question 26

prolonged Grief disorder

Answer 26

Question 27

adjustment disorder

Answer 27