Anxiety Disorders Flashcards
Models of stress
Biomechanical engineering
Medicophysiological
Psychological (transactional)
Biomechanical engineering model of stress
Stimulus in external environment puts stress on a person
Physical or psychological
Can only be tolerated until a following point
Medicophysiological model of stress
Flight or fight response to a demand
If stressor persists then there is an alarm reaction followed by physiological adaptations which can only be maintained for so long until this leads to exhaustion
Psychological (transactional) model of stress
Interactive
An individuals reaction to stress will depend on a balance between their cognitive processing of any perceived threat and perceived ability to cope
Coping of stress models
Problem focussed
- where efforts are dedicated to modifying stressor
Emotion focused
- modify emotional reaction.
- mental defence mechanisms e.g. denial, relaxation training
What does the optimal point of stress mean?
Performance will be at its best as ready to go and do the task. Anything beyond this anxiety can become problematic
Symptoms of anxiety
Psychological Arousal
- fearful anticipation (worrying about what is going to happen)
- irritability
- sensitivity to noise
- poor concentration
- worrying thoughts
Autonomic arousal
- GI (dry mouth, swallowing difficulties, dyspepsia, nausea, wind, frequent lose motions)
- Resp ( tight chest, difficulty inhaling)
- CVS (palpitations / missed beats, chest pain)
- Genitourinary (frequency/urgency of micturition, amenorrhoea/dysmenorrhoea, erectile failure)
- CNS (dizziness, sweating)
Muscle tension
- tremor
- headache
- muscle pain
Hyperventilation
- breathlessness
- CO2 deficit hypocapnia
- numbness / tingling in extremities
Sleep disturbance
- insomnia
- frequent waking
- nightmares / night terrors
Difference between Phobic Anxiety disorder and General Anxiety disorder (GAD)
Same core anxiety symptoms
EITHER occur in particular circumstances (phobias) OR occur persistently (GAD)
Which gender gets GAD more?
W > M
Presentation of GAD
PERSISTENT (several months) Symptoms not confined to a situation or object Psychological arousal - persistent nervousness - fear relatives will get ill Autonomic arousal - sweating - palpitations - epigastric discomfort muscle tension Restlessness Irritability Somatic symptoms - hyperventilation - tachycardia - sweating Sleep disturbance Extensive and uncontrollable worry
Treatment of GAD
Counselling Advice via caffeine, alcohol, exercise Relaxation training (applied relaxation) Medications - sedatives - Antidepressants SSRI or TCA or pregabalin CBT Psychological / behavioural therapy
Why are Sedatives generally avoided?
High risk dependency
Presentation of phobic anxiety disorders
Same core features as GAD but ONLY 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”
Types of phobic anxiety disorders
Agoraphobia
Social phobia
Specific (isolated phobias)
Features of agoraphobia
Fear of being trapped somewhere e.g. shops, restaurants
Can make people become trapped in their own house
Panic attacks are also a feature
Patients with this can end up with little anxiety because they can avoid their specific situations
Features of social phobia
Inappropriate anxiety in a situation where a person feels observed or could be criticised
restaurants, shops / queues, public speaking
Symptoms are any of the anxiety cluster but BLUSHING AND TREMOR PREDOMINATE
Which symptoms of social phobia predominate?
Blushing
Tremor
Treatment of social phobias
CBT
- addressing groundless fear of criticism
Education and Advice
SSRI antidepressants
Examples of specific (isolated) phobias
Spiders Heights The dentist Public toilets Blood
Differential diagnosis of anxiety disorders
Psychiatric - depression - schizophrenia - dementia - substance misuse Physical - thyrotoxicosis - hypoglycaemia - asthma - arrhythmias - pheochromocytoma
Core features of OCD
Experience of recurrent obsessional thoughts and/or compulsive acts
What does OCD stand for?
Obsessive Compulsive Disorder
Which gender gets OCD more?
M = F
Genes In OCD
Gene coding for 5HT receptors causing 5 HT function abnormalities (the gene coding for serotonin)
Presentation of OCD
Obsessional thoughts / features - ideas, images or impulses - occurring repeatedly not willed - unpleasant and distressing Compulsive acts/rituals - stereotypical behaviours repeated again and again - not enjoyable and not helpful
Where does the usual key anxiety symptom come from in OCD?
Arises because of the obsessive thoughts or attempts to resist
Management of OCD
Exclude treatable depressive illness Education and explanation involving carer and family Exposure and response prevention therapy Serotonergic drugs - SSRI e.g. fluoxetine - Clomipramide CBT Psychosurgery
Definition of PTSD
Delayed or protracted response to a stressor of exceptional diversity (would distress anyone). Can be a stressor of brief or prolonged duration
What does PTSD stand for?
Post traumatic stress disorder
Which gender gets PTSD more?
W > M 2:1
Examples of stressors in PTSD
Combat natural or human caused disaster rape assault torture witnessing any of the above
Causes of PTSD
Nature of stressor (life threatening and degree of exposure generally confers greater risk) Vulnerability factors - mood disorder - previous trauma esp as child - lack of social support - female Susceptibility partly genetic
Protective factors of PTSD
Higher education and social group
Good paternal relationship
3 key elements to the reaction of PTSD
- HYPERAROUSAL
- persistent anxiety
- irritability
- insomnia
- poor concentration - RE-EXPERIENCING PHENOMENA
- intense intrusive images (flashbacks when aware, nightmares when asleep) - AVOIDANCE OF REMINDERS
- emotional numbness
- cue avoidance
- recall difficulties
- diminishes interests
- anxiety and depression linked in the symptoms of avoidance
Treatment of PTSD
Mild symptoms - watchful waiting - review further month More severe symptoms - trauma focused CBT Eye movement desensitisation and reprocessing (EMDR) Medications - sedatives - SSRI - TCA
What do sedatives have a risk of?
Dependence
When are survivors of a disaster screened for PTSD?
At one month
What organic conditions could cause anxiety?
Pheochromocytoma
Thyroid storm
What is GAD often co morbid with?
Major depression
Panic
OCD
What is panic disorder?
Sudden, unpredictable episodes of severe anxiety
Presentation of panic disorder
SOB
Autonomic symptoms
Fear of dying / suffocating etc
1st line drug treatment for panic disorder
SSRIs
What should be ruled out if presenting with anxiety symptoms?
Thyroid disorder
