Anxiety Disorders Flashcards
What is the difference between phobic anxiety disorders and general anxiety disorder?
Both these sets of disorders have same core anxiety symptoms but they EITHER occur in particular circumstances:
- PHOBIAS
- Agoraphobia
- Social phobia
- Specific (Isolated) Phobias
OR Occur persistently
- GENERALISED ANXIETY DISORDER (GAD)
What is generalised anxiety disorder?
Persistent (several months) symptoms not confined to a situation or object.
All the symptoms of human anxiety mentioned earlier can occur
- Psychological arousal
- Autonomic Arousal
- Muscle Tension
- Hyperventilation
- Sleep Disturbance
What are the psychological differential diagnoses for anxiety?
- Depression
- Schizophrenia
- Dementia
- Substance Misuse
What are the physical differential diagnoses for anxiety disorders?
- Thyrotoxicosis
- Phaeochromoctoma
- Hypoglycaemia
- Asthma and or Arrhythmias
What is the management of generalised anxiety disorder?
Counselling
- Clear Plan of Management
- Explanation and education
- Advice re caffeine, alcohol exercise etc.
Relaxation training
- Group or individual
- DVDs, tapes or clinician led
Medication
- Sedatives have high risk dependency
- Antidepressants SSRI or TCA
Cognitive Behavioural Therapy
The management for generalised anxiety disorder consists of;
Counselling
- Clear Plan of Management
- Explanation and education
- Advice re caffeine, alcohol exercise etc.
Relaxation training
- Group or individual
- DVDs, tapes or clinician led
Medication
- Sedatives have high risk dependency
- Antidepressants SSRI or TCA
Cognitive Behavioural Therapy
Expand on CBT
Cognitive Behavioural Therapy (CBT) for Anxiety Disorders
- See full account Oxford Textbook 5th Edition pp594 onwards
- Our emotional response to a situation will depend on our cognitive processing of it.
- Identifying errors, reprocessing and reassessing responsibility are key elements
- Patients tend to find this intuitively sensible
- Survival in remission appears superior to drug therapy
What are the key features of phobic anxiety disorder?
- Same core features as GAD
- ONLY in specific circumstances
- Person behaves to avoid these circumstances “phobic avoidance”
- Sufferer also experiences anxiety if there is a perceived threat of encountering the feared object or situation “anticipatory anxiety”
Phobic anxiety disorders can be broken down into 3 clinically important syndromes;
- Specific Phobias
- Social Phobia
- Agoraphobia
- type of anxiety disorder in which you fear and avoid places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed
What is the management of social phobia?
- Cognitive Behavioural Therapy addressing the groundless fear of criticism. CBT challenges
- Negative views of self
- “Safety barriers”
- Unrealistically high standards
- Excessive self monitoring
- Education and advice
- Medication SSRI antidepressants
What is obsessive-compulsive disorder (OCD)?
Core features are experience of recurrent obsessional thoughts and or compulsive acts
Obsessional Thoughts
- Ideas, images or impulses
- Occurring repeatedly not willed
- Unpleasant and distressing (often the antithesis of personality type)
- Obscene
- Violent or senseless
- Recognised as the individual’s own thoughts
- Usual key anxiety symptoms arise because of distress of the thoughts or attempts to resist
Compulsive Acts or Rituals
- Stereotypical behaviours repeated again and again
- Not enjoyable
- Not helpful i.e. do not result in useful activity
- Often viewed by sufferer as
- preventing some harm to self or others; “magical undoing”
- Viewed as pointless and resisted with key anxiety symptoms accompanying resistance
What is the management for OCD?
- Good history and MSE exclude treatable depressive illness
- General measures
- Education and explanation
- Involve partner/family
- Serotonergic Drugs
- SSRI eg Fluoxetine
- Clomipramine
- Cognitive Behavioural Therapy (CBT)
- Exposure and response prevention
- Examination of evidence to weaken convictions
- Psychosurgery
What is post-traumatic stress disorder?
“Delayed and or protracted reaction to a stressor of exceptional severity” (would distress anyone)
- Combat
- Natural or human-caused disaster
- Rape
- Assault
- Torture
- Witnessing any of the above
What are the 3 key elements to reaction?
- Hyperarousal
- Re-experiencing phenomena
- Avoidance of reminders
The 3 key elements to reaction are;
- Hyperarousal
- Re-experiencing phenomena
- Avoidance of reminders
How does hyperarousal relate to PTSD?
- Persistent anxiety
- Irritability
- Insomnia
- Poor concentration
