Anxiety Disorders Flashcards
What is the 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 can be problem or emotion focused.
What is problem focussed coping?
Where efforts are directed toward modifying stressor.
What is emotion focussed coping?
Modifying the emotional reaction. Mental defence mechanisms.
What is the brain’s physical response to stress?
Stressor causes hypothalamus to release Corticotropin releasing hormone.
Stimulates pituitary gland to release Adrenocorticotropic hormone, prolactin and growth hormone and hard-wiring of sympathetic innervation.
Adrenocorticotropin acts on adrenal gland to release Glucocorticoid hormones and Noradrenaline and adrenaline.
All these contribute to producing T cells, Monocytes, B cells, NK cells and APC cells. These produce cytokines such as IL-1 that then act on brain.
What are some symptom groups of Anxiety?
Psychological arousal Autonomic arousal Muscle tension Hyperventilation Sleep disturbance
What symptoms come under Psychological arousal?
Fearful anticipation Irritability Sensitivity to noise Poor concentration Worrying thoughts
What symptoms come under autonomic arousal?
GI - dry mouth, swallowing difficulties, dyspepsia, nausea, wind, frequent loss motions.
Resp - chest tightness, difficulty inhaling.
Cardio- palpitations, missed beats, chest pain.
Genitourinary - Frequency/urgency or micturition, amenorrhoea/dysmenorrhoea, erectile failure.
CNS - dizziness, sweating.
What features of muscle tension may be present under stress?
Tremor
Headache
Muscle pain
What may occur due to hyperventilation under stress?
CO2 deficit hypocapnia
Numbness tingling in extremities may lead to carpopedal spasm
Breathlessness
How may sleep be disturbed under stress?
Initial insomnia
Frequent waking
Nightmares and night terrors.
What is Generalised Anxiety Disorder (GAD)?
Persistent symptoms not confined to a situation or object. All symptoms of human anxiety can occur.
F>M
How is Generalised Anxiety disorder managed?
Counselling - clear plan, explanation and education, advice re caffeine, alcohol, exercise.
Relaxation training
Medication - sedatives, antidepressants SSRIs or TCAS.
CBT
What is Phobic Anxiety Disorder?
Persistent symptoms that occur only in a specific circumstance. All symptoms of human anxiety can occur.
Person behaves to avoid these circumstances.
Can also experience anticipatory anxiety.
What are some examples of Phobic anxiety disorders?
Specific phobias
Social phobia
Agoraphobia
What is agoraphobia?
Fear of being in situations where escape might be difficult or that help wouldn’t be available if things go wrong.
What is social phobia?
Inappropriate anxiety in situation where person feels observed or could be criticised. Any anxiety symptoms can occur but blushing and tremor predominate.
Situations include restaurants, shops or queues, public speaking.
What is the management for Social phobia?
CBT to address the groundless fear of criticism.
Education and advice
Medication SSRI antidepressants.
What is Obsessive Compulsive Disorder (OCD)?
Experience of recurrent obsessional thoughts and or compulsive acts.
Obsessional thoughts are ideas, images or impulses occurring repeated and unwilled. They can be unpleasant and distressing and anxiety arises because of the distress of the thoughts or the attempt to resist them.
What is the aetiological theory of OCD?
Genetic involvement of gene coding for 5HT receptors resulting in 5HT function abnormalities.
What is the management for OCD?
Education and explanation involving partner/family.
Serotonergic drugs - SSRIs and Clomipramine.
CBT - exposure and response prevention, examination of evidence to weaken convictions.
Psychosurgery
What is Post Traumatic Stress Disorder?
Delayed and or protracted reaction to a stressor of exceptional severity. The stressor would distress anyone.
Examples include combat, natural or human caused disaster, rape, assault, torture or witnessing any of the above.
What are 3 key elements to a reaction in PTSD?
Hyperarousal
Re-experiencing phenomena
Avoidance of reminders
What are some symptoms of hyperarousal?
Persistent anxiety
Irritability
Insomnia
Poor concentration
What are some symptoms of Re-experiencing?
Intense intrusive images
Flashback when awake
Nightmares during sleep
What are some symptoms of avoidance of reminders?
Emotional numbness
Cue avoidance
Recall difficulties
Diminished interests
What are some risk factors for PTSD?
Mood disorder Previous trauma especially as a child Lack of social support Female Genetics
What is the management of PTSD?
NICE guidelines
Survivors of disasters screened once a month.
Trauma focused CBT if severe.
Eye movement desensitisation and reprocessing.
SSRIs or TCAs
