Anxiety Disorders Flashcards
What are the three models of stress?
Bio mechanical engineering
Mediopsychiological
Psychological (transactional)
How does stress occur?
The body is designed to cope with certain amounts of stress but too much causes damage and negative effects on the body
What is th medicophysiological theory of stress
Fight or flight reposnse
Alarm reaction
Physiological adaptation
Exhaustion
What is the bio mechanical model of stress
Overload on a structure leads to damage e.g. too much force on a muscle leads to damage
What is the psychological (transactional) model of stress
An interactive response that is unique to someone’s own perspective
Someone assess a situation and decide how they cope with it. They deal with stress in two ways:
Problem focused
Emotional focused
What is a problem focused way to react to stress?
Do things to get rid of things that relate to stress.
What is an emotion focused approach to dealing with stress
Modifying your emotional response with mental defence mechanisms.
E.g. go a run, denial, taking a sedative drug
What is the pathophysiology of anxiety
The production of steroids causes damage to the reticular system of the brain, heightening its further response in anticipation of stress
What are the fight or flight responses of anxiety
Psychological arousal Autonomic arousal Muscle tension Hyperventilation Sleep disturbance
What symptoms occur due to the psychological component of anxiety?
Fearful anticipation Irritability Sensitivity to noise Poor concentration Worrying thoughts
What symptoms of autonomic arousal occur during an anxiety response?
GI- Dry mouth, swallowing difficulties, dyspepsia
Resp-tight chest, difficulty inhaling
Cardio- palpitations, chest pain
Urinary- erectile failure
CNS- dizziness and sweating
What can muscle tension caused by anxiety cause?
Tremor
Headache
Muscle pain
What can hyperventilation caused by anxiety lead to
CO2 deficit hypocapnia
Numbness/tingkjng in the extremities may lead to carpopedal spasm
Breathlessness
What symptoms of sleep disturbance can be caused by anxiety
Frequent waking
Insomnia
Nightmares and night terrors
How are phobic anxiety dorsders and general anxiety disorders
Similar
Different
Symptoms are practically the same
Phobias- occurs in specific situations
Generalised- occurs all the time
Describe the presentation of generalised anxiety disorder
Persistant nervousness Trembling Muscle tremors Palpitations Dizziness Epigastric discomfort
Lasts for a few months, described as free flowing anxiety
What are the psychiatric differentials for generalised anxiety disorders
Depression
Schizophrenia
Dementia
Substance misuse
What are the physical differentials for generalised anxiety disorders
Thyrotoxicosis
Pheaechromoctoma
Hypoglycaemia
Asthma or arrythmias
How do you manage generalised anxiety disorder?
Counselling- clear plan of management, explanation and education, advice re caffeine, alcohol and exercise
Relaxation training-group or individual, DVD’s
Medication- sedatives, SSRI or TCA
CBT
Describe phobic anxiety disorders?
Same core features as generalised anxiety disorders
Only in specific circumstances
Leads to phobic avoidance
sufferer also experiences perceived threat of encountering the feared object or situation
What are the three clinically important syndromes in phobic anxiety disorders
Specific phobias
Social phobias
Agoraphobia- scared to leave house, can cause panic attacks
Describe the presentation of social phobia
Avoidance of scrutinisation/ being observed.
Avoid restaurants, shops or queues, public speaking
May present with blushing,hand tremors, nausea
May lead to panic attacks
How do you manage social phobias?
CBT, bake to challenge the negative views of self, safety barriers, unrealistically high stands dad and excessive self monitoring
SSRI’s
Education
How does OCD present
An association with recurrent thoughts/ideas or impulses
Patient often tries to resist these thoughts and actions
Patient knows it’s their own thought but may not be rational
How is OCD different to OCPD
Presence of obsessional thoughts and compulsions to do things is only present in OCD.
People are distressed by intrusive thoughts and compulsions in OCD
People with OCD are more likely to seek help
How do you manage OCD
Education and explanation (involve partner/family)
Serotinergic drugs (SSRI) Clomipramine
CBF (best outcome)
Psychosurgery- treatment resistant OCD
Where can PTSD arise from
A protracted stress reposnse from a substantial event e.g.
Combat Disaster Rape Assault Torture
How is PTSD characterised
Hyperarousal- persistant anxiety, irritability, insomnia, poor concentration
Re-experiencing phenomena- intensive intrusive images, flashbacks when awake, nightmares during sleep, also have anhedonia
Avoidance- emotional numbness, cue avoidances, recall difficulties, diminished interests
What may make you vulnerable to PTSD
Mood disorder Previous trauma as a child Lack of social support Female Lack of higher education and social groups Good paternal relationships
How do you treat PTSD
Survivors of disasters screened at one million GH
Mild symptoms “watchful waiting” and review a month later
Trauma focused CBT if more severe symptoms
Eye movement desensitisation and reprocessing
Risk of dependence with sedatives so SSRI or TCA
