Anxiety Disorders Flashcards
What are the 3 models of stress?
- Biomechanical “engineering”
- Medicophysiological
- Psychological (transactional)
- Emphasises interaction between individual and environment
- Environment does not cause stress, but individual response to stressor does
What are the different foccuses for coping mechanisms?
- Problem focussed
- Where stressor is modified
- Such as preparation, studying or interview practice
- Emotion focussed
- Modify emotional reaction
- Such as mental defence mechanisms (denial relaxation training) or taking sedative drugs
What model describes how you need some stress to perform at best?
Yerkes Dodson curve
What are human reactions to stress producing anxiety?
- Psychological arousal
- Fearful anticipation
- Irritability
- Sensitivity to noise
- Poor concentration
- Worrying thoughts
- Autonomic arousal
- Symptoms mediated by autonomic nervous system
- GI
- Dry mouth
- Swallowing difficulties
- Dyspepsia, nausea and wind
- Frequent loose motions
- Resp
- Tight chest, difficulty inhaling
- CVS
- Palpitations/missed beats
- Chest pain
- Genitourinary
- Frequency/urgency of micturition
- Amenorrhoea/dysmenorrhoea
- Erectile failure
- CNS
- Dizziness and sweating
- GI
- Symptoms mediated by autonomic nervous system
- Muscle tension
- Tremor
- Headache
- Muscle pain
- Hyperventilation
- Hypocapnia
- Numbness and tingling in extremities due to carpopedal spasm
- Breathlessness
- Sleep disturbance
- Initial insomnia
- Frequent waking
- Nightmares and night terrors
What is seen in psychological arousal in response to stress?
- Psychological arousal
- Fearful anticipation
- Irritability
- Sensitivity to noise
- Poor concentration
- Worrying thoughts
What is seen in autonomic arousal in response to stress?
- Autonomic arousal
- Symptoms mediated by autonomic nervous system
- GI
- Dry mouth
- Swallowing difficulties
- Dyspepsia, nausea and wind
- Frequent loose motions
- Resp
- Tight chest, difficulty inhaling
- CVS
- Palpitations/missed beats
- Chest pain
- Genitourinary
- Frequency/urgency of micturition
- Amenorrhoea/dysmenorrhoea
- Erectile failure
- CNS
- Dizziness and sweating
- GI
- Symptoms mediated by autonomic nervous system
What are signs of muscle tension in response to stress?
- Muscle tension
- Tremor
- Headache
- Muscle pain
What is seen in hyperventilation in response to stress?
- Hyperventilation
- Hypocapnia
- Numbness and tingling in extremities due to carpopedal spasm
- Breathlessness
What are signs of sleep disturbances in response to stress?
- Sleep disturbance
- Initial insomnia
- Frequent waking
- Nightmares and night terrors
What is the difference between phobic anxiety disorders and general anxiety disorders?
Both have same core anxiety symptoms but the either occur in particular circumstances:
- Phobias
- Agarophobia (fear of leaving home and entering crowded places, travelling alone)
- Social phobia
- Specific (isolated) phobias
- General anxiety disorder (GAD)
- Occurs persistently
What does GAD stand for?
General anxiety disorder
What are different kinds of phobias?
- Agarophobia (fear of leaving home and entering crowded places, travelling alone)
- Social phobia
- Specific (isolated) phobias
What is agarophobia?
- Agarophobia (fear of leaving home and entering crowded places, travelling alone)
Pathology - generalised anxiety disorders
Persistent (several months) and symptoms not confined to a situation or object
Aetiology - generalised anxiety disorders
- No clear line between “normal” anxiety and anxiety disorders
- Differ in extent of symptoms and durations
- Stressor acting on personality predisposed to disorder
- Due to genetic factors and environmental influences since childhood
Epidemiology - generalised anxiety disorders
(sex, prevalence)
- W>M
- Prevalence 5%
Presentation - generalised anxiety disorders
- Psychological arousal
- Autonomic arousal
- Muscle tension
- Hyperventilation
- Sleep disturbance
Differential diagnosis - generalised anxiety disorders
- Psychiatric conditions
- Depression
- Schizophrenia
- Dementia
- Substance misuse
- Physical conditions
- Thyrotoxocosis
- Phaeochromoctoma
- Hypoglycaemia
- Asthma
Management - generalised anxiety disorders
- Counselling
- Clear plan of management
- Explanation and education
- Advice regarding caffeine, alcohol, exercise
- Relaxation training
- Medication
- Antideppresants
- SSRI
- TCA
- Not sedatives as high risk dependency
- Antideppresants
- Cognitive behavioural therapy (CBT)
Classification - phobic anxiety disorders
- 3 clinically important syndromes
- Specific phobia
- Common ones include: heights, blood, germs, dentist
- Social phobia
- Anxiety in situations where person feels observed or could be criticised
- Normal presentation combined with blushing and tremor
- Agorophobia
- Specific phobia
Presentation - phobic anxiety disorders
- Same core features as general anxiety but occur only in specific circumstances
Complications - phobic anxiety disorders
- Leads to people avoiding these circumstances
- Could lead to panic attack
Management - social phobia
- CBT
- Education and advice
- Medication
- SSRI antideppresants
What are the core features of OCD?
Core features are experience of recurrent obsessional thoughts and/or compulsive acts
What are obsessive thoughts?
- Ideas, images or impulse
- Occurring repeatedly and not willed
- Unpleasant and distressing
- Recognised as individual’s own thoughts
- Usual key anxiety symptoms arise because of distress of the thoughts or attempts to resist
What are compulsive acts of rituals?
- Behaviours that are repeated again and again
- Not enjoyable
- Not helpful
- Viewed by sufferer as
- Preventing some harm to self or others
- Viewed as pointless and resisted with key anxiety symptoms accompanying resistance
What are the rituals during OCD viewed as by the patient?
- Viewed by sufferer as
- Preventing some harm to self or others
- Viewed as pointless and resisted with key anxiety symptoms accompanying resistance
Aetiology - OCD
- Genetic
- Gene coding for 5HT receptors
- 5HT function abnormalities
Epidemiology - OCD
(prevalence, sex)
- Prevalence 2%
- M=F
Management - OCD
- General measures
- Education and explanation
- Involve partner/family
- Serotonergic drugs
- SSRI such as Fluoxetine
- Clomipramine
- CBT
- Psychosurgery
Pathology - PTSD
Delayed and/or protracted reaction to a stressor of exceptional severity (would distress anyone), could be:
- Combat
- Natural or human0caused disaster
- Rape
- Assault
- Torture
- Witnessing any of the above
What are some things that could cause PTSD?
- Combat
- Natural or human0caused disaster
- Rape
- Assault
- Torture
- Witnessing any of the above
Aetiology - OCD
- Stressful event which is of exceptional severity
- Vulnerability factors
- Mood disorder
- Previous trauma – especially as child
- Lack of social support
- Female
- Protective factors
- Higher education and social group
- Good paternal relationship
What are vulnerability and protective factors for OCD?
- Vulnerability factors
- Mood disorder
- Previous trauma – especially as child
- Lack of social support
- Female
- Protective factors
- Higher education and social group
- Good paternal relationship
Epidemiology - OCD
(prevalence, sex)
- 1-4% 1 year prevalence
- M:F 1:2
Presentation - OCD
- 3 key elements to reaction
- Hyperarousal
- Persistent anxiety
- Irritability
- Insomnia
- Poor concentration
- Re-experiencing phenomena
- Intense intrusive images
- Flashbacks when awake
- Nightmares during sleep
- Intense intrusive images
- Avoiding reminders
- Emotional numbness
- Cue avoidance
- Recall difficulties
- Hyperarousal
- Can happen months/years after event
What are the 3 key elements to OCD reaction?
- Hyperarousal
- Persistent anxiety
- Irritability
- Insomnia
- Poor concentration
- Re-experiencing phenomena
- Intense intrusive images
- Flashbacks when awake
- Nightmares during sleep
- Intense intrusive images
- Avoiding reminders
- Emotional numbness
- Cue avoidance
- Recall difficulties
Management - OCD
- Survivors of disasters screened at 1 month
- Mild symptoms
- Watchful waiting and review 1 month on
- More severe symptoms
- CBT
- Eye movement desensitisation and reprocessing
- Medication
- SSRI or TCA
