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Year 3 Psych thats the wrong number > Anxiety disorders > Flashcards

Anxiety disorders Flashcards

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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
Q

Re-experiencing the phenomena is one of the key elements of PTSD

What might the patient describe?

A

Intense intrusive images

flashbacks when awake

nightmares when asleep

26
Q

‘Avoidance’ is one of the key features of PTSD

What does this mean?

A

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
Q

In the definition of PTSD - it says that it is a ‘delayed & protracted reaction’ to the traumatic event

What does ‘delayed’ mean in this?

A

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
Q

Are there any risk factors for PTSD?

A

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
Q

What are protective factors from PTSD?

A

Higher education & social group

Good paternal relationship

30
Q

Describe the management of PTSD

A

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
Q
A

Year 3 Psych thats the wrong number (20 decks)

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