Anxiety Disorders Flashcards
Models of stress
Biomechanical “engineering” - someone can only take so much stress and eventually reaches breaking point
Medicophysicolegal - event causes stress -> stress response -> physiological adaptation to stressor, prolonged exposure -> exhaustion
Psychological - transactional
Features of psychological stress model
Interactive
An individual’s reaction to stress will depend on balance between their cognitive processing of any perceived threat and perceived ability to cope
Types of coping
Problem focused - where efforts are directed toward modifying a stressor, preparation, studying etc.
Emotion focused - modify emotional reaction, mental defence mechanism e.g. denial, relaxation training
Symptoms groups of anxiety
Psychological arousal Autonomic arousal Muscle tension Hyperventilation Sleep disturbance
Symptoms oa psychological arousal
Fearful anticipation Irritability Sensitivity to noise Poor concentration Worrying thoughts
GI symptoms of autonomic arousal
Dry mouth
Difficulty swallowing
Dyspepsia, nausea, wind
Frequent loose stools
Respiratory symptoms of autonomic arousal
Tight chest
Difficulty breathing
CVS symptoms of autonomic arousal
Palpitations
Missed beats
Chest pain
GU symptoms of autonomic arousal
Frequency/urgency of micturition
Amenorrhoea/dysmenorrhoea
Erectile failure
CNS symptoms of autonomic arousal
Dizziness
Sweating
Muscle tension symptoms
Tremor
Headache
Muscle pain
Hyperventilation symptoms
O2 deficit hypocapnia
Numbness/tingling in extremities, may lead to carpopedal sapsms
Breathlessness
Sleep disturbance symptoms
Initial insomnia
Frequent wakening
Nightmares and night terrors
What are phobic and general anxiety disorders?
Both have the same core anxiety symptoms but they either occur in particular circumstances e.g. phobias or occur persistently e.g. generalised anxiety disorder
Features of generalised anxiety disorder
Persistent (several months) of symptoms, not confined to a situation or object
All of the symptoms of human anxiety can occur
Differential diagnoses for anxiety
Psychiatric
- depression
- schizophrenia
- dementia
- substance misuse
Physical
- thyrotoxicosis
- phaeochromocytoma
- hypoglycaemia
- asthma/arrhythmias
Epidemiology of GAD
One year prevalence around 3% in US
Women > men
Aetiology of GAD
No clear line between normal anxiety and anxiety disorders
In general terms, GAD is caused by a stressor acting on a personality predisposed to the disorder by a combination of genetic factors and environmental influences in childhood
Management of GAD
Counselling
- clear plan of management
- explanation and education
- advice re caffeine, alcohol, exercise etc.
Relaxation training
- group or individual
- DVDs/tapes/clinical led
Medication
- sedatives high risk dependency so not recommended
- antidepressants can successfully treat - SSRI or TCA
Cognitive behavioural therapy
- identifying errors, reprocessing and reassessing responsibility
Features of phobic anxiety disorders
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/situation - anticipatory anxiety
What are the clinical important syndromes of anxiety disorders?
Specific phobias
Social phobias
Agoraphobia
Features of social phobia
Inappropriate anxiety in a situation where a person feels observed or could be criticised e.g. restaurants, shops, queues
Symptoms are any of the anxiety cluster, but blushing and tremor predominate
Management of social phobia
CBT addressing the groundless fear of criticism
Education and advice
Medication - SSRI
What does CBT challenge?
Negative views of self
Safety barriers
Unrealistically high standards
Excessive self-monitoring
Core features of obsessive compulsive disorder
Experience of recurrent obsessional thoughts and/or compulsive acts
Features of obsessional thoughts
Ideas, images or impulses
Occurring repeatedly, not willed
Unpleasant and distressing e.g. obscene, violent
Recognised as the individual’s own thoughts
Usual key anxiety symptoms arise because of distress of the thoughts or attempts to resist
Features of compulsive acts or rituals
Stereotypical behaviours repeated again and again
Not enjoyable
Not helpful
Often viewed by sufferer as preventing some harm to self or others or viewed as pointless and resisted with key anxiety symptoms accompanying resistance
Epidemiology of OCD
2% overall one year prevalence
M = F
Aetiology of OCD
Genetic e.g. gene coding for 5HT receptors
5HT function abnormalities
Management of OCD
Good history and MSE, exclude treatable depressive illness
General measures - education and explanation, involve partner/family
Serotonergic drugs e.g. fluoxetine, clomipramene
CBT - exposure and response prevention
Psychosurgery - very rare circumstances
What is post-traumatic stress disorder?
Delayed and/or protracted reaction to a stressor of exceptional severity
Causes of PTSD
Combat Natural or man-made disaster Rape Assault Torture Witnessing of the above
What are the 3 key elements to reaction causing PTSD?
Hyperarousal
Re-experiencing phenomena
Avoidance of reminders
Features of hyperarousal
Persistent anxiety
Irritability
Insomnia
Poor concentration
Causes of re-experiencing phenomena
Intense intrusive images
Flashbacks when awake
Nightmares
Features of avoidance
Emotional numbness - anhedonia, avoidance of activities/situations
Cue avoidance
Recall difficulties
Diminished interests
Prevalence of PTSD
1-4% one year prevalence
Aetiology of PTSD
Depends on nature of stressor - life-threatening and degree of exposure generally confers greater risk
Susceptibility is partly genetic
What are the vulnerability factors of PTSD?
Mood disorder
Previous trauma, especially as a child
Lack of social support
Female
What are the protective factors of PTSD?
Higher education and social group
Good paternal relationship
Management of PTSD
NICE Guidance
Survivors of disasters screened at one months
Mild symptoms - watchful waiting and review at one further month
Trauma-focussed CBT if more severe symptoms
Eye movement desensitisation and reprocessing
Risk of dependence with any sedatives but patients may prefer medication - SSRI, TCA
