Anxiety Disorders Flashcards
What are the 3 models of stress?
- Biomechanical “Engineering”
- Medicophysiological
- Psychological (Transactional)
What is the psychological model of stress?
An individual’s reaction to stress will depend on a balance between their cognitive processing of any perceived threat and perceived ability to cope
What are the types of coping?
- Problem focussed
- Emotion focussed
What is problem focussed coping?
-Where efforts are directed toward modifying stressor. -Preparation, studying or interview practice
What is emotion focussed coping?
- Modify emotional reaction. Mental defence mechanisms eg Denial. Relaxation training
- Take a sedative drug.
How are our physiological and psychological reactions to stress elicited?
- Stressor leads to release of corticotropin releasing hormone
- Adrenocorticotropic hormone and prolactin and growth hormone release
- Glucocorticoid, noradrenaline and adrenaline release
- Release of cytokines into the blood and hardwiring of sympathetic innervation
What are the symptoms groups of the fight or flight response?
- Psychological arousal
- Autonomic arousal
- Muscle tension
- Hyperventilation
- Sleep disturbance
What is the Yerkes Dodson curve of stress performance connection?
As stress increases so to does performance until stress becomes too much and performance declines
What psychological arousal can be produced by stress?
- Fearful Anticipation
- Irritability
- Sensitivity to noise
- Poor concentration
- Worrying Thoughts
How can stress affect the GIT?
- Dry mouth
- Swallowing difficulties
- Dyspepsia, nausea and wind
- Frequent loose motions
How can stress affect the respiratory system?
- Tight chest
- Difficulty inhaling
How can stress affect the cardiovascular system?
- Palpitations/ missed beats
- Chest pains
How can stress affect the genitourinary system?
- Frequent/ urgency of micturition
- Amenorrhoea/ dysmenorrhoea
- Erectile dysfunction
How can stress affect the CNS?
- Dizziness
- Sweating
How can muscle tension associated with stress manifest??
- Tremor
- Headache
- Muscle pain
How can hyperventilation associated with stress manifest?
- Causing CO2 deficit: hypocapnia
- Numbness tingling in extremeities may lead to carpopedal spasm
- Breathlessness
How can sleep disturbance associated with stress manifest?
- Initial insomnia
- Frequent waking
- Nightmares and night terrors
How are anxiety disorders characterised?
ICD10 F40-F48
How do phobias and GAD differ?
They have the same core anxiety symptoms but phobias occur in particular circumstances and GAD occurs persistently
What symptoms are associated with GAD?
- Persistent (several months) symptoms not confined to a situation or object.
- All the symptoms of human anxiety mentioned earlier can occur including: Psychological arousal, Autonomic Arousal, Muscle Tension, Hyperventilation, Sleep Disturbance
What is the differential diagnosis for anxiety disorder?
Psychiatric Conditions
- Depression
- Schizophrenia
- Dementia
- Substance Misuse
Physical Conditions
- Thyrotoxicosis
- Phaeochromoctoma
- Hypoglycaemia
- Asthma and or Arrhythmias
What is the epidemiology of GAD?
- One year prevalence around 4.4% in England
- More women affected than men (nb cultural factors and diagnosis of alcohol use)
What is the aetiology of GAD?
- No clear line between anxiety and anxiety disorders. They differ in extent and duration
- In general terms GAD for instance is caused by a stressor acting on a personality predisposed to the disorder by a combination of genetic factors and environmental influences in childhood
How are GAD managed?
Counselling
- Clear Plan of -Management
- Explanation and education
- Advice re caffeine, alcohol, exercise etc.
Relaxation training
- Group or individual
- DVDs, tapes or clinician led
Medication
- Sedatives have high risk dependency
- Antidepressants SSRI or TCA
Cognitive Behavioural Therapy
How is CBT used in anxiety disorders?
- Our emotional response to a situation will depend on our cognitive processing of it.
- Identifying errors, reprocessing and reassessing responsibility are key elements
- Patients tend to find this intuitively sensible
- Maintaining remission appears superior to drug therapy
What are the key features of phobic anxiety disorders?
- Same core anxiety features as GAD
- 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 or situation “anticipatory anxiety”
What are the 3 clinically important phobic anxiety syndromes?
- Specific phobias
- Social phobia
- Agoraphobia
What is social phobia?
- Inappropriate anxiety in situation where person feels observed or could be criticised including restaurants, shops or any queues and public speaking
- Symptoms are any of the anxiety cluster mentioned above but blushing and tremor predominate
How is social phobia managed?
Cognitive Behavioural Therapy addressing the groundless fear of criticism. CBT challenges
- Negative views of self
- “Safety barriers”
- Unrealistically high standards
- Excessive self monitoring
Education and advice
Medication SSRI antidepressants
What are the core features of OCD?
- Recurrent obsessional thoughts
- Compulsive acts
What are the features of obsessional thoughts associated with OCD?
- Ideas, imaged or impulses
- Occurring repeatedly, not willed
- Unpleasant and distressing (often the antithesis of personality type)
- Recognised as the individual’s own thoughts
- Usual key anxiety, symptoms arise because of distress of the thoughts or attempts to resist
What are the features of compulsive acts or rituals associated with OCD?
- Stereotypical behaviours repeated again and again
- Not enjoyable
- Not helpful i.e. do not result in useful activity
- Often viewed by sufferer as preventing some harm to self or others or are viewed as pointless and resisted with key anxiety symptoms accompanying resistance
What is the epidemiology of OCD?
- Overall one year prevalence is 2%
- Equally affects men and women
What are the aetiological theories for OCD?
- Genetic e.g. gene coding for 5HT receptors
- 5 HT function abnormalities
How is OCD managed?
General measures
- Education and explanation
- Involve partner/family
Serotonergic Drugs
- SSRI eg Fluoxetine
- Clomipramine
Cognitive Behavioural Therapy (CBT)
- Exposure and response prevention
- Examination of evidence to weaken convictions
Psychosurgery
What is PTSD?
“Delayed and or protracted reaction to a stressor of exceptional severity” (would distress anyone)
- Combat
- Natural or human-caused disaster
- Rape
- Assault
- Torture
- Witnessing any of the above
What are the 3 key elements to PTSD reaction?
- Hyperarousal
- Re-experiencing phenomena
- Avoidance of reminders
What can occur due to hyperarousal in PTSD?
- Persistent anxiety
- Irritability
- Insomnia
- Poor concentration
What can occur during re-experiencing phenomena in PTSD?
Intense intrusive images
- Flashbacks when awake
- Nightmare during sleep
What can occur due to avoidance of reminders in PTSD?
- Emotional numbness
- Cue avoidance
- Recall difficulties
- Diminishes interests
What is the epidemiology of PTSD?
- Much of the population data comes from the USA
- Variable cultural factors and exposure to disaster lead to a variable prevalence, 1-4% one year prevalence
- Women sufferers outnumber men 2 to 1 in USA
What is the aetiology of PTSD?
- Nature of stressor: life threatening and degree of exposure generally confers greater risk
- Susceptibility partly genetic
What vulnerability and protective factors influence the nature of a stressor in PTSD?
Vulnerability factors
- Mood disorder
- Previous trauma especially as child
- Lack of social support
- Female
Protective factors
- Higher education and social group
- Good paternal relationship
How is PTSD managed?
- NICE guidance ww.nice.org.uk
- Survivors of disasters screened at one month
- Mild symptoms “watchful waiting” and review further month
- Trauma-focused CBT if more severe symptoms
- Eye Movement Desensitisation and Reprocessing
- Risk of dependence with any sedatives but patient may prefer medication SSRI or TCA
