Anxiety & Stress-Related Disorders

Question 1

What are the two main literature books used for diagnoses in psychiatry?

Answer 1

ICD-11 (International Classification of Disease)

DSM-5 = (Diagnosis and Statistical Manual of Mental Disorders)

Question 2

How has stress changed with evolution of mankind?

Answer 2

Has gone from being more acute fight / flight stresses to a more chronic stress on a daily basis

Question 3

What is a stressor?

Answer 3

An event or situation that causes stress.

Question 4

What did Holmes & Rahe develop?

Answer 4

The social readjustment rating scale - determines how stressful an event is deemed on a numeric scale.

Question 5

What three types of response can you have to a stressor?

Answer 5

Somatic response
Emotional response
Psychological response

Question 6

What is a somatic response?

Answer 6

A physical response (e.g. activation of fight / flight system) = Inc HR, BR, sweating

Question 7

What is the difference between anxiety and fear?

Answer 7

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.

Question 8

What is the emotional response to danger?

Answer 8

Fear

Question 9

What is fear?

Answer 9

An emotional response to danger

Question 10

What is anxiety?

Answer 10

An emotional response to threat of danger

Question 11

What is depression?

Answer 11

An emotional response to separation / loss

Question 12

Name three potentially helpful responses to stress.

Answer 12

Avoidance / denial (in the short term)

Working out how to remove / resole the problem

Coming to terms with the problem

Question 13

Name three maladaptive ways Ps deal with stress

Answer 13

Alcohol / drug misuse

Aggressive / exaggerated behaviours

Deliberate self-harm

Question 14

If someone undergoes an exceptionally stressful event - what is the immediate response to this known as?

Answer 14

Acute stress reaction

Question 15

What is an acute stress reaction?

Answer 15

Severe symptoms of the normal stress reaction - that usually appear within a few hours to days after the stressor event

Question 16

When does the acute stress reaction usually resolve?

Answer 16

Normally within a few days of the event / removal of threat.

Question 17

How long can a patient be termed to be suffering from acute stress reaction? What does it become if it persists beyond this point?

Answer 17

Up to one month = ongoing acute stress reaction.

After one month = PTSD

Question 18

What symptoms can indicate an acute stress reaction?

Answer 18

Dissociative symptoms
Insomina
Restlessness
Poor concentration
Autonomic arousal
Anger / anxiety / depression
Social withdrawal

Question 19

What are dissociative symptoms?

Answer 19

Emotional numbness - feel like being in a daze, can cause inability to recall the stressful event

Question 20

What are the two main types of dissociative symptoms?

Answer 20

Depersonalisation

Derealisation

Can have both at the same time

Question 21

What is depersonalisation?

Answer 21

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.

Question 22

What is derealisation?

Answer 22

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.

Question 23

What is it called when the P has an out of proportion response to a stressor, with more gradual onset and prolonged response?

Answer 23

Adjustment disorder

Question 24

What does adjustment disorder arise from?

Answer 24

As a direct consequence of acute stress or ongoing stress.

Question 25

How can you differentiate between adjustment disorder and other behavioural disorders?

Answer 25

The adjustment disorder would not have arisen had it not been for the presence of the stressor in the P's life.

Question 26

What is PTSD?

Answer 26

A response to an exceptionally threatening or catastrophic event - with symptoms that last for at least a month.

Question 27

What are PTSD symptoms?

Answer 27

Increased arousal Dissociative symptoms Hypervigilance / startle Flashbacks / nightmares Avoiding reminders of the stressful event Maladaptive coping strategies

Question 28

What is the minimum period of time that has to pass from the stressor before a diagnosis of PTSD can be confirmed?

Answer 28

1 month

Question 29

What percentage of PTSD recover within 3 months and what percentage develop chronic PTSD?

Answer 29

30% 30%

Question 30

Give an example of an anxiety disorder in which the P feels anxious all the time.

Answer 30

Generalised anxiety disorder

Question 31

What is an anxiety disorder that is experience by a P only in a specific situation (e.g. spider runs over Hannah's hand)?

Answer 31

Phobia

Question 32

Which anxiety disorder can be experienced by a P for intermittent periods of time but irrelevant of the situation the P is in?

Answer 32

Panic disorder

Question 33

What is OCD termed as?

Answer 33

An anxiety disorder

Question 34

What are the general symptoms of anxiety disorders?

Answer 34

Psychological arousal Autonomic arousal (F or F) Muscle tension Hyperventilation Sleep disturbance

Question 35

How can psychological arousal present in anxiety?

Answer 35

Fearful Ps Irritability Restlessness Poor concentration Worry

Question 36

How does autonomic arousal present in anxious patients?

Answer 36

Respiratory - tightness & SOB GI - dry mouth, swallowing inhibition, epigastric pain & diarrhoea CVS - palpitations & discomfort GUI - need to wee, failure of erection, menstrual discomfort

Question 37

What are the muscle symptoms of anxiety?

Answer 37

Tremor Headaches Aching muscles

Question 38

What are the symptoms of hyperventilation?

Answer 38

Dizziness Tingling hands & feet Feeling breathless

Question 39

What sleep disturbances can you have with anxiety?

Answer 39

Insomnia Night terrors

Question 40

What is the disorder when symptoms of anxiety persist all the time and are not restricted to a specific set of circumstances?

Answer 40

Generalised anxiety disorder

Question 41

What symptoms are often found with generalised anxiety disorder?

Answer 41

Worry Fearful apprehension Headache Irritability Poor concentration Autonomic arousal Sleep disturbances

Question 42

What symptoms can also be found in conjunction with generalised anxiety disorder?

Answer 42

Depersonalisation Low mood Fixation with detail

Question 43

What other differentials can there be for generalised anxiety disorder?

Answer 43

Other anxiety disorders Depressive illnesses Schizophrenia Dementia Substance misuse Physical illness

Question 44

Who is more likely to be affected by generalised anxiety disorder?

Answer 44

Females more than males (2:1) Also associated with - Lower income, unemployment, divorced/separated Ps

Question 45

What are the possible causes of generalised anxiety disorder?

Answer 45

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.

Question 46

Which disorder means the P has recurrent panic attacks that are not in response to a phobic stimulus?

Answer 46

Panic disorder

Question 47

How long do panic attacks last?

Answer 47

2-3 minutes

Question 48

What are the symptoms of a panic attack?

Answer 48

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

Question 49

What does hyperventilation cause?

Answer 49

Reduced CO2 in blood -> dizziness, tingling, tinnitus, weakness, faintness, SOB

Question 50

What are the risk factors for panic disorder?

Answer 50

Genetics (x7 if first degree relative) Precipitating events (stressful life events) Traumatic early life events

Question 51

What can phobias be divided into?

Answer 51

Specific phobias Agoraphobia Social anxiety disorders

Question 52

When do most specific phobias begin?

Answer 52

Childhood

Question 53

What are the symptoms of a specific phobia?

Answer 53

Phobia regarding specific circumstances - with anticipatory anxiety + intense anxiety + avoidance

Question 54

Why do some patients faint with phobias?

Answer 54

There is a biphasic anxiety reaction - initial short SS arousal followed by PSS arousal = vasovagal syncope

Question 55

What are the causes of specific phobias?

Answer 55

Genetics Classical conditioning Biological preparedness hypothesis

Question 56

What is the biological preparedness hypothesis?

Answer 56

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.

Question 57

Which disorder affects a P by giving inappropriate anxiety regarding social interactions / being observed by others?

Answer 57

Social anxiety disoder

Question 58

What are the symptoms of social anxiety disorder?

Answer 58

Anticipatory anxiety Anxiety Blushing Trembling Nausea

Question 59

What can social anxiety disorder be relieved by in the short term?

Answer 59

Alcohol

Question 60

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?

Answer 60

Agoraphobia

Question 61

What do Ps with agoraphobia fear?

Answer 61

Confinement Crowding Distance from home (especially when alone)

Question 62

What are the clinical features of agoraphobia?

Answer 62

Anxiety symptoms and panic attacks about loss of control - leading to extreme avoidance of these situations.

Question 63

Which disorder means the P suffers with obsessional thinking and compulsive behaviour?

Answer 63

Obsessive Compulsive Disorder

Question 64

What other psychiatric symptoms can present with OCD?

Answer 64

Anxiety Depression Depersonalisation

Question 65

What are obsessional thoughts?

Answer 65

Thoughts / doubts / impulses which intrude forcibly into the mind. They cannot be resisted, usually unpleasant and are unwanted intrusions.

Question 66

What are compulsive behaviours?

Answer 66

Repetitive, purposeful behaviours carried out in a stereotyped way in response to an obsession.

Question 67

What are thought to be the risk factors for OCD?

Answer 67

Genetic link Brain disorder evidence (encephalitis & Sydenham's chorea) Neurobiological factors Also are psychoanalytic and cognitive theories