Anxiety Disorders Flashcards
Define Neurosis
The maladaptive psychological symptoms not due to organic causes or psychosis, and usually precipitated by stress.
List the clinical features of generalised anxiety disorder.
Free floating anxiety Depression Fatigue Insomnia Irritability Worry Obsessions Compulsions Somatisation Tension Agitation Feelings of impending doom Poor concentration Butterflies in stomach Hyperventilation (tingling, tinnitus, chest pain) Headache Palpitations Poor appetite Nausea Lump in throat Repetitious thoughts and activities Sweating
List the ways in which GAD can be managed.
Symptom control Regular exercise CBT Progressive relaxation therapy Meditation Medications
Describe how symptom control is used to manage GAD.
Listen to the worries of the patient and explain none of their symptoms are serious and they are not in any psychical harm
Describe how progressive relaxation therapy is used to manage GAD.
Deep breathing using the diaphragm , followed by tensing and relaxation of the muscle groups.
This isn’t a long-term solution
What medications are used to augment psychotherapy in the management of GAD?
1) Benzodiazepines– used for acute episodes of anxiety, for no more than four weeks
2) SSRIs – social anxiety
3) Azapirones – similar to diazepam, but is less addictive and has fewer withdrawal issues
4) Old-style antihistamines
5) Beta-blockers
6) Others – pregabalin and venlafaxine
When is a panic disorder diagnosed?
The patient has more than four panic attacks in a one month period
What are panic attacks?
Periods of sudden onset, uncontrollable anxiety lasting minutes to hours
Symptoms of a panic attack
Somatic symptoms - Sweating - Tachycardia - Palpitations - Tremor - Paraesthesia due to rapid overbreathing Cognitive deficits Patient believes a large misfortune is about to befall them e.g. heart attack
What is a phobia anxiety disorder?
Only provoked in certain situations. The patient has no symptoms so long as the patient avoids the stimulus, thus leading to obsessive avoidance behaviours
How are phobias managed?
Graded introduction to the avoided situations - gradually increasing the level of exposure
What is agoraphbia?
Fear of unfamiliar surrounding with no easy way to ‘escape’ or hide
Usually affects women aged 18-35
What are the typical situations in which a person experiences agoraphobia?
Being a long way from home
Shops – because of having to pay before leaving
Large shops/shopping centres/cinemas
What are compulsions and what are obsessions?
Compulsions
- senseless, repeated rituals
Obsessions
- stereotyped, purposeless words, ideas or phrases that come into the mind
How do obsessions and compulsions in OCD differ from delusional beliefs, hallucinations or thought insertion.
Both obsessions and compulsions are perceived by the patient as nonsensical (differing from delusional beliefs) and originating from themselves (unlike hallucinations or thought insertion).
Give an example of compulsive behaviour and the obsession behind it.
a man who can never do a long walk as he constantly wonders if he remembered to lock the car, and has to return repeatedly to ensure it is locked
How is OCD managed?
Behavioural or cognitive behavioural therapy
Medications
- SSRIs
- Clomipramine
Symptoms of an acute stress reaction.
Fearful, horrified, dazed Helpless, dumb, detached Decreased emotional responsiveness Intrusive thoughts Derealisation Depersonalisation Dissociative amnesia Reliving of events Avoidance of stimuli Hypervigilance Restlessness Autonomic arousal Headache/abdo pains
How is PTSD diagnosed?
When the symptoms of an acute stress reaction become chronic, usually a few months after the incident
What are the signs and symptoms of PTSD?
Difficulty modulation arousal Isolated-avoidant modes of living Alcohol abuse Numb to emotions and relationships Survivors guilt Depression Altered world view in which fate is seen as untameable, capricious or absurd Life can yield no meaning or pleasure Flashbacks
Describe flashbacks experienced in PTSD.
They feel as though they are re-experiencing the event (more vivid a recall than when recalling a memory).
They are seen as intrusive and can occur at any time, usually in response to a trigger; which can lead to avoidance behaviour.
How is PTSD managed?
Eye Movement Desensitisation and Reprocessing
CBT
Drug therapy
- SSRIs and TCAs
- improve positive symptoms of PTSD (e.g. flashbacks, increased arousal)
What is
Eye Movement Desensitisation and Reprocessing?
In PTSD it is thought that the heightened emotions experienced with the traumatic event mean the memory of the event isn’t stored correctly. This causes the re-experience when recalling the memory, rather than remembering. In EMDR the patient moves their eyes in various eye movement patterns (15-30 second bursts), which recalling the memory. This is known as dual-processing, and is thought to help re-process the memory to it can be stored correctly
