Anxiety Disorders Flashcards
What are the models of stress?
Biomechanical engineering
Medicophysiological
Psychological
Describe the psychological model of stress
Transactional
- interactive
- reaction to stress depends on balance between cognitive processing of perceived threat and perceived ability to cope
Describe coping
Can be problem focussed or emotion focussed
Problem; efforts directed toward modifying stresor i.e. preparation, studying
Emotion; modify emotional reaction, mental defence mechanisms i.e. denial, relaxation training
Describe the symptom groups in anxiety
Psychological arousal Autonomic arousal Muscle tension Hyperventilation Sleep disturbance
Describe psychological arousal symptoms
Fearful anticipation Irritability Sensitivity to noise Poor concentration Worrying thoughts
Describe autonomic arousal symptoms
Gastrointestinal arousal; dry mouth, difficulty swallowing
Resp; tight chest, struggle inhaling
Cardio; palpitation, chest pain
Genitourinary; frequency, amenorrhoea/dysmennorhoea, erectile failure
CNS; dizziness, sweating
Describe muscle tension symptoms
Tremor
Headache
Muscle pain
Describe hyperventilation symptoms
CO2 deficit hypocapnia
Numbness tingling in extremities may lead to carpopedal spasm
Breathlessness
Describe sleep disturbance symptoms
Initial insomnia
Frequent waking
Nightmares and night terrors
What is the difference between phobic anxiety disorder and generalised anxiety disorder?
Same symptoms but phobia only when faced with trigger, GAD occurs persistently
What are some differential diagnoses for anxiety disorders?
Psychiatric; depression, schizophrenia, dementia, substance misuse
Physical condition; thyrotoxicosis, phaeochromocytoma, hypoglycaemia, asthma/arrythmias
Describe options in management of generalised anxiety disorders
Counselling; management plan, explanation and education, advice re caffeine, exercise etc
Relaxation training; group/individual, DVD/tape/clinician led
Medication; sedatives have high risk dependency, antidepressant SSRI or TCA
CBT
What are clinically important syndromes in phobic anxiety disorders?
Specific phobias
Social phobia
Agoraphobia
Describe social phobia
inappropriate anxiety in situation where feel observed or could be criticised;
- shops/queues
- restaurants
- public speaking
Blushing and tremor predominate, but any GAD symptoms can occur
How can social phobia be managed?
CBT addressing groundless fear of criticism
CBT Challenges
- negative views of self
- “safety barriers”
- unrealistically high standards
- excessive self-monitoring
Education and advice
Medication SSRI antidepressants
Describe OCD
Obsessional thoughts;
- ideas, images or impulses
- occurring repeatedly not willed
- unpleasant and distressing; obscene, violent or senseless
- recognised as own thoughts
Usual key anxiety symptoms bc of distress or attempts to resist
Describe compulsive acts or rituals in OCD
Stereotypical behaviours repeated again and again
Not enjoyable or helpful
Often viewed by sufferer as preventing some harm or as pointless and resisted resulting in anxiety symptoms
What is the aetiological theory in OCD?
Genetic e.g. gene coding for 5HT receptors
5HT function abnormalities
Describe management OCD
Good history and MSE; exclude treatable depressive illness
- education and explanation, involve partner and family
Serotonergic drugs
- SSRI eg fluoxetine
- clomipramine
CBT
- exposure and response prevention
- examination of evidence to weaken convictions
Psychosurgery
What is PTSD
Delayed and/or protracted reaction to a stressor of exceptional severity
- combat
- natural or human-caused disaster
- rape
- assault
- torture
- witnessing any of the above
What are the key elements to reaction in PTSD?
Three key
- Hyperarousal
- Re-experiencing phenomena
- Avoidance of reminders
Describe hyperarousal
Persistent anxiety
Irritability
Insomnia
Poor concentration
Describe re-experiencing phenomena
Intense intrusive images
- flashbacks when awake
- nightmares during sleep
Describe avoidance
Emotional numbness
Cue avoidance
Recall difficulties
Diminishes interests
Describe the aetiology of PTSD
Nature of stressor
- life threatening and degree of exposure generally confers greater risk
Vulnerability factors
- mood disorder
- previous trauma
- lack of social support
- female
- protective factors
- higher education and social group
- good paternal relationship
Describe the management of PTSD
Survivors of disasters screened at one month
Mild symptoms “watchful waiting” and review further month
Trauma focussed CBT if more severe
Eye movement desensitisation and reprocessing
Risk dependence with any sedatives but patient may prefer medication SSRI or TCA
