Anxiety Disorders Flashcards
What are the main models of stress?
Biomechanical engineering
Medicophysiological
Psychological (transactional)
Describe the psychological model of stress?
The psychological/transactional model of stress as having either problem focussed, or emotion focussed coping methods. Problem focussed coping is where efforts are directed towards modifying the stressor, where emotion focussed involves modifying the emotional reaction.
What are the five symptom groups associated with anxiety?
Psychological arousal Autonomic arousal Muscle tension Hyperventilation Sleep disturbance
What are the specific symptoms associated with psychological arousal?
Fearful Anticipation Irritability Sensitivity to noise Poor concentration Worrying Thoughts
What are the specific symptoms associated with autonomic arousal?
Gastrointestinal: -Dry mouth -Swallowing difficulties -Dyspepsia -Nausea -Frequent diarrhoea Respiratory: -Tight chest -Difficulty breathing Cardiovascular: -Palpitations -Chest pain Genitourinary: -Frequency/urgency of micturition -Amenorrhoea or dysmenorrhoea -Erectile failure Nervous System: -Dizziness -Sweating
What are the specific symptoms associated with muscle tension?
Tremor
Headache
Muscle pain
What are the specific symptoms associated with hyperventilation?
CO2 deficient hypocapnia
Numbness in periphery- can cause carpopedal spasm
Breathlessness
What are the specific symptoms associated with sleep disturbance?
Initial insomnia
Repeated wakening
Nightmares/ night terrors
What is the difference between generalised and phobixc anxiety disorders?
Both phobic and generalised anxiety disorders share the core anxiety symptoms but phobic anxiety disorders only occur in certain situations and generalised anxiety disorder occurs persistently.
What are the three main types of phobic anxiety disorder?
Agoraphobia
Social phobia
Specific phobias
How is generalised anxiety disorder characterised?
By persistent (several months) of the anxiety symptoms detailed above that are not tied to a situation or object
What is included on a differential diagnosis for anxiety disorders?
Depression Schizophrenia Dementia Substance misuse Thyrotoxicosis Phaeochromoctoma Hypoglycaemia Asthma and/or arrhythmias
How are generalised anxiety disorders managed?
Counselling
Relaxation training
Medication (ideally avoid sedatives due to risk of dependence, SSRIs or TCAs better choices)
Cognitive behavioural therapy
How are phobic anxiety disorders characterised?
Phobic anxiety disorders have the same core features of generalised anxiety disorders but they only present in specific situations. The patient will act to avoid these situations, which is known as phobic avoidance. The sufferer will also likely experience anxiety if there is a risk of them encountering the perceived threat.
How is social phobia managed?
CBT
Education/advice
SSRIs
What is the core feature of obsessive compulsive disorder?
Experiencing recurrent obsessional thoughts and/or compulsive acts
What are the features of obsessional thoughts?
Ideas, images or impulses
Occurring repeatedly and not willed
Unpleasant and distressing
Recognised as the individuals own thoughts (will likely realise they are irrational ideas)
Usual key anxiety symptoms arise because of distress of thoughts or attempts to resist
What are the features of compulsive acts/rituals?
Stereotypical behaviours repeated again and again
Not enjoyable
Not helpful i.e. do not result in useful activity
Often viewed by sufferer as either preventing some harm to self or others or viewed as pointless and resisted with key anxiety symptoms accompanying resistance
How is OCD managed?
Thorough history and MSE to exclude treatable depressive illness
Education, explanation and the involvement of family/partner
Serotonergic drugs such as SSRIs or clomipramine
CBT
Psychosurgery
How is post traumatic stress disorder defined?
A delayed and or protracted reaction to a stressor of exceptional severity
What are some common causative stressors for PTSD?
Combat Natural or human-caused disaster Rape Assault Torture Witnessing any of the above
What are the key elements to the reaction associated with PTSD?
Hyperarousal
Re-experiencing the phenomena
Avoidance of reminders
What are the characteristics of hyperarousal?
Persistent anxiety
Insomnia
Irritability
Poor concentration
What are the potential presentations of re-experiencing of phenomena?
Intense, intrusive images which can be nightmares or flashbacks
What are the potential presentations of avoidance of reminders?
Emotional numbness
Cue avoidance
Recall difficulties
Diminishes interests
What factors increase an individual’s susceptibility to PTSD?
Mood disorder Previous trauma especially as child Lack of social support Female sex Higher education and social group Good paternal relationship Partly genetic
How is PTSD managed?
Management of mild PTSD involves observing for a month to check if symptoms worsen. In more severe disorder, the following can be helpful:
• Trauma focused CBT
• Eye movement desensitisation and reprocessing
• SSRI or TCA but be wary of risk of dependence
