Anxiety Disorders Flashcards
what are the models of stress?
- Biomechanical “Engineering”
- Medicophysiological
- Psychological (Transactional)
what is the Psychological (Transactional) model of stress?
- Interactive
- An individual’s reaction to stress will depend on a balance between their cognitive processing of any perceived threat and perceived ability to cope
- Coping:
- Problem focussed
- Emotion focussed
coping with stress can be done either problem focussed or emotion focused, what is the difference?
(E.g. with Interview or Exams)
- Problem focussed (So with a problem focussed strategy, a person attempts to influence the source of the stress to reduce or eliminate it.) - Where efforts are directed toward modifying stressor. Preparation, studying or interview practice
- Emotion focussed - Modify emotional reaction. Mental defence mechanisms eg Denial. Relaxation training. Take a sedative drug
“Fight or Flight Response” and symptoms of anxiety - what are the different symptoms groups?
- Psychological arousal
- Autonomic Arousal
- Muscle Tension
- Hyperventilation
- Sleep Disturbance
do we need stress?
We do need some stress
Optimal level of stress
Human physiological and psychological reactions to stress producing anxiety - What symptoms may you experience in regards to Psychological arousal?
- Fearful Anticipation
- Irritability
- Sensitivity to noise
- Poor concentration
- Worrying Thoughts
Human physiological and psychological reactions to stress producing anxiety - What symptoms may you experience in regards to autonomic arousal?
Symptoms mediated by the autonomic nervous system
Impact on several bodily symptoms
Human physiological and psychological reactions to stress producing anxiety - What symptoms may you experience in regards to muscle tension?
Tremor
Headache
Muscle pain
Human physiological and psychological reactions to stress producing anxiety - What symptoms may you experience in regards to hyperventilation?
Causing CO2 deficit hypocapnia
Numbness tingling in extremities may lead to carpopedal spasm (frequent involuntary spasms of the feet and the hands which are caused by lower calcium levels brought about by hyperventilating)
Breathlessness
Human physiological and psychological reactions to stress producing anxiety - What symptoms may you experience in regards to sleep disturbance?
Initial insomnia
Frequent waking
Nightmares and night terrors
part 2
Phobic Anxiety Disorders and General Anxiety Disorder: what is their similarities and differences?
Both these sets of disorders have same core anxiety symptoms but they EITHER occur in particular circumstances:
•PHOBIAS - Agoraphobia, Social phobia, Specific (Isolated) Phobias
OR Occur persistently:
•GENERALISED ANXIETY DISORDER (GAD) - It’s anxiety that is generalised and persistent and not restricted to a specific event
Phobias are in a very _________ situation where as ___ are all the time
particular
GAD
what are some symptoms you may see in GAD?
GAD usually this involves symptoms such as persistent nervousness, trembling, muscular tension, sweating, light-headedness and palpitations, dizziness, epigastric discomfort, and also fears the patient might have that some harm is going to come soon to themselves or to their loved ones.
what is a panic attack?
Panic attacks are often associated with agoraphobia and a panic attack occurs when somebody experiences sudden periods of intense fear that may include palpitations, sweating, shaking, shortness of breath, numbness or a feeling that something really bad is going to happen.
Generalised Anxiety Disorder (GAD) - when and what symptoms are experienced?
- Persistent (several months) symptoms not confined to a situation or object
- All the symptoms of human anxiety mentioned earlier can occur:
- Psychological arousal
- Autonomic Arousal
- Muscle Tension
- Hyperventilation
- Sleep Disturbance
what are some Differential Diagnosis (for) Anxiety Disorders?
there may be some overlap with the types of symptoms you would experience in an anxiety disorder that you might experience in these symptoms, in these conditions as well. So these need to be considered and ruled out
Psychiatric Conditions:
- Depression
- Schizophrenia
- Dementia
- Substance Misuse
Physical Conditions:
- Thyrotoxicosis
- Phaeochromoctoma
- Hypoglycaemia
- Asthma and or Arrhythmias
what is the Epidemiology Generalised Anxiety Disorder?
- One year prevalence around 4.4% in England
- More women affected than men (nb cultural factors and diagnosis of alcohol use)
what is the Management of Generalised Anxiety Disorder?
•Counselling
- Clear Plan of Management
- Explanation and education
- Advice re caffeine, alcohol, exercise etc.
•Relaxation training
- Group or individual
- DVDs, tapes or clinician led
•Medication
- Sedatives have high risk dependency (Sedatives are not recommended because of the high risk of dependency)
- Antidepressants SSRI or TCA (can be effective)
•Cognitive Behavioural Therapy
how can Cognitive Behavioural Therapy be used to manage GAD?
- Our emotional response to a situation will depend on our cognitive processing of it
- Identifying errors, reprocessing and reassessing responsibility are key elements
- Patients tend to find this intuitively sensible
- Maintaining remission appears superior to drug therapy (for generalised anxiety disorder)
what are the key features of Phobic Anxiety Disorders?
- Same core features as GAD
- ONLY in specific circumstances
- Person behaves to avoid these circumstances “phobic avoidance”
Sufferer also experiences anxiety if there is a perceived threat of encountering the feared object or situation “anticipatory anxiety
Phobic Anxiety Disorders - what are Three clinically important syndromes?
- Specific Phobias
- Social Phobia
- Agoraphobia
what are examples of psecific phobias?
spiders
heights
germs
dentist
blood
Social Phobia as example Phobic Disorder - what is it and what symptoms are experienced?
- Inappropriate anxiety in situation where person feels observed or could be criticised
- Restaurants
- Shops or any queues
- Public speaking
- Symptoms are any of the anxiety cluster mentioned above but blushing and tremor predominate
how do you manage a social phobia?
- Cognitive Behavioural Therapy addressing the groundless fear of criticism. CBT challenges: - Negative views of self, “Safety barriers”, Unrealistically high standards, Excessive self monitoring, CBT combats thought errors
- Education and advice
- Medication SSRI antidepressants
what is Obsessive Compulsive Disorder (OCD)?
Core features are experience of recurrent obsessional thoughts and or compulsive acts
Obsessional Thoughts:
- Ideas, images or impulses
- Occurring repeatedly not willed
- Unpleasant and distressing (often the antithesis of personality type) - Obscene, Violent or senseless
- Recognised as the individual’s own thoughts
Usual key anxiety symptoms arise because of distress of the thoughts or attempts to resist
Obsessive Compulsive Disorder (OCD) - Compulsive Acts or Rituals:
- Stereotypical behaviours _______ again and again
- Not ________ and Not _____ i.e. do not result in useful activity
- Often viewed by ______ as:
- preventing some harm to self or others; “magical undoing”
- Viewed as pointless and resisted with key anxiety symptoms accompanying resistance
repeated
enjoyable
helpful
sufferer
Obsessive Compulsive Disorder (OCD) - who does it affect?
- Overall one year prevalence is 2%
- Equally affects men and women
- Aetiological Theory:
- Genetic e.g. gene coding for 5HT receptors
- 5 HT function abnormalities
what is the management of OCD?
Good history and MSE exclude treatable depressive illness
General measures - Education and explanation, Involve partner/family
Serotonergic Drugs - SSRI eg Fluoxetine, Clomipramine (TCA)
Cognitive Behavioural Therapy (CBT) (prob best) - Exposure and response prevention, Examination of evidence to weaken convictions
Psychosurgery
Post Traumatic Stress Disorder (PTSD):
“Delayed and or protracted reaction to a stressor of exceptional severity” (would distress anyone)
what are examples of things that may cause it?
- Combat
- Natural or human-caused disaster
- Rape
- Assault
- Torture
- Witnessing any of the above
Could be a brief event or something that occurred over a long duration
a event which you would describe as exceptionally threatening or catastrophic
thinking of an event which is likely to cause pervasive distress in almost anyone
PTSD - what are the Three key elements to reaction?
- Hyperarousal
- Re-experiencing phenomena
- Avoidance of reminders
in PTSD what is hyperarousal?
- Persistent anxiety
- Irritability
- Insomnia
- Poor concentration
usually a state of autonomic hyperarousal with hyper vigilance and an enhanced startle reaction and insomnia
in PTSD what is Re-experiencing phenomena?
•Intense intrusive images
- Flashbacks when awake
- Nightmares during sleep
So typical features include episodes of repeatedly reliving the trauma and within intrusive memories. So we call these flashbacks. But also it can occur in dreams and nightmares.
in PTSD what is avoidance?
– Emotional numbness
– Cue avoidance
– Recall difficulties
– Diminishes interests
what is the Epidemiology PTSD?
- Variable cultural factors and exposure to disaster lead to a variable prevalence, 1-4% one year prevalence
- Women sufferers outnumber men 2 to 1 in USA (likely associated with sexual assault and rape)
what is the Aetiology of PTSD?
- Nature of stressor
- Life threatening and degree of exposure generally confers greater risk however
Vulnerability factors - Mood disorder, Previous trauma especially as child, Lack of social support, Female
Protective factors (examples) - Higher education and social group, Good paternal relationship
•Susceptibility partly genetic
what is the management of PTSD?
- Survivors of disasters screened at one month (after) - can take itme for PTSD to show
- Mild symptoms “watchful waiting” and review further month
- Trauma-focused CBT if more severe symptoms (most effective)
- Eye Movement Desensitisation and Reprocessing
- Risk of dependence with any sedatives but patient may prefer medication SSRI or TCA
