Anxiety & Stress-Related Disorders Flashcards
What are the two main literature books used for diagnoses in psychiatry?
ICD-11 (International Classification of Disease)
DSM-5 = (Diagnosis and Statistical Manual of Mental Disorders)
How has stress changed with evolution of mankind?
Has gone from being more acute fight / flight stresses to a more chronic stress on a daily basis
What is a stressor?
An event or situation that causes stress.
What did Holmes & Rahe develop?
The social readjustment rating scale - determines how stressful an event is deemed on a numeric scale.
What three types of response can you have to a stressor?
Somatic response
Emotional response
Psychological response
What is a somatic response?
A physical response (e.g. activation of fight / flight system) = Inc HR, BR, sweating
What is the difference between anxiety and fear?
Fear is what we experience when there is a real danger in front of us.
Anxiety = the experience we have when there is a threat of danger.
What is the emotional response to danger?
Fear
What is fear?
An emotional response to danger
What is anxiety?
An emotional response to threat of danger
What is depression?
An emotional response to separation / loss
Name three potentially helpful responses to stress.
Avoidance / denial (in the short term)
Working out how to remove / resole the problem
Coming to terms with the problem
Name three maladaptive ways Ps deal with stress
Alcohol / drug misuse
Aggressive / exaggerated behaviours
Deliberate self-harm
If someone undergoes an exceptionally stressful event - what is the immediate response to this known as?
Acute stress reaction
What is an acute stress reaction?
Severe symptoms of the normal stress reaction - that usually appear within a few hours to days after the stressor event
When does the acute stress reaction usually resolve?
Normally within a few days of the event / removal of threat.
How long can a patient be termed to be suffering from acute stress reaction? What does it become if it persists beyond this point?
Up to one month = ongoing acute stress reaction.
After one month = PTSD
What symptoms can indicate an acute stress reaction?
Dissociative symptoms
Insomina
Restlessness
Poor concentration
Autonomic arousal
Anger / anxiety / depression
Social withdrawal
What are dissociative symptoms?
Emotional numbness - feel like being in a daze, can cause inability to recall the stressful event
What are the two main types of dissociative symptoms?
Depersonalisation
Derealisation
Can have both at the same time
What is depersonalisation?
Feeling of disconnection within yourself & from other people - that you feel unreal and detected, and that your thoughts and feelings are of those of another person - feel separated via a pane of glass. Watching yourself from afar in 3rd person.
What is derealisation?
World around you is unreal.
This can feel as if reality is a dream, a TV show, or that it’s fake and could cease to exist at any moment. It can feel like you’re seeing the world from inside a glass bubble. You can feel a disconnection from the people around you, as if they’re actors or robots. Colours , objects, the whole world can look like it’s flat, 2D and unreal.
What is it called when the P has an out of proportion response to a stressor, with more gradual onset and prolonged response?
Adjustment disorder
What does adjustment disorder arise from?
As a direct consequence of acute stress or ongoing stress.
How can you differentiate between adjustment disorder and other behavioural disorders?
The adjustment disorder would not have arisen had it not been for the presence of the stressor in the P’s life.
What is PTSD?
A response to an exceptionally threatening or catastrophic event - with symptoms that last for at least a month.
What are PTSD symptoms?
Increased arousal
Dissociative symptoms
Hypervigilance / startle
Flashbacks / nightmares
Avoiding reminders of the stressful event
Maladaptive coping strategies
What is the minimum period of time that has to pass from the stressor before a diagnosis of PTSD can be confirmed?
1 month
What percentage of PTSD recover within 3 months and what percentage develop chronic PTSD?
30%
30%
Give an example of an anxiety disorder in which the P feels anxious all the time.
Generalised anxiety disorder
What is an anxiety disorder that is experience by a P only in a specific situation (e.g. spider runs over Hannah’s hand)?
Phobia
Which anxiety disorder can be experienced by a P for intermittent periods of time but irrelevant of the situation the P is in?
Panic disorder
What is OCD termed as?
An anxiety disorder
What are the general symptoms of anxiety disorders?
Psychological arousal
Autonomic arousal (F or F)
Muscle tension
Hyperventilation
Sleep disturbance
How can psychological arousal present in anxiety?
Fearful Ps
Irritability
Restlessness
Poor concentration
Worry
How does autonomic arousal present in anxious patients?
Respiratory - tightness & SOB
GI - dry mouth, swallowing inhibition, epigastric pain & diarrhoea
CVS - palpitations & discomfort
GUI - need to wee, failure of erection, menstrual discomfort
What are the muscle symptoms of anxiety?
Tremor
Headaches
Aching muscles
What are the symptoms of hyperventilation?
Dizziness
Tingling hands & feet
Feeling breathless
What sleep disturbances can you have with anxiety?
Insomnia
Night terrors
What is the disorder when symptoms of anxiety persist all the time and are not restricted to a specific set of circumstances?
Generalised anxiety disorder
What symptoms are often found with generalised anxiety disorder?
Worry
Fearful apprehension
Headache
Irritability
Poor concentration
Autonomic arousal
Sleep disturbances
What symptoms can also be found in conjunction with generalised anxiety disorder?
Depersonalisation
Low mood
Fixation with detail
What other differentials can there be for generalised anxiety disorder?
Other anxiety disorders
Depressive illnesses
Schizophrenia
Dementia
Substance misuse
Physical illness
Who is more likely to be affected by generalised anxiety disorder?
Females more than males (2:1)
Also associated with
- Lower income, unemployment, divorced/separated Ps
What are the possible causes of generalised anxiety disorder?
Not really known for sure - but combination of
- Stressful events
- Genetic
- Early adverse experiences
Are also cognitive theories and neurobiological mechanisms which can account for a diagnosis of GAD.
Which disorder means the P has recurrent panic attacks that are not in response to a phobic stimulus?
Panic disorder
How long do panic attacks last?
2-3 minutes
What are the symptoms of a panic attack?
Sudden onset of severe anxiety symptoms
Palpitations
Sensation of being unable to breathe / choking
Dizziness and faintness
Dissociation
Chest pain
Fear of dying
Fear of losing control / sanity
What does hyperventilation cause?
Reduced CO2 in blood -> dizziness, tingling, tinnitus, weakness, faintness, SOB
What are the risk factors for panic disorder?
Genetics (x7 if first degree relative)
Precipitating events (stressful life events)
Traumatic early life events
What can phobias be divided into?
Specific phobias
Agoraphobia
Social anxiety disorders
When do most specific phobias begin?
Childhood
What are the symptoms of a specific phobia?
Phobia regarding specific circumstances - with anticipatory anxiety + intense anxiety + avoidance
Why do some patients faint with phobias?
There is a biphasic anxiety reaction - initial short SS arousal followed by PSS arousal = vasovagal syncope
What are the causes of specific phobias?
Genetics
Classical conditioning
Biological preparedness hypothesis
What is the biological preparedness hypothesis?
That today’s commonly feared stimuli are those historically linked to threatening the survival of the species - and that we are genetically more prepared to learn to fear these stimuli.
Which disorder affects a P by giving inappropriate anxiety regarding social interactions / being observed by others?
Social anxiety disoder
What are the symptoms of social anxiety disorder?
Anticipatory anxiety
Anxiety
Blushing
Trembling
Nausea
What can social anxiety disorder be relieved by in the short term?
Alcohol
Which disorder means Ps have intense fear and anxiety in situations which might make escape difficult and/or fear that help may not be available?
Agoraphobia
What do Ps with agoraphobia fear?
Confinement
Crowding
Distance from home (especially when alone)
What are the clinical features of agoraphobia?
Anxiety symptoms and panic attacks about loss of control - leading to extreme avoidance of these situations.
Which disorder means the P suffers with obsessional thinking and compulsive behaviour?
Obsessive Compulsive Disorder
What other psychiatric symptoms can present with OCD?
Anxiety
Depression
Depersonalisation
What are obsessional thoughts?
Thoughts / doubts / impulses which intrude forcibly into the mind. They cannot be resisted, usually unpleasant and are unwanted intrusions.
What are compulsive behaviours?
Repetitive, purposeful behaviours carried out in a stereotyped way in response to an obsession.
What are thought to be the risk factors for OCD?
Genetic link
Brain disorder evidence (encephalitis & Sydenham’s chorea)
Neurobiological factors
Also are psychoanalytic and cognitive theories
