Anxiety Disorders Flashcards
Describe the stress response
- Stressor (stimulus) sent to amygdala where emotional processing takes place
- Interpretation in amygdala
- Amygdala signals hypothalamus
- Hypothalamus signals adrenal cortex via sympathetic system
- Adrenals secrete adrenaline
- Once adrenaline levels subside, hypothalamus activates HPA axis –> CRH and ACTH released
- These hormones cause adrenal glands to secrete cortisol
What differentiates pathological anxiety from physiological anxiety?
More prolonged
Occurs when there is no threat
Focus of attention is not the external threat, but the physiological response itself (ex. increased heart rate)
Severe distress and difficulty in daily activities
Classification of Anxiety Disorders
- Generalised Anxiety Disorder
- Panic Disorder
- Agoraphobia
- Social Phobia
- Specific Phobia
- OCD
Buzzword = “free floating”
Generalised anxiety disorder
Characteristics of Generalised Anxiety
Excessive, uncontrolled, irrational worry about everyday things that is out of proportion to the actual source of the worry
Not restricted to any particular environmental circumstance
Diagnostic Criteria of Generalised Anxiety (DSM)
A. Anxiety for more days than not over 6 months
B. Not controllable
C. Significant distress/impairment of social & occupational functioning
D. Not due to substance misuse or other medical condition
Symptoms of generalised anxiety
Restlessness; feeling keyed up or on the edge Persistent nervousness Light-headedness Easily fatigued Irritability Trouble sleeping (of any kind) Palpitations Muscle tension Nausea, vomiting, epigastric discomfort
Epidemiology of Generalised Anxiety
Age: 20 to 40
Gender: 2:1::F:M
Comobordity: depression, substance abuse
Treatment of Generalised Anxiety
Cognitive Behavioural Therapy
SSRIs/SNRIs
Pregabalin
Benzodiazepene (short term only
What are panic attacks?
Period of intense fear of some kind of catstrophe occurring
Cluster of typical symptoms that develop rapidly
Last a few mins
May occur in all anxiety disorders
What is Panic Disorder?
Recurrent panic attacks that take place unexpectedly
Not due to substance misuse or other medical condition
Not specific to a particular setting
Dominant symptoms of Panic Disorder
Sudden onset palpitations Choking Chest pain Feelings of unreality (depression, depersonalisation) Fear of an impending medical emergency
NOTE: rule out hyperthyroid symptoms
Commonly presents with agoraphobia
Epidemiology of panic disorder
Age: late adolescence to age 30
Comorbidity: agoraphobia, anxiety disorder, depression, substance abuse
Higher prevalence in cardiology clinic
Aetiology of Panic Disorder
- Genetic
- Biochemical - imbalance in neurotransmitter activity in the brain
- Cognitive hypothesis- patients with panic disorder more often have fears concerning physical symptoms
Treatment of Panic Disorder
CBT
SSRI/SNRI
Pregabalin
Benzodiazepine (short term)
What are the 3 types of phobias
a) simple/specific phobia
b) social phobia
c) Agoraphobia
Features of phobic anxiety disorders (3)
- Specific circumstances only
- Avoidance of circumstances that provoke anxiety
- Anticipatory anxiety - prospect of encountering a particular situation
What is agoraphobia?
Anxiety symptoms in an unfamiliar situation, from which they cannot escape or in which they perceive they have little control
Leads to avoidance of those situation
Clinical features of agorahobia
Anxious when away from home, crowds, social situations
Anticipatory anxiety
Avoidance of those situations
Anxious thoughts - fainting and loss of control
panic attacks
depression
depersonalisation
What is social phobia?
Inappropriate anxiety in social settings which lead to the desire for escape or avoidance
Fear of social scrutiny and public humiliation
Social phobia vs agoraphobia?
Agoraphobia - big setting/crowd
Social phobia - small social setting
Clinical features of social phobia
Specific concerns - insight that they are irrational
Avoidance
Anticipatory anxiety
Blushing and trembling
Fear of vomiting
Urgency/fear of micturition or defecation
Onset of social phobia
Late adolescence
Aetiology of social phobia
- exaggerated normal concerns
- Parenting styles
- Childhood experiences
Treatment of social phobia
- CBT
- SSRI/SNRI
- Benzodiazepene (short term)
Onset of agoraphobia
Peak - 20, but bimodal
15-30 and 70- 80 years of ago
Clinical course of agoraphobia
1st episode: unexplained panic attack in a crowded place and patient will hurry home
Repetition of this episode in the same setting leads to agoraphobia
What is Specific Phobia?
Inappropriately anxious in the presence of a particular object/situation
Clinical features of specific phobia
exposure to stimulus - anxiety response/panic attack
Patient recognises fear is unreasonable
Treatment of social phobia
- Behavioural therapy - exposure
i. Graded exposure/systematic desensitisation
ii. Add in CBT (if necessary) - SSRI/SNRI (if required)
What is OCD?
Obsessions and/or compulsions that the patient feels driven to perform according to specific rules in order to prevent an imagined dreaded event
Criteria/Features of OCD
Obsessive symptoms and compulsive acts must be present for atleast 2 weeks AND be a source of distress or interference in activities
Obsessions must be individual’s own thoughts
Resistance must be present
Rituals are unpleasant
Obsessional thoughts/impulses/images are repetitive
Epidemiology of OCD
onset: mean age - 20
No gender bias
Aetiology of OCD
Familial, but no genes identified
Comorbidity of OCD
Schizophrenia Tourettes and other tic disorders Body dysmorphic disorder Eating disorder Trichtillomania
Treatment of OCD
CBT
SSRIs/Clomipramine
