Anxiety disorders: Clinical picture Flashcards

Question

Describe some biological models of the aetiology of panic

Answer 1

Panic attacks may be triggered in the locus coeruleus ↑ firing associated with ↑ CO2 etc Noradrenergic agents (yohimbine & isoproterenol) stimulate attacks in sufferers SSRIs are effective but contradictory findings regarding the role of serotonin γ-Aminobuyric acid (GABA) has a role: Benzodiazepine agonists are clearly effective Benzodiazepine antagonist (flumazenil) aggravates attacks Cholecystokinin causes panic attacks in animals & pentagastrin causes attacks in panic disorder patients

Answer 2

Inappropriate anxiety in the presence of one or more particular objects or situations Characterised by adding the name of the stimulus (e.g. Spider Phobia) Avoid jargon (e.g. Arachnophobia)

Answer 3

Blood, injection, injury – a specific case? Animals & Insects Aspects of the natural environment (e.g. heights) Situational (e.g. flying) Other (e.g. dental/medical procedures, choking, etc.).

Answer 4

Individuals with blood–injection–injury phobias exhibit a biphasic anxiety reaction: Initial short-lived sympathetic arousal Followed by parasympathetic arousal May result in vasovagal syncope The subjective experience tends to disgust and repulsion rather than pure apprehension In other subtypes, exposure to the phobic stimulus evokes intense anxiety that may meet the criteria for a situationally bound panic attack There is extreme apprehension and desire to escape or avoid the phobic stimulus

Answer 5

>80% experience at least one lifetime psychiatric disorder (odds ratio 5x) Lifetime prevalence: 11.3% Mean age of onset: 15 years Animal phobias onset age 7 Blood phobias onset age 9 Claustrophobia onsets age 20 Women > men (blood–injection–injury phobia did not differ)

Answer 6

``` All Specific Phobias: evidence for genetic transmission 31% of 1st degree relatives affected Animal phobias: monozygotic 26% Dizygotic 11% ```

Answer 7

Psychoanalytic approach: Symptoms related to unresolved unconscious conflicts Classical conditioning: phobias are learned through association of negative experience with an object or situation Marks’ ‘preparedness’ theory maintains that commonly feared objects are those that historically threatened the survival of the individual or the species Large number of studies suggest that phobias may be acquired via observational learning

Answer 8

Inappropriate anxiety in: Situations where the person is observed Situations where there is potential for criticism Leads to avoidance of trigger situations Eating in public Dinner parties Committees, seminars, public speaking

Answer 9

Anticipatory anxiety Feeling anxious Blushing Trembling (observed writing is a problem) Relieved by alcohol (potential for abuse)

Answer 10

Possibly as high as 7% of primary care patients Lifetime risk 2.4 – 13.3% depending upon the definition of “caseness” 81% at some time meet the criteria for another psychiatric disorder (very high comorbidity) Onset usually early in life 1st peak before age 5 2nd peak between 11 – 15 Presentation unusual after age 30 Women > men, but men more likely to present

Answer 11

Both genetics and environmental factors contribute, with genetics contributing < ⅓ of the variance in the transmission 16% of relatives of probands vs 5% of relatives of controls Monozygotic > dizygotic

Answer 12

``` Obsessional thoughts / images Words, ideas, beliefs and/or images Recognised as own Intrude forcibly into the mind They are resisted Compulsions reduce anxiety Cleaning/checking Precision – ‘just right' ``` ``` Obsessional impulses Urges to perform acts Obsessional rituals Magic words or numbers Desire to complete acts (e.g. hand washing) ```

Answer 13

Contamination – washing Compulsions – the need to act on the obsessions Doubts - checking

Answer 14

Several researchers have reported lifetime prevalence of 2-3% This rate has been confirmed across different cultures ``` Men = women Some reports suggest a slight female predominance During adolescence, boys > girls. Mean age of onset is ~ 20 years of age. Prevalence 2-3% ```

Answer 15

Major depressive episode: ~67% lifetime prevalence ↑ lifetime risk for: alcohol disorders social phobia specific phobia panic disorder eating disorders Schizophrenia tic disorders (~ 40% in juvenile OCD) ↑ prevalence of Tourette’s syndrome in relatives Unclear relationship between OCD & obsessive–compulsive personality disorder (OCPD), but it appears that OCPD is not a prominent risk factor for OCD

Answer 16

Serotonin dysregulation: Evidence from efficacy of various serotonergic drugs Dopamine dysfunction: Evidence from abundance of OCD symptoms in basal ganglia disorders The therapeutic benefits from co-administration of dopamine blockers and SSRIs in a subset of patients with OCD and tic disorders

Answer 17

Monozygotic >> dizygotic | First-degree relatives of patients with childhood-onset OCD have a higher than expected incidence of OCD

Answer 18

Obsessions are conditioned stimuli: when a relatively neutral stimulus is coupled with an anxiety-provoking stimulus, it produces anxiety when presented alone Compulsions reduce anxiety and the patient repeats them and learns them in order to avoid anxiety Avoidance strategies are learned and become fixed

Answer 19

Obsessional Neurosis first described by Freud | The disorder was thought to result from a regression from the Oedipal Phase to the Anal Phase

Anxiety disorders: Clinical picture Flashcards

(43 cards)