Anxiety Disorders Flashcards
How common are anxiety disorders?
6.6% for generalised anxiety disorder
What is the M:F for anxiety disorders in the UK?
1:2 M:F
Describe the mechanism for anxiety disorders
Normal reaction: Fear due to stimulus -> arousal -> fight or flight reaction
Anxiety causes unthreatening situations to trigger fear -> unnecessary reconditioning to fear harmless situations, leading to avoidant behaviours.
What 3 systems do we process events with? How does this tie in with anxiety?
Thoughts
Feelings
Behaviours
Understanding how they interact can help understand anxiety and aid treatment
What are the symptoms of anxiety?
Racing thoughts
Sympathetic NS arousal eg increased HR, sweating, dry mouth
Inability to concentrate
Cognitive bias
What is cognitive bias?
A mistake in reasoning/processing causing deviation from norm or rationality in judgement.
Can have attentional focus eg to threat, to illness.
Often maintains anxiety disorders
What can pts develop to prevent anxiety?
Safety behaviours
What are safety behaviours?
Behaviours that a pt develops to make a situation seem safer to them
What is the problem with safety behaviours?
Only help short term as the behaviour reinforces the belief that the situation is dangerous and that the behaviour is the only way to cope with that situation
What anxiety disorders are there?
- phobias
- panic disorders
- generalised anxiety disorder
- social anxiety disorder
- OCD
- body dysmorphic disorder
- PTSD
What is a phobia?
A marked fear of something (specific or simple) with marked avoidance of that object/situation
What do pts with phobias lack?
Ability to be rational about the perceived threat
What is a panic disorder?
Fear of ones own physiological/psychological reactions
What can accompany a panic disorder?
Agoraphobia
With a panic disorder, how do pts perceive physiological/psychological changes?
Signs of impending catastrophe
What can perpetuate the beliefs in panic disorder?
Avoidance of situations that trigger responses
Why can agoraphobia develop with panic disorders?
Pt begins to stay at home in order to avoid these situations and because they feel they have the most control over the environment
What does avoidance in a phobia perpetuate?
The phobia and pattern of avoidance
What does avoidance in a phobia perpetuate?
The phobia and pattern of avoidance
What are the 2 types of worrying?
Type 1 - Everyday worries that everyone gets about day to day things
Type 2 - worrying about worrying
What maintains the worrying in generalised anxiety disorder?
The belief that worrying is good and has got them where they are i.e. they become dependant on worrying
What demographic groups is generalised anxiety disorder common in?
High achievers
Healthcare professionals
What is social anxiety disorder?
Fear of negative evaluation by others
What does this fear in social anxiety disorder lead to?
Avoidance of feared situations, safety behaviours, and “post-mortem”-ing situations afterwards
What can perpetuate the situation in social anxiety disorder?
Avoidant behaviours of the pt draw attention to them, which is a situation they are afraid of
Define OCD
Anxiety disorder in which recurrent obsessional thoughts or compulsive acts which are invariably distressing to the patient
What are some common intrusive thoughts?
Being contaminated, causing harm, behaving inappropriately/against personal belief set
What are some common compulsions?
Washing Checking (gas, lights etc) Flicking switches Ordering/aligning Praying Counting Repeating words
What is body dysmorphic disorder?
A psychological disorder in which a person becomes obsessed with imaginary defects in their appearance
Define PTSD
A mental health condition that’s triggered by a terrifying event — either experiencing it or witnessing it.
What are the 3 main features of PTSD?
Re-experiencing
Avoidance or rumination
Hyperarousal
What symptoms do people with PTSD experience?
Flashbacks Nightmares Severe anxiety Uncontrollable thoughts about the event Difficulty adjusting/coping
How can PTSD be treated?
Screening for it in at risk groups iver very valuable.
Psychotherapy - CBT and group therapy
Medication such as antidepressants
Eye-movement desensitisation and reprocessing with stress management.
How can PTSD be treated?
Psychotherapy - CBT and group therapy
Medication such as antidepressants
Which groups in society are at higher risk of PTSD?
- People who have experienced sexual assault or abuse
- Refugees/asylum seekers
- First responders
- Military personnel
- PMHx of psychiatric disorders
What risk factors for military personnel increases the risk for PTSD?
- Duration of combat exposure
- Low morale
- Poor social support
- Unmarried
- Low educational attainment
- Hx of childhood adversity
How might PTSD re-experiencing manifest?
- Flashbacks
- Nightmares
- Distressing images or sensory impressions intruding during waking hours
- Reminders provoking distress
What symptoms do patients with PTSD experience if they exhibit avoidance or rumination?
Ask themselves or others:
- Why me?
- Coud it have been prevented?
- How can I take revenge?
How might hyperarousal manifest in a patient with PTSD?
- Hypervigilant for threat
- Startle easy
- Irritable
- Poor concentration
- Sleep problems
- Difficulty with emotions
- Feeling detached
- Amnesia around trauma
What complications can a person wit PTSD have?
- Depression
- Drug or alcohol abuse
- Unexplained medical symptoms
Which demographic group present much differently with PTSD?
Why?
Children - limited verbal skills and different means of responding to stress.
Much more likely to experience stress dreams, sleep disturbance, behavioural difficulties, and re-enacting experience in joyless play.
What are compulsions?
Repetitive behaviours or mental acts that the person feels driven to perform.
Give an example of a complusion.
- Checking the door is locked
- Checking the gas is off
- Repeating phrases in their head
Which very common state can act as a stressor/trigger for OCD?
Pregnancy or the post-natal period
How long should symptoms be present for in a diagnosis of OCD?
2 weeks or more
What is important to establish about obsessions and compulsions in OCD?
They originate in th emind of the patient and not imposed by outside persons or influences
With a patient with OCD, what do we need to check about their symptoms impact on their life?
Exactly how severe the impact is on their bility to function day to day.
What is the first line intervention recommended for OCD?
Psychological intervention e.g. CBT with exposure and response prevention
If a patient has severe functional impairment due to OCD, what mnagement should be offered?
High-intensity psychological therapy + SSRI
