Anxiety disorders Flashcards
What are the 3 models of stress?
Biomechanical ‘engineering’ – occurs when someone’s environment is disturbed in some way by an external stress. This puts a strain on them – up to a point this strain can be tolerated but if this level is exceeded then physiological or psychological damage will occur.
Medico-physiological model – stressor triggers the fight or flight response. Alarm reaction, physiological adaptation to the stressor and then eventually exhaustion/ ‘burn out’.
Psychological (transactional) model – dynamic model of stress. An interaction between the individual and the environment. The response of the individual is related to how they perceive the stressor. The person decides how a stressor affects them, it may be irrelevant, positive even or stressful. The person then evaluates their own ability to cope with the perceived demand. Stress occurs when there is an imbalance between the perceived demand and the person’s perceived ability to cope.
Describe what is meant by a ‘Problem focused approach’
Efforts are directed towards modifying the stressor i.e studying/practicing for the exam/interview
Describe what is meant by an ‘Emotion focused approach’
Psychological or behavioural responses which attempt to reduce the negative emotions associated with stress.
Mental defence mechanisms i.e studying but taking time off to relax, sport.
5 symptom groups of anxiety
-
Psychological arousal
- Fearful anticipation
- Irritability
- Sensitivity to noise
- Poor concentration
- Worrying thoughts
-
Autonomic arousal
- Dry mouth, swallowing difficulties, dyspepsia, nausea and wind
- Palpations/missed beats, chest pain, dizziness and sweating, difficulty inhaling
- Erectile failure, frequency / urgency of micturition, frequent loose stools
-
Muscle tension – response to stress – persistent muscle tension can result in:
- Muscle pain
- Tremor
- Headache
-
Hyperventilation
- Causing CO2 deficit - hypocapnia
- Numbness / tingling in the extremities may lead to carpopedal spasm (frequent and involuntary muscle spasms in the feet or hands
- Breathlessness
-
Sleep disturbance
- Initial insomnia
- Frequent waking
- Nightmares and night terrors
What are 3 clinically important types of phobic disorder?
- Agoraphobia – scared of leaving your house and having to go into shops and things
- Social phobia – fear of scrutiny/criticism/judgement by other people – may present with blushing, hand tremor or trembling
- Specific (isolated) phobias – flying, heights or animals etc
Describe phobic disorders
- Phobias have the same symptoms as GAD but they just occur in very specific circumstances.
- People behave in a particular way to avoid these phobias.
- Sufferer also experiences anxiety if there is a perceived threat of encountering the feared object or situation “anticipatory anxiety”.
How can social phobias be managed?
- CBT – negative thought errors surrounding these phobias
- Education and advice
- Medication with SSRI antidepressants
What is Generalised Anxiety Disorder (Anxiety)?
- Generalised anxiety can occur all or most of the time.
- It is generalised (symptoms are not confined to a situation or object) and persistent (several months).
- Symptoms occur in all 5 symptom groups.
- F>M.
Symptoms of anxiety
- Sweating
- Muscle tension
- Persistent nervousness
- Trembling
- Light headedness
- Dizziness
- Epigastric discomfort
- Palpitations
- Fears that harm is going to come soon to yourself or loved ones
Management of anxiety
Counselling
- Clear Plan of Management
- Explanation and education
- Advice to minimise anxiety re caffeine, alcohol, exercise etc.
- Relaxation training – any method/process/activity that helps a person to relax
- Group or individual
- DVDs, tapes or clinician led
- Medication
- Sedatives are not recommended as they have high risk of dependency
- Antidepressants SSRI or TCA
- Cognitive Behavioural Therapy – challenges thought errors
OCD
- What is it?
- Prevalence?
- A disorder characterised by recurrent, strong obsessional thoughts that are calmed by compulsive acts/rituals. 5HT receptor / serotonin relates to feelings of wellbeing and it is thought that OCD has abnormalities here.
- M=F, common
What are obsessional thoughts?
Ideas, images or impulses occurring repeatedly not willed. Unpleasant and distressing, often the antithesis of personality type (obscene, violent or senseless).
What are compulsive acts or rituals
- Stereotypical behaviours repeated again and again.
- They are not enjoyable and not helpful i.e. do not result in useful activity.
- Often viewed by sufferer as preventing some harm to self or others; “magical undoing” or viewed as pointless and resisted with key anxiety symptoms but it is difficult to stop.
- If these tasks are not completed then anxiety increases.
How is OCD managed?
- Mild
- Moderate
- Severe
- Mild - 1st line = Exposure response prevention therapy = part of CBT. If they cannot engage in low intensity CBT (including ERP) should be offered an SSRI.
- Moderate - SSRI or more intensive CBT (including ERP)
- Severe - SSRI and CBT
