Anxiety Disorders Flashcards
What is the normal physiological response in anxiety?
Normal response to percieved threat
Complex neural pathways centred on amygdala -> coordinates with hippocampus (memories) and hypothalamus (autonomic system for response via systemic endocrine)
Regulates by cognitive appraisal of threat via the ventromedial prefrontal cortex.
This prevents unchecked, persistent and pervasive anxiety.
What is the typical cognitive reponse of anxiety?
High state or alertness
Polraised thinking ( all or nothing)
Negative mental filtering
Overgeneralization
Catastrophizing
Fallacy of control (internal and external)
Should statements
What is the emotional state of an anxiety patient?
Apprehension of danger
Dread/foreboding
Tense “jumpy” or nervous
Irritability
What are some physical symptoms of anxiety?
Nausea
Abdominal discomfort
Light headedness
Sweating
Dry mouth
Paraesthesia
Muscle tension
Restlessness
Shortness or breath
Palpitations
Chest pains
Headache
Insomnia
What are some behavioural consequences of anxiety?
Avoidance of feared or trigger situation
Dysfunctional behaviours to try and rid oneself of anxiety
Disruption to daily life
Reduced performances e.g work, study
Impaired relationships
What are the key features of a panic disorder? (types of anxiety disorder)
Episodic paroxysmal anxiety
Sudden onset
Intense
Severe physical symptoms of anxiety
Fear of impending death common
Transient - between 5 to 20 minutes
What are the key features of a specific phobia anxiety disorder?
Persistent, irrational fear of specific objects, activities or situation which leads to avoidance
Typically filled by a fear of fear
For example - agoraphobia (fear of crowded spaces)
What are the key features of OCD as an anxiety disorder?
Recurrent and irrational thoughts or mental imagery (obsessions) which generate marked anxiety and which lead to repetitive behaviours (compulsions) in an attempt to alleviate that anxiety.
What are the typical treatments for anxiety disorders?
Psychoeducation - understanding a condition, cause and benign effects, is a reducer of anxiety
Self-help - facilitated or non-guided using workbooks, online resources etc, which help patients to identify and modify cognitive distortions, mindfulness or meditation, CBT
What are the different cognitive aspects that are challenged in CBT?
Autonomic thoughts - obsessions in OCD
Faulty assumptions - cognitive distortions
Core beliefs - often dysfunctional due to previous adverse life experiences.
What medications can be offered for anxiety disorders?
SSRI e,g sertraline
Alternative SSRI or SNRI
Pregabalin - caution class C controlled drug - risk of misuse or dependence
Benzos - extreme situations for a short duration as possible
Caution of physical or psychological dependence.
What disorders are included as an anxiety disorder?
Generalised anziety disorder
Specific phobias
Panic disorders
OCD
PTSD
What scales are often used for screening for anxiety disorders?
Beck Anxiety Inventory
Hospital Anxiety and Depression Scale.
What are the key features of Generalised Anxiety Disorders?
Chronic and pervasive - worry across various life domains.
Difficuly controlling worru
Congitive and physical symptoms are also present
Occurs for at least 6 months
What is the typical management of anxiety disorder?
Majority in primary care
Advice and reassurance can help prevent early or mild problems from worsening
Counselling - low intensity
Second line = high intensity psychological intervention such as CBT or applied relaxation
Medical management - SSRIS
What is important to know about starting a patient on an SSRI for anxiety disorders?
Many undcrease risk fo suicidal thinking and self harm
Patient under 30yrs should therefore have a 1w follow up appointment to monitor progress
Symptomatic - propanolol
What are the specific features of aographobia?
Fear of open spaces and assocaited factures e.g crowds, fear of difficulty of escape to safe space (often home)
May be gradual or sudden
Comorbid depression is common
What are the ICD-11 features of social phobia?
Fear of scrutiny by others in relatively small groups (as opposed to crowds), results in avoidance of social situations
Relatively small groups generally consisting of 5-6 people (usually 1 to 2 is tolerable)
May be specific (public speaking) or generalised
What is the typical management plan for phobias?
CBT first line - commonly add an exposure technique such as flooding or modelling
If ineffective or severe functional impairment - SSRIs are the first line medical management
Propranolol can be used if somatic symptoms predmoninate
