Anxiety Disorders Flashcards
What does an individual’s response to stress depend on?
Cognitive processing of any perceived threat and perceived ability to cope with threat
What are the two kinds of coping and how do they differ?
Problem focussed - dealing modifying with the stressor
Emotion focussed - modifying emotions towards the stressor, e.g. denial or relaxation therapy
What are the groups of symptoms in anxiety disorders?
Muscle tension - MORE Sleep disturbance - SAD Psychological arousal - PEOPLE Hyperventilation - HAVE Autonomic arousal - ANXIETY
What is the model describing that the right amount of stress is helpful?
Yerkes-Dodson Curve
Too little stress leads to sleep, low alertness etc., too much leads to anxiety and disorganisation
What symptoms are included within the psychological arousal symptom group?
Irritability Sensitivity to noise Poor concentration Fearful anticipation Worrying thoughts
What symptoms are included within the autonomic arousal symptom group?
GI - nausea/loose stools/wind/dyspepsia/dry mouth/difficulty swallowing
Resp - tight chest, difficulty inhaling
CV - palpitations/missed beats/chest pain
GU - urinary frequency/urgency/erectile dysfunction/a/dysmenorrhoea
CNS - dizziness, sweating
What symptoms are included within the muscle tension symptom group?
Tremor
Muscle cramps
Headache
What symptoms are included within the hyperventilation symptom group?
Hypocapnia
Tingling fingers (may lead to carpopedal spasm (intense muscle pain in hands/feet)
Breathlessness
What symptoms are included within the sleep disturbance symptom group?
Initial insomnia
Frequent waking
Night terrors/nightmares
What is the differences between phobic and generalised anxiety?
Same symptoms that occur but GAD occurs persistently and anxiety is not confined to a particular object/situation, whereas phobic anxiety is
What are the three most clinically relevant phobic anxieties?
Agoraphobia
Social phobia
Specific phobias
What is agoraphobia?
Fear of being in situations where escape/seeking help would be difficult
What is social phobia?
Inappropriate anxiety in a situation where the person feels observed/criticised
What are specific phobias?
Intense, persistent fear of a particular object/situation
How do you diagnose GAD?
Persistent (>6m) anxiety symptoms not confined to a situation/object
What are differential diagnoses for anxiety conditions?
Psychiatric - depression, schizophrenia, substance misuse, dementia
Physical - phaeochromocytoma, thyrotoxicosis, asthma/arrhythmias, hypoglycaemia
What is the 1 year prevalence of GAD?
4.4%
Which gender is most affected by GAD?
Woman
What causes GAD?
Caused by a stressor acting on a personality predisposed to the disorder by genetic and environmental influences in childhood
How do you manage GAD?
Counselling - advice (re caffeine, alcohol, exercise), education, planning management
Relaxation training
Medication - sedatives/SSRIs/TCAs
CBT
What are the key features of phobic anxiety?
Same features as GAD but only in specific circumstances
Avoidance of these circumstances = phobic avoidance
Anxiety in perceived threat of encountering object/situation = anticipatory anxiety
What are the main symptoms of social phobia?
Blushing and tremor
How do you manage social phobia?
CBT addressing fear of criticism, challenging negative view of self, safety barriers, unrealistic exceptions, excessive self-monitoring
Education and advice
SSRIs
What are the core features of OCD?
Recurrent obsessional thoughts and compulsive acts
What are the obsessional thoughts in OCD?
Ideas, images, impulses
Not willed, repeated
Unpleasant/intrusive/violent/obscene
RECOGNISED AS INDIVIDUALS OWN THOUGHTS
What causes anxiety in OCD?
Distress of thoughts or attempting to resist compulsions
What are the compulsions like in OCD?
Stereotypical behaviours repeated over and over
Not enjoyable/helpful
How does the sufferer tend to view their compulsions in OCD?
As a way of preventing harm to self or others
As pointless and they get symptoms of anxiety when trying to resist them
What is the prevalence of OCD?
2%
Which gender is OCD affect more?
Equally
What is the aetiology of OCD?
Genetic abnormality in gene coding from 5HT receptor –> 5HT function abnormality
How do you manage OCD?
Rule out depression
Education, advice, involve family
Serotonergic drugs, e.g. fluoxetine, clomperamine
CBT (graded exposure, response prevention, weakening convictions)
What is PTSD?
Delayed/protracted reaction to stressor of exceptional severity
What may be stressors causing PTSD?
Combat Assault Rape Natural/human caused disasters Torturing Witnessing the above
What are the three key elements of PTSD?
Hyperarousal
Avoidance of reminders
Re-experiencing phenomena
What is included in hyperarousal in PTSD?
Irritability
Poor concentration
Persistent anxiety
Insomnia
What is included in re-experiencing phenomena in PTSD?
Nightmares/flashbacks
What is involved in avoidance of reminders in PTSD?
Emotional numbness
Cue avoidance
Difficulty recalling
Diminished interests
Which gender does PTSD affect more?
2x more woman
What is the aetiology of PTSD?
Nature of stressor - more lifethreatening/more exposure –> greater risk
(vulnerability/protective factors)
Some genetic susceptibility
What are the vulnerability factors for PTSD?
Mood disorder
Prev trauma, esp in childhood
Lack of social support
Female
What are the protective factors for PTSD?
Higher educational attainment/social group
Good paternal relationship
How do you manage PTSD?
Trauma focused CBT
Eye movement desensitisation and reprocessing
SSRI/TCA
How is it made sure that we catch PTSD in at risk populations?
Survivors of disasters screened monthly
If mild symptoms - watch and review next month
