Anxiety disorders Flashcards

1
Q

What are the 3 main models of stress?

Briefly describe each model

A

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
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2
Q

In the psychological model of stress - people can attempt to cope with stresses in 2 ways

What are these?

A

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
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3
Q

The symptoms of human anxiety are in many ways similar to the fight or flight response

What are the groups of symptoms of anxiety?

A

Psychological arousal

Autonomic arousal

Muscle tension

Hyperventilation

Sleep disturbance

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4
Q

Symptoms of ‘psychological arousal’ can be present in anxiety

What symptoms are these?

A

Fearful anticipation

Irritability

Poor concentration

Sensitivity to noise

Worrying thoughts

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5
Q

Symptoms of ‘autonomic arousal’ can occur in anxiety

What sort of symptoms are these?

A

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

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6
Q

Intense and prolonged feelings of anxiety can cause symptoms of ‘muscle tension’

What are these?

A

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

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7
Q

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)?

A

Hyperventilation

Hyperventilation causes hypocapnia which can cause:

  • tingling in the extremities
  • carpopedal spasm (spasms of feet/hands due to hypocalcaemia)
  • dyspnoea ironically
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8
Q

What symptoms involving sleep disturbance can be present in anxiety disorders?

A

Insomnia

Frequent waking

Nightmares and night terrors

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9
Q

What are the main anxiety disorders (that we need to know of/about)?

A

Generalised anxiety disorder (GAD)

Phobic anxiety disorders

OCD

PTSD

Dissociative disorders

Somatoform disorders

a wee table of them all if u want x

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10
Q

What are the similarities and differences between:

Generalised anxiety disorder (GAD)

Phobic anxiety disorders

A

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

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11
Q

What are the main phobic anxiety disorders?

A

Agorophobia

Social phobias

Specific phobias

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12
Q

What is agorophobia?

What symptoms in a history are typical of agorophobia?

A

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

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13
Q

What are the differentials for anxiety disorders?

A

Other psychiatric disorders:

  • depression
  • schizophrenia
  • dementia
  • substance misuse

Other non-psychiatric conditions:

  • thyrotoxicosis
  • phaechromocytoma
  • hypoglycaemia
  • asthma
  • arrhythmias
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14
Q

What are the management options for GAD?

A

Counselling

Relaxation training

Antidepressants (SSRIs or TCAs)

CBT

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15
Q

What are the key features of Phobic anxiety disorders?

A

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

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16
Q

What are social phobias?

How would patients with social phobias present?

A

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

17
Q

How are social phobias managed?

A

CBT

Education & advice

SSRI antidepressants

18
Q

OCD is an anxiety disorder in which there are recurrent obsessional thoughts and/or compulsive acts

What is meant by the obsessional thoughts?

A

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

19
Q

OCD is an anxiety disorder in which there are recurrent obsessional thoughts and/or compulsive acts

What is meant by the ‘compulsive acts’?

A

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
20
Q

How is OCD managed in the sort of ‘pre-treatment’ phase?

A

Good history & MSE to exclude depressive illness

Education & explanation to patient

Involve partner/family members

21
Q

What are the treatment options for OCD?

A

Antidepressants:

  • SSRIs - eg Fluoxetine
  • TCAs - eg Clomipramine

Cognitive behavioural therapy

  • exposure & response prevention
  • examination of evidence to weaken convictions

Psychosurgery

22
Q

What is Post traumatic stress disorder?

What events can precipitate PTSD?

A

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

23
Q

What are the 3 key elements (groups of symptoms) of PTSD?

Aside from these - what general symptoms may be experienced?

A

Hyperarousal

Re-experiencing phenomena

Avoidance of reminders

Patients with PTSD often also experience anxiety, depression, suicidal thoughts

24
Q

What are the symptoms of Hyperarousal that is seen in PTSD?

A

Persistent anxiety

Irritability / easily startled

Insomnia

Poor concentration

25
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
26
'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
27
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
28
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
29
What are protective factors from PTSD?
Higher education & social group Good paternal relationship
30
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
31