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Anxiety Disorders Flashcards

1
Q

Anxiety

A

Universal, functional & normal emotional state everyone experiences
Disorders are diagnosed when the anxiety has a significant impact on a persons day to day functioning
On a continuum, both normal emotion & diagnosable disorder

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2
Q

Anxiety vs Fear

A

Anxiety; -ve mood state, bodily symptoms of physical tension & apprehension about future
Can be good in small amounts

Fear; immediate alarm reaction to danger
Can protect us

Evidence that anxiety & fear differ in psychological & physiological processes

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3
Q

Panic attack

A

Fear occurring at inappropriate time
Surge of intense fear of discomfort that reaches a peak within minutes
Physical symptoms

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4
Q

Precipitants (causes) of anxiety disorders

A 
External & internal triggers 
PTSD; life-threatening 
Adjustment disorder; stressful life change 
Phobia; feared situation/object 
GAD; the world, chronic apprehension
PD; intense autonomic symptoms 
OCD; intrusive thoughts, imagined harm
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5
Q

Co-morbidity

A

Very high rates of co-occurring anxiety disorders
All share same features of anxiety, fear & panic
Share same biological & psychological vulnerabilities
Differ in terms of trigger & in some cases pattern of attacks

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6
Q

Shared vulnerabilities

A

Biological; heritable contribution to negative affect
Specific psychological; e.g. physical sensations are potentially dangerous
Generalised psychological; sense that events are uncontrollable/unpredictable

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7
Q

Genetic contribution

A

heritability of tendency to panic or be tense/uptight/anxious, complex trait, combination with stress= vulnerability

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8
Q

Neurochemical contribution

A

Reduced GABA activity produces anxiety in animal models
Drugs with increase GABA function are anxiolytic
Noradrenaline in Locus Coereleus may be important in panic disorder
Antidepressants with affect noradrenaline are helpful
OCD may involve serotonin imbalance
SSRI antidepressants may help patients

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9
Q

Behavioural Inhibition System

A

Anti-anxiety drugs
Conflict generation; signals of punishment, signals of non-reward, novel stimuli & inmate fear stimuli
Conflict resolution; behavioural inhibition, increased arousal & increased attention

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10
Q

Threat system

A

Fight or flight

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11
Q

Psychological factors

A

Anxiety: sense of control or uncontrollability, role of early childhood & parental style

Panic; conditioning, external & internal cues

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12
Q

Lifetime prevelance of anxiety & OCD related disorders

A 
Any anxiety disorder; 28.8%
Panic disorder; 4.7%
Agoraphobia w/o panic; 1.4%
Specific phobia; 12.5%
Social phobia; 12.1%
GAD; 5.7%
PTSD; 6.8%
OCD; 1.6%
Separation anxiety disorder; 5.2%
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13
Q

Generalised Anxiety Disorder symptoms

A

Physical; over-awareness of autonomic activity, gastrointestinal, respiratory, cardiovascular, genito-urinary, CNS changes, muscle tension

Psychological; fearful anticipation, irritability, lack of concentration, sensitivity to noise, restlessness, insomnia & loss of libido

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14
Q

Diagnosis of GAD

A

Excessive anxiety & worry occurring more days than not for atleast 6 months
Atleast 3 other symptoms
Clinically significant distress or impairment in social, occupational or other important areas of functioning
Disturbance not due to direct physiological effects of substance/condition or other disorder

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15
Q

Integrative model of GAD

A

Generalised psychological/biological vulnerability -> stress -> anxious apprehension -> worry process -> GAD

Worry process; avoidance of imagery -> restricted autonomic response OR intense cognitive processing -> inadequate problem-solving skills

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16
Q

GAD CBT treatment

A

Reinterpret ambiguous stimuli

Likelihood of negative event

Exposure

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17
Q

What is Panic Disorder?

A

Recurrent episodes of sudden, inexplicable & overwhelming apprehension
Sudden onset of attacks lasting approximately 10 minutes
Shortness & severity distinguish it from other anxiety disorders
Unexpected; spontaneous
Expected (cued); can identify trigger event

18
Q

Symptoms of panic disorder

A

Emotion: extreme terror, sense of impending doom
Physical: swearing, palpitations, dizziness
Cognitive; catastrophic misinterpretation

19
Q

Prevelance of Panic disorder

A

Lifetime incidence; 4.7%
Higher concordance for MZ twins
30% of close relatives of individuals with PD also experience it

20
Q

Panic Disorder diagnosis

A

Recurrent unexpected panic attacks
Absence of agoraphobia
Not due to substance, medication or other disorder e.g. social phobia
Atleast one attack has been following by 1 month of; persistent concern about additional attacks, worry about implications of attack or significant change in behaviour related to attacks

21
Q

Agoraphobia

A

Fear of entering unfamiliar situations
Anxious when away from home, in crowds & situations they cannot leave easily
Generally same symptoms as other anxiety disorder
Other symptoms e.g. depression, de-personalisation & obsessive thoughts more common than with other disorders

22
Q

Agoraphobia prevelance

A

Most common phobia (50-80% of phobic cases)

Women 2x as likely to suffer

23
Q

Diagnosing agoraphobia

A

Marked fear or anxiety about 2 or more agoraphobic stimuli
Due to thoughts they may start to panic or not escape
Fear out of proportion to actual danger
Lasts 6 months or more
Significant distress or impairment in important areas of functioning
Not better explaining by other disorder

24
Q

Nocturnal panic

A

60% who have panic attacks have nocturnal ones
EEG shows they occur in deepest stage of sleep, link to anxiety around letting go
Isolated sleep paralysis; occurs just before waking or going to sleep, more prevalent in African Americans, link to PTSD

26
Model of panic disorder w or w/o agoraphobia
1) Generalised psychological/biological vulnerability 2) Stress 3) False or learned alarm 4) Specific psychological vulnerability 5) Anxious apprehension 6) Panic disorder
27
Cognitive model of panic
1) trigger (external or internal) 2) threat perceived 3) anxiety symptoms (catastrophic misinterpretation) & body or mental symptoms
28
Panic disorder CBT treatment
Reinterpret bodily symptoms Exposure
30
Phobia
Irrational fear Same core symptoms of GAD but only occur in specific situations or in response to specific stimuli Typically a persistent & disproportionate fear of something that presents little or no danger Individual avoids circumstances that provoke anxiety Experience anticipatory anxiety prior to situation
31
Specific phobia diagnosis
Marked fear/anxiety about specific object/stimuli Lasting at least 6 months Phobic stimulus almost always provokes immediate fear/anxiety & is avoided or endured with intense fear/anxiety Fear/anxiety out of proportion to danger Clinically significant distress or impairment in important areas of functioning Not better explained by another disorder
32
Types of phobia
4 major subtypes; blood-injection, situational, natural environment & animal type Differences in response to feared stimuli People often have several phobias Never have panic attack outside of context of their phobic object
33
Phobia prevelance
4:1 Female;male ratio | Around 30% of first degree relatives have same or similar phobias
34
Social phobia/social anxiety disorder
Fear of situations in which one is exposed to the scrutiny of others Fear that one may do something that will cause humiliation or embarrassment High levels of social withdrawal, isolation & depression Fear of public speaking is a form of SAD Most prevelant next to specific phobia
35
Social anxiety disorder model
1) generalised psychological/biological vulnerability 2) stressor 3) no alarm (but perceived poor social skills), false alarm (associated with social-evaluative situations) or true alarm (due to direct experience) 4) false & true alarm become learned alarms 5) anxious apprehension (& increased self-focused attention) 6) specific psychological vulnerability 7) social anxiety disorder
36
Phobia CBT treatment
1) dispute beliefs about phobic stimuli 2) behavioural experiments 3) exposure
38
OCD & related disorders
OCD previously classed as anxiety disorder In its own class along with; hoarding, trichotillomania, body dysmorphia & excoriation (skin picking) disorder Distressing intrusive thoughts (obsessions) about potential for harm to self or others & unwanted repetitive safety behaviours to prevent something bad happening In OCD behaviour leads to distress I’m OC personality individuals enjoy behaviours No external cues; urges arise from within person
39
OCD & related disorders cognitive & motor patterns
``` Obsessions Ruminations Cognitive rituals Compulsive motor rituals Compulsive avoidances 4 main compulsion categories; counting, checking, cleaning & avoidance ```
40
OCD & related disorders prevelance
1-3% incidence No gender differences Genetic predisposition; incidence of 5-7% in people who’s parents had OCD
41
OCD diagnosis
Presence of obsessions and/or compulsions Time-consuming (>1hr a day) or cause clinically significant distress or impairment in important areas of functioning Disturbance not due to substance, medication or another mental disorder
42
OCD model
1) generalised psychological/biological vulnerability 2) stress due to life events 3) intrusive thoughts, images or impulses 4) specific psychological vulnerability 5) anxious apprehension OR false alarm (associated with unacceptable thoughts) becoming a learned alarm & resulting in anxious apprehension 6) cognitive or behavioural rituals to neutralise or suppress thoughts 7) OCD
43
Treatment for anxiety disorders
Drug treatments often no more effective than placebo CBT; aims to change the misperceptions or irrational beliefs If moderate or severe depression is present, just treat the depression

Mental Health & Disorder (9 decks)

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