Anxiety disorders Flashcards
What are the three groups of symptoms associated with anxiety?
Physical
Cognitive
Behavioural
What are some of the physical symptoms of anxiety?
- Sweating, hot flushes or cold chills
- Trembling or shaking
- Muscle tension or aches and pains
- Numbness or tingling sensations
- Feeling dizzy, unsteady, faint or lightheaded
- Dry mouth (not due to medication or dehydration)
- Feeling of choking
- A sensation of a lump in the throat, or difficulty in swallowing
- Difficulty breathing
- Palpitations or pounding heart, or accelerated heart rate
- Chest pain or discomfort
- Nausea or abdominal distress (e.g. churning in stomach)
What are some of the cognitive symptoms of anxiety?
- Fear of losing control, “going crazy or dying
- Feeling keyed up, on edge or mentally tense.
- Difficulty in concentrating, “mind going blank”
- Feeling that objects are unreal - derealization
- Feeling that the self is distant or “not really here” -depersonalisation
- Hypervigilance (internal and external)
- Racing thoughts
- Meta-worry (worry about everything, worrying about worrying)
- Health anxiety
- Beliefs about the importance of worry
- Preference for order and routine
What are the behavioural symptoms of anxiety?
- Avoidance
- Social isolation
- Hyperchondriasm
- Sleep disturbance
- Excessive planning
- Weight loss
- Substance abuse
- Seeking reassurance
What is the amygdala?
Two almond-shaped groups of nuclei located deep and medially within the temporal lobes of the brain, known to process memory, decision-making, and emotional reactions
What part does the amygdala play in the stress response?
Amygdala acts as the emotional filter of the brain for assessing whether sensory material via the thalamus requires a stress or fear response
What happens to cortisol levels during stress?
Increases
What is generalised anxiety disorder?
Anxiety that is generalized and persistent but not restricted to, or even strongly predominating in, any particular environmental circumstances
What are the symptoms of generalised anxiety disorder?
Persistent nervousness, trembling, muscular tensions, sweating, lightheadedness, palpitations, dizziness, and epigastric discomfort
Fears that the patient or a relative will shortly become ill or have an accident are often expressed
There is no specific trigger for these symptoms/fears
What non-specific symptoms is generalised anxiety disorder associated with?
- Restlessness or feeling keyed up or on edge
- Becoming easily fatigued
- Difficulty concentrating or mind going blank
- Irritability
- Muscle tension
- Sleep disturbance (difficulty falling or staying asleep, restless unsatisfying sleep)
What is the male:female ratio of those affected by generalised anxiety disorder?
1:2 male:female
What is the typical age of onset of GAD?
20-40
What is panic disorder?
The essential feature is recurrent attacks of severe anxiety (panic), which are not restricted to any particular situation or set of circumstances and are therefore unpredictable
What are the dominant symptoms of panic disorder?
Sudden onset of palpitations, chest pain, choking sensations, dizziness, and feelings of unreality (depersonalization or derealization)
There is often also a secondary fear of dying, losing control, or going mad
What are the three types of phobia?
- Agoraphobia
- Social phobia
- Specific phobia
What is agoraphobia?
A fairly well-defined cluster of phobias embracing fears of leaving home, entering shops, crowds and public places, or travelling alone in trains, buses or planes
How do lots of those with agoraphobia cope with the condition?
Avoidance: some agoraphobics experience little anxiety because they avoid their phobic situations e.g. by never leaving their house
What is a specific phobia?
A marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation
What are the features of a specific phobia?
- Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response, akin to a panic attack
- The person recognises that the fear is excessive or unreasonable
- The phobic situation(s) is avoided or else endured with intense anxiety or distress
- Normal functioning impaired by the avoidance, anxious anticipation, or distress in the feared situation(s)
What is social phobia?
A persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others
What are appetitive/approach systems?
Systems that function to mediate seeking and approach behaviours including pleasure
What are some of the appetitive/approach systems in the brain?
ascending dopamine systems – mesolimbic/cortical projection
amygdala (conditioning / learning)
orbitofrontal cortex (relative reward preference / rule learning)
What are aversive/defensive systems?
Systems that function to promote surivival in the event of threat
What are some of the aversive/defensive mechanisms in the brain?
ascending serotonin systems
central nucleus of amygdala
hippocampus
What are the consequences of disordered aversive functioning?
Enhanced identification of threat stimuli
Increased arousal and hyper vigilance.
Inability to relax or sleep, move more, eat less, lose weight (?), less sexual interest
Reduced contact with previously rewarding stimuli
Tense, anxious or fearful mood
Increased use of ‘anxiety management techniques’ – alcohol or drugs & avoidance
Rehearsal and overdoing of ‘safety’ behaviours (rituals)
What is obsessive compulsive disorder?
OCD is a chornic anxiety disorder, marked by obsessions and/or compulsions
What are obsessions and their features?
Recurrent, intrusive and distressing thoughts, ideas, images, memories, impulses
Unwanted
Usually resisted
Recognised as originating from own mind
Associated with the emergence or increase of anxiety
What are some of the common obsessions in OCD?
What are compulsions and their features?
Repetitive, seemingly purposeful behaviours that individual feels driven to perform
Can include physical and mental rituals
Carrying out compulsions tends to reduce anxiety – e.g. handwashing
Resistance to performing a compulsion increases anxiety
Usually recognised as ‘irrational’
What are some of the common compulsions associated with OCD?
What is the peak age of incidence of OCD in males?
13-15
What is the peak age of incidence of OCD in females?
24-25
What are some of the co-morbid conditions associated with OCD?
Obsessive compulsive personality disorder
Autism Spectrum
Schizophrenia
Hypochondriasis
Body dysmorphic disorder
What are the features of obsessive compulsive personality disorder?
- preoccupation with rules, lists, order, schedules
- perfectionism interfering with task completion
- excessive devotion to work
- overconscientious, scrupulous and inflexible
- unable to discard worthless objects
- reluctance to delegate, need to be in control
- miserliness
- rigidity and stubbornness
What are poor prognostic indicators in OCD?
Early onset
Tics
Male
Multiple symptoms
What are the three domains of dysfunctional belief in OCD?
Overestimation of threat
Beliefs about the importance of, and need to control, intrusive thoughts
Perfectionism and intolerance of uncertainty
What is involved in the psychotherapy used to treat OCD?
Deliberate exposure to obsessional stimuli
Prevention of compulsions typically used to lessen distress associated with feared stimuli
Repeated exposure to the obsessional cues whilst employing strict response prevention leads to habituation
What are the 5 screening questions helpful in identifying OCD?
- Do you wash or clean a lot?
- Do you check things a lot?
- Is there any thought that keeps bothering you that you would like to get rid of but can’t?
- Do your daily activities take along time to finish?
- Are you concerned about orderliness or symmetry?
What are schemas?
Deep rooted unconditional basic beliefs that stem from childhood conditioning
What neurotransmitter is most involved in appetitive and approach systems?
Dopamine
