Anxiety disorders Flashcards
Which disorder has a higher prevalence in its epidemiology
Anxiety is more common than schizophrenia or bipolar
Three types of stress related and adjustment disorders
- Acute Stress reaction
- Adjustment disorder
- PTSD
Clinical picture of acute stress reaction
- acute stress reaction lasts hours to 3 days
- a response to exceptionally stressful events (physical/psychological)
- Initial daze
- mixed and usually changing picture
- individual vulnerability
Typical symptoms of acute stress
Feelings of being numb or dazed Insomnia Restlessness Poor concentration Autonomic arousal Anger/Anxiety/Depression Withdrawal
Adjustment disorder
Wide range of emotional or behavioural symptoms
Stressor not necessarily life threatening
Out of proportion to stressor
Lasts up to 6 months
PTSD
Response to exceptionally threatening or catastrophic event
Experienced, witnessed, event tat involved actual or threatened death or serious injury or threat to physical integrity of self or others
Response involved intense fear, helplessness or horror
PTSD Symptoms
Reexperiencing flashbacks/nightmares with the same emotional intensity which retraumatises them Numbness/detachment Avoidance Hypervigilance/detachment Insomnia Anxiety/depression
PTSD stats
> 50% experience a traumatic event in life
Men experience more traumatic events than women
Women more likely to develop PTSD following trauma (except rape- men are more traumatised by it)
PTSD course
Usually immediate onset Most recover within 1 year Rape victims - 94% at 2 weeks - 65% at 1 month - 42% at 6 months
Generalised Anxiety disorders: Clinical picture
Symptoms are persistent
Symptoms are not restricted to or strongly predominating in any particular set of circumstances
Characteristic features:
- Worry and apprehension
- Headache and motor tension (restless/trembling)
- Autonomic hyperactivity (sweating/palpitations/dry mouth/epigastric discomfort/dizziness)
Psychological symptoms of GAD
Fearful anticipation (something bad is going to happen) Irritability Sensitivity to noise Restlessness Poor concentration Worrying thoughts
Physical symptoms of GAD
GI: Dry mouth, difficulty swallowing, epigastric discomfort, excessive wind, frequent/loose motions
Respiratory: tight chest, difficulty inhaling, hyperventilation
CVS: Palpitations, chest pain, missed beats
Genitourinary: frequent/urgent micturition, erectile failure, dysmenorrhoea, amenorrhoea
Neuromuscular: tremor, paraesthesia, tinnitus, dizziness, headaches, muscular aches and pains
Additional symptoms of GAD
Sleep disturbances (insomnia, night terrors)
Sadness
Depersonalisation
Fixation with details
Epidemiology of GAD
Lifetime prevalence: 8.9%
Women> men
Estimated to be 3x higher in patients in primary care clinics
High level of comorbidity especially simple phobias, social phobia, panic disorder and depression
Aetiology of GAD
Genetic predisposition: modest role
Association with life events: Several studies found an association with stressful/traumatic events
Early environmental factors: Attachment theory (Caregivers play an important role in childs development. Disruption of the protective and secure base leads to withdrawal and depression)
Parenting in the aetiology of GAD
A healthy parent-child relationship fosters a sense of control over events (Responsiveness to childs efforts at engagement and encouragement of the child to explore and manipulate the environment).
A lack of warmth and encouragement leads to a general perception of personal inefficacy which may predispose to negative emotional states
Overprotection coupled with a lack of warmth and responsiveness toward the child could lead to anxiety
Mothers of anxious preschool children were (more critical and intrusive, less responsive to their children)
Compared to controls, adults who rated their parenting as more protective and less caring had higher trait anxiety scores and met more criteria for GAD and panic disorder
One hypothesis is that the relationship of these early parenting experiences to the subsequent development of anxiety or depression if mediated by the early formation of cognitive vulnerability best described as a sense of uncontrollability regarding future events in ones life
Clinical picture of panic
Psychic: fear of losing control, going mad, fainting, dying, derealisation, depersonalisation
Somatic: palpitations, tachycardia, sweating, trembling, dyspnoea, choking, chest pain, nausea, butterflies, urgency, dizziness, faintness, parasthesia, chills/flushes
Panic Ddx
Endocrine (Hypoglycaemia, Phaecromocytoma, carcinoid) Cardiovascular (arrythmia) Respiratory (asthma) Drugs Neurological (seizures, vestibular)
Clinical picture of agoraphobia
- Anxiety in specific context (away from home, in crowds, in situations they cannot easily leave)
Presents with anxiety symptoms and panic attacks
Anxious cognitions about fainting and loss of control are common
Avoidance is common
Epidemiology of panic
Panic attacks 7-9% of the population
Panic disorder: 1.5-2.5% lifetime prevalence
Onset has two peaks: 15-24 and 45-54
Aetiology of panic
Genetic predisposition: modest inheritability suggested by family and twin studies.
Environmental factors: At least 50% encironmental influences (precipitating events in 60-96% of cases eg separation/loss/relationship difficulties/ new responsibilities. Traumatic early life events eg early parental separation, traumatic childood and early sexual abuse)
Biological models:
Panic attacks may be triggered in the locus coeruleus (increased firing associated with increased carbon dioxide). Noradrenargic agents stimulate attacks in sufferers.
SSRIs are effective but contradictory findings regarding the role of serotonin
GABA has a role (benzodiazepine agonists are clearly effective and antagonists aggravate attacks)
CCK causes panic attacks in animals and pentagastrin causes attacks in panic disorder patients
Clinical picture of specific phobias
inappropriate anxiety in the presence of one or more particular objects or situations
Characterised by additing the name of the stimulus
Subtypes:
- blood, injection, injury
- animals and insects
- aspects of the natural environment
- situational
- other eg dental/medical procedures/choking
Specific phobias responses
Individuals with blood-injection-injury phobias exhibit a biphasic anxiety reaction:
- initial short-lived sympathetic arousal
- followed by parasympathetic arousal
- may result in vasovagal syncope
- the subjective experience tends to disgust and repulsion rather than pure apprehension
In other subtypes, exposure to the phobic stimulus evokes intense anxiety that may meet the criteria for a situationally bound panic attack
There is extreme apprehension and desire to escape or avoid the phobic stimulus
Aetiology of specific phobias
Genetics: all specific phobias have evidence for genetic transmission
Psychological theories:
- Psychoanalytic approach: symptoms related to unresolved unconscious conflicts
- classical conditioning: phobias are learned through association of negative experience with an object or situation
- Marks preparedness theory maintains that commonly feared objects are ones that historically threatened the survival of the individual or the species.
- large number of studies suggest that phobias may be acquired via observational learning
Clinical picture of social phobia
Inappropriate anxiety in
- situations where the person is observed
- situations where there is potential for criticism
Leads to avoidance of trigger situations:
- eating in public
- dinner parties
- committees, seminars, public speaking
Symptoms of social phobia
Anticipatory anxiety
Feeling anxious
Blushing
Trembling (observed writing is a problem)
Relieved by alcohol (potential for abuse)
Aetiology of social phobia
Both genetis and environmental factors contribute, with genetics contributing <1/3 of the variance in the transmission. Monozygotic> dizygotic
Clinical picture of OCD
Obsessional thoughts/images - words, ideas, beliefs and images - recognised as own - intrude forcibly into the mind - they are resisted Compulsions reduce anxiety cleaning/checking precision- just right
Epidemiology of OCD
Men- women
During adolescence boys> girls
man age of onset about 20 y o
prevalence 2-3 %
OCD comorbidity
Major depressive episode increased lifetime risk for - alcohol disorders - social phobia - specific phobia - panic disorder - eating disorder - schizophrenia - tic disorders increased prevalence of tourrettes syndrome in relatives
Aetiology of OCF genetics
Monozygotic»»> dizygotic
first degree relatives of patients with childhood-onset OCD have a higher than expected incidence of OCD
