Anxiety Disorders Flashcards
name 3 models of stress
biomechanical engineering
medicophysiological
psychological (transactional)
name two ways of coping with psychological stress
problem focussed
emotion focussed
symptom groups of flight or fight response
psychological arousal autonomic arousal muscle tension hyperventilation sleep disturbance
features psychological arousal stress response
fearful anticipation irritability sensitivity to noise poor concentration worrying thoughts
features autonomic arousal stress response - GI
dry mouth, swallowing difficulties, dyspepsia, nausea, wind, frequent loose motions
features autonomic arousal stress response - respiratory
tight chest
difficulty inhaling
features autonomic arousal stress response - CV
palpitations/missed beats
chest pain
features autonomic arousal stress response - GU
frequency
urgency
amenorrhoea/dysmenorrhoea
erectile failure
features autonomic arousal stress response - CNS
dizziness and sweating
features of muscle tension in a stress response
tremor
headache
muscle pain
features of hyperventilation in a stress response
CO2 deficit hypocapnia
numbness and tingling in extremities may lead to carpopedal spasm
breathmessness
features of sleep disturbance in a stress response
initial insomnia
frequent waking
nightmares and night terrors
what is the difference between phobic anxiety disorders and GAD?
same core anxiety symptoms
occur in particular circumstances or persistently
what is agoraphobia?
Agoraphobia is a type of anxiety disorder in which you fear and avoid places or situations that might
cause you to panic and make you feel trapped, helpless or embarrassed.
what is social phobia?
This is inappropriate anxiety in a situation where a person feels observed or could be criticised e.g.
restaurants, shops, queues, public speaking. Symptoms are any of the anxiety cluster but blushing and
tremor predominate.
define GAD
This is a persistent (several months) presence of symptoms that are not confined to a situation or
object. All the symptoms of human anxiety mentioned earlier can occur. Dominant sympoms are
variable but include tremor, palpitations, epigastric pain, worried thoughts, fear, trembling.
list the psychiatric DDx for anxiety
depression
schizophrenia
dementia
substance misuse
list the physical DDx for anxiety
thyrotoxicosis
pheochromocytoma
hypoglycaemia
asthma and or arrhythmias
prevalence of GAD
4.4%
women > men
management of GAD
counselling
relaxation training
medication
CBT
counselling in GAD
clear plan of management
explanation and education
advice re caffeine, alcohol, exercise
relaxation training in GAD
group or individual
DVDs, tapes or clinician led
medication in GAD
SSRI or TCA
define phobic anxiety disorders
Same core features as GAD but only in specific circumstances. The person behaves to avoid these
circumstances i.e. phobic avoidance. The sufferer also experiences anxiety if these is a perceived
threat of encountering the feared object or situation i.e. anticipatory anxiety.
management of social phobia
CBT
SSRI
Education and advice
what are the core features of OCD?
recurrent obsessional thoughts and or compulsive acts
describe obsessional thoughts
ideas, images or impulses
occurring repeatedly not willed
unpleasant and distressing
recognised as the individuals own thoughts
usual key anxiety symptoms arise because of distress of the thoughts or attempts to resist
describe compulsive acts or rituals
sterotypical behaviours repeated again and a again
not enjoyable
not helpful
often viewed by the sufferer as preventing some harm or pointless
what is the prevalence of OCD?
2%
men=women
name the theories of aetiology of OCD
abnormality in gene coding for 5HT receptors and 5HT function abnormalities
management of OCD
education
Serotonergic drugs - SSRI (fluoxetine), clomipramne
CBT
psychosurgery
define PTSD
delayed and or protracted reaction to a stressor of exceptional severity i.e. would distress anyone
to what events may people develop PTSD?
combat natural or human caused disaster rape assault tortue witnessing any
3 key elements of PTSD
hyperarousal
re-experiencing phenomena
avoidance of reminders
hyperarousal in PTSD
persistent anxiety
irritability
insomnia
poor concentration
re-experiencing phenomena in PTSD
intense intrusive images either flashbacks or nightmares
avoidance of reminders in PTSD
emotional numbness
cue avoidance
recall difficulties
diminishes interests
M:F ratio in PTSD
M1:F2
causes of PTSD
• Nature of stressor o Life threatening and degree of exposure generally confers greater risk however § Vulnerability factors • Mood disorder • Previous trauma especially as child • Lack of social support • Female § Protective factors • Higher education and social group • Good paternal relationship • Susceptibility is partly genetic
management of PTSD
- 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
