Anxiety disorders Flashcards
What are the 3 main models of stress?
Briefly describe each model
Biomechanical / “Engineering”:
- people have a threshold for stress that can be tolerated - but if an external stress exceeds that threshold - then psychological & physiological damage can occur
Medicophysiological:
- focusses on the fight/flight physiological reaction of a person to a stress/demand and has 3 distinct stages:
- alarm reaction
- physiological adaptation (to the stress)
- exhaustion & burnout
Psychological (transactional):
- an individuals reaction to a stress depends on:
- the significance, to them, of the percieved threat
- the percieved ability to cope with the threat
In the psychological model of stress - people can attempt to cope with stresses in 2 ways
What are these?
Problem focussed coping:
- where efforts are directed towards modifying the stress - eg:
- The stress = an upcoming exam
- Problem focussed coping = studying for that exam
Emotion focussed coping:
- where efforts are focussed towards the emotional reaction - eg:
- The stress = an upcoming exam
- Emotional focussed coping = focussing on relaxing or being in denial
The symptoms of human anxiety are in many ways similar to the fight or flight response
What are the groups of symptoms of anxiety?
Psychological arousal
Autonomic arousal
Muscle tension
Hyperventilation
Sleep disturbance
Symptoms of ‘psychological arousal’ can be present in anxiety
What symptoms are these?
Fearful anticipation
Irritability
Poor concentration
Sensitivity to noise
Worrying thoughts
Symptoms of ‘autonomic arousal’ can occur in anxiety
What sort of symptoms are these?
These are the more physical feelings - outside of your head - that you can experience in anxiety
Gastrointestinal - dry mouth, frequent loose stools, nausea etc
Respiratory - dyspnoea, tight chest
Cardiovascular - palpitations, chest pain
Genitourinary - frequent micturation, a/dysmenorrhoea, erectile failure
CNS - dizziness, sweating, blurred vision
Intense and prolonged feelings of anxiety can cause symptoms of ‘muscle tension’
What are these?
Fight/flight response tenses our muscles up normally (to increase our mobility n stuff) - but if prolonged can lead to:
Tremor - ie shaking when nervous
Headache
Muscle pain
Hyperventilation is one of the key symptoms of acute severe anxiety (eg panic attacks)
What is the effect of hyperventilation (ie what other symptoms are associated with it)?
Hyperventilation
Hyperventilation causes hypocapnia which can cause:
- tingling in the extremities
- carpopedal spasm (spasms of feet/hands due to hypocalcaemia)
- dyspnoea ironically
What symptoms involving sleep disturbance can be present in anxiety disorders?
Insomnia
Frequent waking
Nightmares and night terrors
What are the main anxiety disorders (that we need to know of/about)?
Generalised anxiety disorder (GAD)
Phobic anxiety disorders
OCD
PTSD
Dissociative disorders
Somatoform disorders
a wee table of them all if u want x
What are the similarities and differences between:
Generalised anxiety disorder (GAD)
Phobic anxiety disorders
Both have more or less the same symptoms (as previously discussed)
But phobic anxiety disorders affect the patient in very specific circumstances - ie when fixating on/presented with the phobia
GAD occurs more persistently
What are the main phobic anxiety disorders?
Agorophobia
Social phobias
Specific phobias
What is agorophobia?
What symptoms in a history are typical of agorophobia?
Agorophobia
Put simply - the fear of leaving home
Put less simply - the fear of being in situations where escape might be difficult or that help wouldn’t be available if things go wrong
Panic attacks are often associated with agorophobia - the patient experiences sudden intense fear with symptoms such as palpitations, sweating, shaking, dizziness etc
What are the differentials for anxiety disorders?
Other psychiatric disorders:
- depression
- schizophrenia
- dementia
- substance misuse
Other non-psychiatric conditions:
- thyrotoxicosis
- phaechromocytoma
- hypoglycaemia
- asthma
- arrhythmias
What are the management options for GAD?
Counselling
Relaxation training
Antidepressants (SSRIs or TCAs)
CBT
What are the key features of Phobic anxiety disorders?
Same core features as GAD - but only in specific circumstances
Person behaves to avoid their phobia - ie a germophobe will avoid touching handles etc
Person will develop ‘anticipatory anxiety’ if they think they will be exposed to their phobia
What are social phobias?
How would patients with social phobias present?
Inappropriate anxiety in situations where person feels observed or could be criticised - eg queues, public speaking
Patients will present with any of the human anxiety symptoms - but blushing and tremor predominate
How are social phobias managed?
CBT
Education & advice
SSRI antidepressants
OCD is an anxiety disorder in which there are recurrent obsessional thoughts and/or compulsive acts
What is meant by the obsessional thoughts?
Ideas, images and impulses that occur repeatedly and are not willed
These thoughts are often obscene, violent or senseless - and the patient usually finds them distressing (generating anxiety)
The patient recognises them as their own thoughts
OCD is an anxiety disorder in which there are recurrent obsessional thoughts and/or compulsive acts
What is meant by the ‘compulsive acts’?
Stereotypical (ie the same/predictable) acts or ‘rituals’ that are:
1) Repeated
2) Not enjoyable
3) Not useful
The patient may believe these acts are:
- necessary to prevent harm to self/others
- pointless and resisted with consequent anxiety
How is OCD managed in the sort of ‘pre-treatment’ phase?
Good history & MSE to exclude depressive illness
Education & explanation to patient
Involve partner/family members
What are the treatment options for OCD?
Antidepressants:
- SSRIs - eg Fluoxetine
- TCAs - eg Clomipramine
Cognitive behavioural therapy
- exposure & response prevention
- examination of evidence to weaken convictions
Psychosurgery
What is Post traumatic stress disorder?
What events can precipitate PTSD?
Condition in which there is a 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
*PTSD 2x more common in women - mainly due to this
What are the 3 key elements (groups of symptoms) of PTSD?
Aside from these - what general symptoms may be experienced?
Hyperarousal
Re-experiencing phenomena
Avoidance of reminders
Patients with PTSD often also experience anxiety, depression, suicidal thoughts
What are the symptoms of Hyperarousal that is seen in PTSD?
Persistent anxiety
Irritability / easily startled
Insomnia
Poor concentration
Re-experiencing the phenomena is one of the key elements of PTSD
What might the patient describe?
Intense intrusive images
flashbacks when awake
nightmares when asleep
‘Avoidance’ is one of the key features of PTSD
What does this mean?
The patient will avoid activities/situations reminiscent of the traumatic experience - but will also kind of avoid emotions altogether…
They will experience:
- emotional numbness
- anhedonia / diminished interests
- cue avoidance
- recall difficulties
In the definition of PTSD - it says that it is a ‘delayed & protracted reaction’ to the traumatic event
What does ‘delayed’ mean in this?
After the traumatic event has happened, it usually takes months/years for the person to begin experiencing symptoms of PTSD - and even longer to seek help for it
Are there any risk factors for PTSD?
PTSD happens following life severe traumatic events that would cause it in pretty much anyone.
However - there are some factors that increase someones vulnerability:
- mood disorders
- female
- previous trauma (as child)
- lack of social support
- genetic factors
What are protective factors from PTSD?
Higher education & social group
Good paternal relationship
Describe the management of PTSD
Survivors of disasters screend at 1 month
if mild/no symptoms - ‘watchful waiting’ & review month later
if severe:
- trauma-focused CBT
- eye movement desensitisation & reprocessing
- sedatives (r.o dependence) or SSRIs/TCAs
