Anxiety Related Disorders Flashcards
Define anxiety
Preoccupied and avoidance, excessive worry
Is anxiety higher among men or women?
Women and decreases with age
What are the most common anxiety disorders?
PTSD and Social Phobia Disorder
List 4 key features of anxiety
- Psyhsiological symptoms
- Avoidance symptoms
- Disturbances in attention - intrusive thoughts, attention biases, re experiencing symptoms
- Subjective feeling of anxiety
What is Specific Phobia?
Fear or anxiety about a specific object or situation eg animal, blood, dentist
What is Dentophonbia?
Fear of the dentist
What is Social Anxiety Disorder?
Fear about one or more social or performance situation in which the person is exposed to possible scrutiny by others.
What are the clinical features of Social Anxiety Disorder?
- Hypersentive to criticism
- Non-assertive
- Low self-esteem
- Comorbid anxiety is common
- Safety behaviours including avoiding eye contact, covering face with hair
Takes observer perspective for social memories - Information processing biases eg negative interpretation of social events, does not detect positive responses of others, focus on the negatives in post event processing.
What is Panic Disorder?
Recurrent and unexpected panic attacks. At least one attack followed by one month of:
- persistent concern about another attack
- significant maladaptive change in behaviour
- Rule out specific phobia, other conditions and substance abuse
What are 4 or more symptoms must occur for a panic attack?
- Palpitations/pounding heart
- Trembling/Shaking
- Feeling of choking
- Nausea/abdominal pain
- Chills/hot flushes
- Derealisation (unreality)/Depersonalisation (detach)
- Fear of losing control/going crazy
- Sweating
- Shortness of breath
- Chest pains/discomfort
- Dizziness/light headness
- Paresthesias (numbness/tingling)
- Fear of dying
What is agoraphobia?
Anxiety about being in a place where escape might be difficult or embarrassing if a panic attack occurs.
List the fears that at least must be present for a diagnosis of Agoraphobia.
- Using public transport
- being in open spaces
- being in enclosed spaces
- standing in line or being in a crowd
- being outside of the home alone
List 6 other anxiety disorders
- Separation Anxiety Disorder
- Selective mutisim
- Substance/Medication induced anxiety disorder
- Anxiety disorder due to medical condition
- Other specified anxiety disorder
- Unspecified anxiety disorder
What is Generalised Anxiety Disorder?
Excessive worry about numerous events/activities with difficulty in controlling the worry
What 3 symptoms must you experience to be diagnosed with Generalised Anxiety Disorder?
- Restlessness/on edge
- Easily fatigued
- Difficulty concentrating/mind blank
- Irritability
- Muscle tension
- Sleep disturbance
- worry and anxiety must cause significant interference
What 3 traits are present in individuals with Generalisd Anxiety Disorder?
- Less tolerance for uncertainty
- Underestimate coping ability
- Overestimate the likely event of negative consequences
What is Body Dysmorphic Disorder?
Fixation on one part of the body
What is Hoarding Disorder?
Inability to let go of objects
What is Trichotillomania?
Hair pulling disorder
What is Excoriation?
Skin picking disorder
What is Obsessive Compulsive Disorder?
Obsessive thoughts and compulsive behaviours to stop the thoughts
What are the DSM-V criteria for OCD?
- Obsessions, compulsions or both
- Cause distress and time consuming (>1hr/day) or cause significant interference
- Not restricted to another axis disorder (eg food obsession in eating disorder)
- Not due to substance abuse or medical condition
- Pecify if with good or fair insight, with poor insight, with absent insight/delusional beliefs.
Is OCD high in males or females?
Females
What is age of onset for OCD?
childhood/teenage. Rare after 35yo.
What forms do obsessions take in OCD?
- Thoughts
- Images
- Impulses
What are common compulsions in OCD?
- Checking
- Washing
- Counting
- Confessing
- Hoarding
What is the context of obsessions in OCD?
- Violent
- Sex
- Blasphemy and sacrilege
What are not obsessions?
- Worries about real life eg work
- Depressive remunerations (thinking/mulling)
- Recurrent sexual fantasies
- Jealousy
- Preoccupations eg car or boyfriend
- Cravings to gamble, drink, etc
What is Post Traumatic Street Disorder?
Exposure to actual or threatened death or serious injury or sexual assault via:
- directly
- witnessing
- learning about it happening to someone close to us
- experiencing repeated/extreme exposure to aversive details
How long must symptoms be present for a diagnosis of PTSD?
1 month
What must be present for a diagnosis of PTSD?
- Involuntary and intrusive distressing memories
- Distressing dreams
- Dissociative reaction eg flashbacks
- Distress or reactivity to cues that resemble event
- Avoidance of stimuli associated with event
- Negative alterations to cognitions and mood eg inability to remember important aspects of trauma, persistent negative state (fear, anger), avolition, detached feelings
What is Acute Stress Disorder?
Must have 9 or more of PTSD symptoms present for 3 days to 1 month and cause significant distress and impairment
What is Adjustment Disorder?
- Distress is out of proportion to stressor eg death of a loved one or starting uni and occurs within 3 months of stressor
- Significant impairment to functioning
- Symptoms do not persist past 6 months
What are the physiological arousal symptoms of trauma and stress related disorders?
- Irritability or angry outbursts
- Reckless or self destructive behaviour
- Hypervigilence
- Exaggerated startle response
- Difficulty concentrating
- Sleep disturbance
What is the Psychodynamic aetiology for Anxiety?
Conflict between unconscious sexual or aggressive wishes (ID) and threats to SuperEgo. When impulse is too high anxiety occurs.
What is the Evolutionary aetiology for Anxiety?
Anxiety is part of protective adaptive system (flight or fight)
What is the Biological aetiology for Anxiety?
- Genetic Predisposition: High concordance in MZ than DZ
- Neuroanatamy/Biology - 2 pathways (subcortical for fight or flight or cortex for slower analysis) so pathways may fire incorrectly.
What happens to anxiety when serotonin and GABA increase?
Anxiety descreases
What part of the brain are affected by anxiety?
Cortical-striatal thalmac circuit (Prefrontal cortex, thalamas, basal ganglia)
What is the Psychosocial aetiology for Anxiety?
- Stressful life events
- Childhood adversity
- Overprotective/controlling parents
- Child temperament/behaviour
- Insecure attachment
What is the Behavioural aetiology for Anxiety?
- Classic conditioning (little albert)
- Operant conditioning - avoidant behaviours negatively reinforce
- Vicarious/observational learning
What is the Cognitive aetiology for Anxiety?
- Misinterpret ambiguous situations as danger
- Maladaptive thoughts/beliefs
- Catastrophic misinterpretation
- Attentional bias to threat
- Thought suppression
- Fear of fear model
- Thought fusion leads to psychological rigidity based on acceptance and commitment therapy
What are the Biological treatments for Anxiety?
Anxiety is due to decreased serotonin:
- Benzodiazepines (GABA transmission), valium
- Tricyclics
- Antidepressants eg SSRI’s ;ike zoloft, prozac, luvox
What are the side effects of Benzodiapines?
- Sedation
- Impaired psychomotor skills
- Decreased attention and memory
- Highly addictive
What are the side effects of Tricyclics?
- Weight gain
- Dry mouth
- Nervous
- Sleeping problems
What are the Psychodynamic treatments for Anxiety?
- Free association
- Dream interpretation
- Interpersonal Psychotherapy
What are the Cognitive and Behavioural treatments for Anxiety?
- Psychoeducation - anxiety is normal and it will pass
- Relaxtion
- Identify anxiety provoking cognitions and restructure them
- Exposure therapy - gradual and repeated exposure to fear based on hierarchical model
- Acceptance and Commitment Therapy - increases patients willingness to take part in exposure therapy
