Anxiety disorders

Question 1

what are the models of stress?

Answer 1

biomechanical, medicophysiological, psychological

Question 2

what is the psychological model of stress?

Answer 2

Interactive, An individual’s reaction to stress will depend on a balance between their cognitive processing of any perceived threat and perceived ability to cope. Coping via: Problem focussed - Where efforts are directed toward modifying stressor – e.g. preparation, studying or interview practice. Emotion focussed - Modify emotional reaction, mental defence mechanisms – e.g. denial, relaxation training, sedative drug.

Question 3

‘Fight or Flight Response’ and Symptoms of Anxiety

Answer 3

Psychological arousal, Autonomic arousal, Muscle tension, Hyperventilation, Sleep disturbance

Question 4

what are Human physiological and psychological reactions to stress producing anxiety - psychological arousal…

Answer 4

Fearful Anticipation, Irritability, Sensitivity to noise, Poor concentration, Worrying Thoughts

Question 5

what are Human physiological and psychological reactions to stress producing anxiety - autonomic arousal…

Answer 5

o Gastrointestinal = dry mouth, swallowing difficulties, dyspepsia, frequent loose motion
o Respiratory = tight chest with difficulty inhaling
o Cardiovascular = palpitations, chest pain
o Genitourinary = frequency/urgency, amenorrhoea/dysmenorrhoea, erectile failure
o CNS = dizziness and sweating

Question 6

What is Genneralised Anxiety disorder (GAD)?

Answer 6

Persistent symptoms not confined to a situation or object, All symptoms of human anxiety can occurs: Psychological arousal, Autonomic arousal, Muscle tension, Hyperventilation, Sleep disturbance. W>M

Question 7

DDX

Answer 7

• Psychiatric conditions: Depression, Schizophrenia, Dementia, Substance misuse
• Physical conditions: Thyrotoxicosis, Phaeochromocytoma, Hypoglycaemia, Asthma and or arrhythmias

Question 8

Mx

Answer 8

• Counselling: Clear plan of management, Explanation and education, Advice about caffeine, alcohol and exercise
• Relaxation training: Group or individual – like cardiac rehab session, DVDs, tapes or can be clinician led
• Medication: Sedatives have high risk dependency – can develop tolerance quickly, Antidepressants SSRIs or TCA – serotonergic effect help with anxiety related problems
• Cognitive behavioural therapy: Emotional response to a situation will depend on our cognitive processing of it, Identifying errors, reprocessing and reassessing responsibility are key elements

Question 9

what are Phobic Anxiety disorders?

Answer 9

Same core features as generalised anxiety disorder BUT it Only happens in specific circumstances

Question 10

what is phobic avoidance?

Answer 10

Person behaves to avoid these circumstances

Question 11

what is anticipatory anxiety?

Answer 11

Will also experience anxiety if there is a perceived threat

Question 12

what are the 3 clinically important phobic anxiety disorders?

Answer 12

Specific Phobias, Social Phobia, Agoraphobia

Question 13

what is Social phobia also which sy/sx predominate?

Answer 13

Inappropriate anxiety in situation where person feels observed or could be criticised: Restaurants, Shops or any queues, Public speaking
Symptoms are any of the anxiety cluster mentioned above but blushing and tremor predominate

Question 14

how is it Mx?

Answer 14

Cognitive behavioural therapy addressing the groundless fear of criticism. CBT challenges: Negative views of self, ‘Safety barriers’, Unrealistically high standards, Excessive self-monitoring. Education and advice. Medication SSRI antidepressants.

Question 15

what is Obsessive Compulsive disorder?

Answer 15

Core features = recurrent obsessional thoughts and or compulsive acts
Obsessional thoughts: Ideas, images or impulses, Occurring repeatedly not willed, Unpleasant and distressing – obscene, violent or senseless, Recognised as the individual’s own thoughts, Usual key anxiety symptoms arise because of distress of the thoughts of attempts to resist
Compulsive acts or rituals: Stereotypical behaviours repeated again and again, Not enjoyable, Not helpful because they do not result in useful activity.

Question 16

Mx

Answer 16

Good history and MSE to exclude treatable depressive illness
General measures: Education and explanation, Involve partner/family
Serotonergic drugs: SSRI – e.g. fluoxetine, Clomipramine (TCA)
Cognitive behavioural therapy (CBT): Exposure and response prevention, Examination of evidence to weaken convictions. Psychosurgery.

Question 17

what is PTSD?

Answer 17

Delayed and or protracted reaction to a stressor of exceptional severity:Examples – combat, natural/manmade disaster, rape, assault, torture, or witnessing any of these (not hearing about it)

Question 18

what are the 3 elements to reaction?

Answer 18

Hyperarousal = constant state of threat: Persistent anxiety, Irritability, Insomnia, Poor concentration
Re-experiencing phenomena = nightmares or flashbacks (feels like you are actually back there) - Intense intrusive images = flashback when awake, nightmares during sleep
Avoidance of reminders = avoid anything to do with the incident - Emotion numbness, Cue avoidance, Recall difficulties, Diminishes interests

Question 19

Aetiology of PTSD

Answer 19

Nature of stressor: Life threatening and degree of exposure generally confers greater risk however there are other factors, Vulnerability factors: Mood disorder, Previous trauma especially as child, Lack of social support, Female gender, Protective factors (examples): Higher education and social group, Good paternal relationship, Susceptibility partly genetic.

Question 20

Mx

Answer 20

De-briefing done in a very informal and social way, Survivors of disasters screened at one month, Mild symptoms – watchful waiting and a review after a month, Trauma focused CBT if more severe symptoms, EDMR = eye movement desensitisation and reprocessing, Risk of dependence with any sedatives – patient may prefer medication SSRI or TCA.