Anxiety Disorders Flashcards
Three models of stress
Biomechanical Engineering
Medicophysiological
Psychological
Psychological (transactional) model of stress
An individuals reaction to stress will depend on a balance between their cognitive processing of any perceived threat and perceived ability to cope. It tends to be problem or emotionally focussed.
Problem focussed coping
When efforts are directed toward modifying stressor. Preparation, studying or interview practice are some examples.
Emotion focussed coping
Modify emotional reaction. Mental defence mechanisms (denial), taking a sedative drug.
Symptom groups of anxiety disorder due to flight or fight response
Psychological arousal
Autonomic Arousal
Muscle Tension
Hyperventilation
Sleep Disturbance
Psychological arousal
Fearful anticipation Irritability Sensitivity to noise Poor concentration Worrying thoughts
GI autonomical arousal symptoms
Dry mouth
Swallowing difficulties
Dyspepsia, nausea and wind
Frequent loose motions
Respiratory autonomic arousal symptoms
Tight chest, difficulty inhaling
CVS autonomical arousal symptoms
Palpitations, chest pain
Urinary autonomic arousal symptoms
Increased frequency and urgency
Amenorrhoea/dysmenorrhoea
Erectile failure
CNS autonimic arousal symptoms
Dizziness and sweating
Muscle tension symptoms
Tremor, headache, muscle pain
Hyperventilation symptoms
Causing CO2 deficit hypocapnia
Numbness tingling in the extremities may lead to carpopedal spasm
Breatlessness
Sleep disturbance symptoms
Initial insomnia
Frequent waking
Nightmares and night terrors
Generalise anxiety disorder
Persistent symptoms not confined to a situation or object. The symptoms can incur all of the symptom groups of anxiety.
Psychiatric differential diagnosis of anxiety disorders
Depression, schizophrenia, dementia, substance misuse
Physical conditions differential diagnosis of anxiety disorders
Thyrotoxicosis
Phaeochromoctoma
Hypoglycaemia
Asthma and or Arrhythmias
Epidemiology of Generalised anxiety disroder
One year prevalence of 4.4% and tends to affect more women than men
Cause of generalised anxiety disorders
Stressor acting on a personality predisposed to the disorder by a combination of genetic factors and environmental influences in childhood.
Management of generalised anxiety disorders
Counselling, relaxation training, medication (sedatives or antidepressants), CBT
CBT generalised anxiety disorder
Identifying errors, reprocessing and reassessing responsibility are the key elements.
Key features of phobic anxiety disorders
Same symptoms as generalised anxiety disorder but it only occurs in specific circumstances. The patient will behave in a way that avoids these circumstances (phobic avoidance). The sufferer also experiences anxiety if there is a perceived threat of encountering the feared object or situation
Specific phobias
When symptoms of anxiety are produced by an object or a situation the patient is frightened of
Social phobia
Inappropriate anxiety in a situation where a person feels observed or could be criticised (rests, shops, public speaking). Symptoms are of any of the anxiety clusters mentioned but blushing and tremor can predominate.
Management of social phobia
CBT addressing the groundless fear of criticism, education and advice, SSRI antidepressants
Core features of Obsessive Compulsive Disorder
Experience of recurrent obsessional thoughts or complusive acts.
Obsessive 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
These are stereotypical behaviours repeated again and again. They are often viewed by the sufferer as preventing some harm to self or others. Viewed as pointless and resisted but key anxiety symptoms arise when resistance occurs.
Epidemiology of OCD
yearly prevalence is 2%
Aetiological theory of OCD
Genetic (gene coding for 5HT receptors), 5HT function abnormalities
Management of OCD
Education and explanation, SSRI (fluoxetine), clomipramine, CBT (exposure and response prevention), psychosurgery
Post Traumatic Stress Disorder
Delayed and or protracted reaction to a stressor of exceptional severity.
Three key elements to reaction in PTSD
Hyperarousal, re-experiencing phenomena and avoidance of all reminders
Hyperarousal
Persistent anxiety
Irritability
Insomnia
Poor concentration
Re-experiencing phenomena
Flashbacks when awake
Nightmares during sleep
Avoidance
Emotional numbness
Cue avoidance
Recall difficulties
Diminishes interests
Epidemiology of PTSD
1-4% prevelance women suffer 2:1
Vulnerability factors for PTSD
Mood disorder
Previous trauma especially as child
Lack of social support
Female
Management of PTSD
Survivors of disasters screened at one month
Mild symptoms “watchful waiting” and review further month
Trauma-focused CBT if more severe symptoms
Eye Movement Desensitisation and Reprocessing
Risk of dependence with any sedatives but patient may prefer medication SSRI or TCA
