Anxiety Disorders Flashcards
Define Neurosis?
- Functional illness
- That is not psychotic (i.e. do not have hallucinations or delusions)
Essentially synonymous with anxiety disorders.
What is the underlying mechanism to anxiety disorders?
Disordered, overly excessive fear response creating high levels of physiological arousal AND avoidance behaviours.
Outline Lang’s three system model?
Thoughts, Behaviours, and Feelings all interact with each other to generate mental illness.
Relevant to the management of anxiety as all 3 can and should be targeted therapeutically (e.g. CBT aims to treat thought and the behaviours which arise from them)
How is every day anxiety distinguished from disordered anxiety?
- Anxiety is a normal response to a perceived threat of any kind (can be physical or related to work etc)
- Anxiety is considered disordered when the perceived danger either doesn’t exist OR the response is out of scale with the size of the threat
- I.e. a psychological factor is generating or amplifying a sense of threat
- Can be considered a ‘false alarm’
What effect does anxiety have (physiologically and cognitively)?
- Sympathetic, physiological arousal
- Racing thoughts
- Inability to concentrate
- Cognitive bias- attentional focus
Outline Padesky’s anxiety equation?
Judgement of a scenario requires subjectively estimating the danger of the situation as well as our ability to cope with it.
Individuals with anxiety over-estimate danger and under-estimate coping.
What are the main anxiety disorders?
Non-specific ADs:
- GAD
- Social Anxiety
- Complex phobias/ Panic disorder
Specific ADs:
- Simple phobias
- Health anxiety
- OCD
- PTSD
Define specific phobia?
A marked fear of a specific object or situation (e.g. dogs, thunder, snakes, blood)
AND
Marked avoidance of such objects or situations.
Define panic disorder?
- A fear of your own physiological and psychological reactions.
- Bodily changes interpreted as signs of impending collapse, insanity or death
- Accompanying avoidance of situations that may trigger these reactions, including agoraphobia (avoidance of going outside)
Describe the cognitive model of panic?
- Internal or external trigger, interpreted as a perceived threat
- Causes anxiety
- Which causes physical or cognitive symptoms
- All of which can be misinterpreted as overly serious, worsening the anxiety and therefore physiological symptoms
- All the while avoidance and safety behaviours are employed and reinforced.
Describe GAD?
- Disorder of worry
- Ability to worry about any number of things (type 1, worries about specific things like being late etc)
- Specific content of type 1 worry changes/varies over time
- Also exhibit type 2 worries (worries about worries e.g. god why am i worrying about this when i should be worrying about exams etc)
- Usually accompanied with low level physical symptoms e.g. insomnia, muscle tension, GI upset, headache
- Often maintained by the belief that worry is useful (positive worry beliefs) e.g. it motivates, shows responsibility, prepares for problems, stops bad things happening.
Describe Social Anxiety Disorder?
- At its core a fear of negative evaluation by others
- Can lead to avoidance of feared situations, use of safety behaviours, anticipatory anxiety, unhelpful post-mortems after social encounters
Describe OCD?
- Unwanted, recurring, distressing intrusive thoughts (aka OBSESSIONS)
- Common obsessions include the potential of doing harm, behaving inappropriately, being contaminated etc…
- These obsessions are distressing because they are completely out of kilter with a person’s own moral values, and often the specifics of what someone believes in shapes their obsessions.
- To manage this distress (primarily anxiety) caused by intrusions the patient conducts neutralising behaviours in the form of COMPULSIONS
- These can be OVERT e.g. washing, checking, ordering or aligning
- Or COVERT e.g. praying, counting, repeating words
Describe PTSD?
- Caused by exposure to event or situation of exceptionally threatening or catastrophic nature which would be likely to cause pervasive distress in almost anyone
- e.g. War, sexual violence, child-birth, RTAs
3 main features:
- Re-experiencing phenomena
- Avoidance behaviour
- Continuous state of hyper-arousal
Commonly co-occurs with other anxiety disorders, depression, substance misuse.
What issues linked to anxiety might patients experience?
- Increased autonomic arousal + physiological symptoms related
- Avoidance behaviours
- Time consuming anxiety reducing behaviours
- Worry
- Procrastination and/or inability to make decisions
- Reduced concentration
- Impact on functioning (work, social, health)
- Impaired sleep pattern
- Alcohol and drug dependence
What are some important DDs to remember in the context of anxiety?
- Bereavement or adjustment disorders
- Other functional psych illnesses
- Organic disorders such as endocrine, neuro (dementia)
- Drug induced (steroids)
- Alcohol or drug misuse
- Infections
- Anaemia
Outline the Clark model of panic?
Panic starts with a Trigger Stimulus, this leads to:
- A perceived threat –>
- Apprehension of this threat –>
- Bodily reactions/sensations associated with this threat (e.g. hyperventilation) –>
- Interpretations of these sensations as indicating something catastrophic
Important when taking a history to go through these steps, to ensure what you’re dealing with really is a panic disorder.
What is the single most distinguishing cognitive feature of a panic attack?
Catastrophic Cognition.
Patients will often report a feeling like they’ll lose control, go crazy, die etc
What are the 3 core, diagnostic features of PTSD?
- Re-experiencing phenomena (e.g. nightmares, intrusions)
- Hyperarousal (e.g. racing heart, disturbed sleep)
- Avoidance behaviours.
What is the most effective management strategy for PTSD?
Psych > Pharm
Trauma focused CBT is NICE recommended. EMDR can be effective for non-combat trauma within 3 months of presentation.
What are the main classes of drugs used in the treatment of anxiety disorders?
- Beta-blockers (e.g. Propanolol)
- Benzodiazepines (e.g. Lorazepam, Diazepam)
- Pregabalin
- Antidepressants (namely SSRIs)
Why are beta-blockers used in the treatment of anxiety?
- Reduce autonomic system activation
- Reducing the physical symptoms involved in Clark’s anxiety cycle
- Theoretically halting the progression of anxiety into severe forms or panic
How effective are beta-blockers in the management of anxiety?
- Can be effective, sometimes given in primary care
- Limited use in secondary care
- Limited efficacy for chronic or persisting anxiety symptoms.
How do benzodiazepines work?
Increase activity of GABA (positive allosteric modulators)
What are the main issues with benzodiazepines?
Tolerance and Dependence
How does Pregabalin work in the context of anxiety, and what is it’s advantage over Benzodiazepines?
- Increases extra-cellular GAGA levels
- Also a CNS depressant
Less potential for misuse, dependence, and tolerance.
What side effects are associated with Pregabalin?
Sedation and weight gain
Distinguish between Somatisation Disorder (ala Briquet’s) and Hypochondriasis?
SD = recurring, multiple, frequently changing and current, clinically significant complaints about somatic SYMPTOMS.
H = Persistent belief of the presence of 2+ serious physical diseases (at least one specifically named by the patient)
