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Systems: Psychiatry AB > Anxiety Disorders > Flashcards

Anxiety Disorders Flashcards

1
Q

What are the 3 models of stress?

A
  • Biomechanical “Engineering”
  • Medicophysiological
  • Psychological (Transactional)
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2
Q

What is the psychological model of stress?

A

An individual’s reaction to stress will depend on a balance between their cognitive processing of any perceived threat and perceived ability to cope

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3
Q

What are the types of coping?

A
  • Problem focussed

- Emotion focussed

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4
Q

What is problem focussed coping?

A

-Where efforts are directed toward modifying stressor. -Preparation, studying or interview practice

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5
Q

What is emotion focussed coping?

A
  • Modify emotional reaction. Mental defence mechanisms eg Denial. Relaxation training
  • Take a sedative drug.
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6
Q

How are our physiological and psychological reactions to stress elicited?

A
  • 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
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7
Q

What are the symptoms groups of the fight or flight response?

A
  • Psychological arousal
  • Autonomic arousal
  • Muscle tension
  • Hyperventilation
  • Sleep disturbance
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8
Q

What is the Yerkes Dodson curve of stress performance connection?

A

As stress increases so to does performance until stress becomes too much and performance declines

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9
Q

What psychological arousal can be produced by stress?

A
  • Fearful Anticipation
  • Irritability
  • Sensitivity to noise
  • Poor concentration
  • Worrying Thoughts
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10
Q

How can stress affect the GIT?

A
  • Dry mouth
  • Swallowing difficulties
  • Dyspepsia, nausea and wind
  • Frequent loose motions
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11
Q

How can stress affect the respiratory system?

A
  • Tight chest

- Difficulty inhaling

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12
Q

How can stress affect the cardiovascular system?

A
  • Palpitations/ missed beats

- Chest pains

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13
Q

How can stress affect the genitourinary system?

A
  • Frequent/ urgency of micturition
  • Amenorrhoea/ dysmenorrhoea
  • Erectile dysfunction
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14
Q

How can stress affect the CNS?

A
  • Dizziness

- Sweating

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15
Q

How can muscle tension associated with stress manifest??

A
  • Tremor
  • Headache
  • Muscle pain
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16
Q

How can hyperventilation associated with stress manifest?

A
  • Causing CO2 deficit: hypocapnia
  • Numbness tingling in extremeities may lead to carpopedal spasm
  • Breathlessness
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17
Q

How can sleep disturbance associated with stress manifest?

A
  • Initial insomnia
  • Frequent waking
  • Nightmares and night terrors
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18
Q

How are anxiety disorders characterised?

A

ICD10 F40-F48

19
Q

How do phobias and GAD differ?

A

They have the same core anxiety symptoms but phobias occur in particular circumstances and GAD occurs persistently

20
Q

What symptoms are associated with GAD?

A
  • 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
21
Q

What is the differential diagnosis for anxiety disorder?

A

Psychiatric Conditions

  • Depression
  • Schizophrenia
  • Dementia
  • Substance Misuse

Physical Conditions

  • Thyrotoxicosis
  • Phaeochromoctoma
  • Hypoglycaemia
  • Asthma and or Arrhythmias
22
Q

What is the epidemiology of GAD?

A
  • One year prevalence around 4.4% in England

- More women affected than men (nb cultural factors and diagnosis of alcohol use)

23
Q

What is the aetiology of GAD?

A
  • 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
24
Q

How are GAD managed?

A

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

25
Q

How is CBT used in anxiety disorders?

A
  • 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
26
Q

What are the key features of phobic anxiety disorders?

A
  • 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”
27
Q

What are the 3 clinically important phobic anxiety syndromes?

A
  • Specific phobias
  • Social phobia
  • Agoraphobia
28
Q

What is social phobia?

A
  • 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
29
Q

How is social phobia managed?

A

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

30
Q

What are the core features of OCD?

A
  • Recurrent obsessional thoughts

- Compulsive acts

31
Q

What are the features of obsessional thoughts associated with OCD?

A
  • 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
32
Q

What are the features of compulsive acts or rituals associated with OCD?

A
  • 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
33
Q

What is the epidemiology of OCD?

A
  • Overall one year prevalence is 2%

- Equally affects men and women

34
Q

What are the aetiological theories for OCD?

A
  • Genetic e.g. gene coding for 5HT receptors

- 5 HT function abnormalities

35
Q

How is OCD managed?

A

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

36
Q

What is PTSD?

A

“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
37
Q

What are the 3 key elements to PTSD reaction?

A
  • Hyperarousal
  • Re-experiencing phenomena
  • Avoidance of reminders
38
Q

What can occur due to hyperarousal in PTSD?

A
  • Persistent anxiety
  • Irritability
  • Insomnia
  • Poor concentration
39
Q

What can occur during re-experiencing phenomena in PTSD?

A

Intense intrusive images

  • Flashbacks when awake
  • Nightmare during sleep
40
Q

What can occur due to avoidance of reminders in PTSD?

A
  • Emotional numbness
  • Cue avoidance
  • Recall difficulties
  • Diminishes interests
41
Q

What is the epidemiology of PTSD?

A
  • 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
42
Q

What is the aetiology of PTSD?

A
  • Nature of stressor: life threatening and degree of exposure generally confers greater risk
  • Susceptibility partly genetic
43
Q

What vulnerability and protective factors influence the nature of a stressor in PTSD?

A

Vulnerability factors

  • Mood disorder
  • Previous trauma especially as child
  • Lack of social support
  • Female

Protective factors

  • Higher education and social group
  • Good paternal relationship
44
Q

How is PTSD managed?

A
  • 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

Systems: Psychiatry AB (18 decks)

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