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NSB! > Clinical features of anxiety and stress-related disorders > Flashcards

Clinical features of anxiety and stress-related disorders Flashcards

1
Q

What is stress?

A
  • cognitive appraisal indicates whether an event is perceived as good or bad for the individual
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2
Q

There is no specific diagnosis in psychiatry, rather grouping together clusters and patterns relating to the patients behaviour. ICD-10 is used in the UK, what does this stand for?

A
  • International class of disease (ICD-10)
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3
Q

There is no specific diagnosis in psychiatry, rather grouping together clusters and patterns relating to the patients behaviour. DSM-5 is used in the USA, what does this stand for?

A
  • Diagnostic and Statistical Manual of Mental Disorders
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4
Q

The social readjustment rating scale provides a score for ‘life changing events’. What does this scale aim to do and over what timescale?

1 - rank life events on how stressful they are over 1 month
2 - rank life events on how stressful they are over 6 months
3 - rank life events on how stressful they are over 12 months
4 - rank life events on how stressful they are over 2 years

A

3 - rank life events on how stressful they are over 12 months
- higher scores equates to risk of developing a stress-related disorder

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5
Q

When we talk about the normal response to a stressor, there are 3 components. What are these?

1 - somatic, emotional, psychological
2 - physical, emotional, psychological
3 - somatic, emotional, psychological
4 - mental, emotional, psychological

A

3 - somatic, emotional, psychological
- somatic (fight or flight)
- emotional
- psychological (reduce the response and try to develop coping strategies)

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6
Q

When we talk about the normal response to a stressor, there are 3 components:

1 - somatic (fight or flight)
2 - emotional
3 - psychological (reduce the response and try to develop coping strategies)

What does the somatic response mean?

A
  • physiological response to stressor
  • do we run or fight?
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7
Q

When we talk about the normal response to a stressor, there are 3 components:

1 - somatic (fight or flight)
2 - emotional
3 - psychological (reduce the response and try to develop coping strategies)

What does the emotional response mean in relation to the following occurrences?

  • danger
  • threat
  • separation/loss
A
  • how we may feel to specific occurrences
  • danger = fear
  • threat = anxiety
  • seperation/loss = depression
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8
Q

Fear and anxiety are 2 different responses to a stressor. What is the key difference between the 2?

A
  • fear = danger is present
  • anxiety = threat is not currently present, rather anxiety/fear of the threat
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9
Q

When we talk about the normal response to a stressor, there are 3 components:

1 - somatic (fight or flight)
2 - emotional
3 - psychological (reduce the response and try to develop coping strategies)

There are 2 main types of psychological response, what are they?

1 - adaptive and toxic
2 - adaptive and maladaptive
3 - maladaptive and toxic
4 - maladaptive and irrational

A

2 - adaptive and maladaptive
- adaptive (relief and development to deal with in future and develop coping strategies)
- maladaptive (relief in short term, but long term problem)

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10
Q

Avoidance and denial are short term psychological responses to stressors. These are maladaptive, why?

1 - provides short term relief, but increases risk of depression
2 - provides short term relief, but increases risk of mortality
3 - provides short term relief, but associated with drugs and alcohol
4 - provides short term relief and no coping strategy

A

3 - provides short term relief, but associated with drugs and alcohol
- short term relief allows continued performance (alcohol or drugs use)
- alcohol or drugs use has developed into patients coping strategy

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11
Q

What is an acute stress reaction?

A
  • reaction occurs when symptoms develop due to a particularly stressful event
  • symptoms develop quickly but do not usually last long
  • events are usually very severe and an acute stress reaction typically occurs after an unexpected life crisis
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12
Q

An acute stress reaction occurs when symptoms develop due to a particularly stressful event. The symptoms develop quickly but do not usually last long. The events are usually very severe and an acute stress reaction typically occurs after an unexpected life crisis. What are some common symptoms of an acute stress reaction?

A
  • dissociative symptoms
  • insomnia
  • restlessness
  • poor concentration
  • autonomic arousal
  • anger/anxiety/depression
  • social withdrawal
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13
Q

An acute stress reaction occurs when symptoms develop due to a particularly stressful event. The symptoms develop quickly but do not usually last long. The events are usually very severe and an acute stress reaction typically occurs after an unexpected life crisis. Dissociative symptoms can occur, what are these?

1 - separation from oneself thoughts and their bodies
2 - separation from family, friends and/or the environment they are in
3 - feeling unreal and detached, separated from people, as through by a pane of glass
4 - separated from the environment

A

2 - separation from family, friends and/or the environment they are in
- patients describe an emotional numbness but separated from stressor

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14
Q

An acute stress reaction occurs when symptoms develop due to a particularly stressful event. The symptoms develop quickly but do not usually last long. The events are usually very severe and an acute stress reaction typically occurs after an unexpected life crisis. Dissociative symptoms can occur, which is an emotional numbness and separation from the stressor. People can also separate from other people, these are called Depersonalisation and Derealisation, which 2 of the below are these?

1 - separation from oneself thoughts and their bodies
2 - separation from family, friends and/or the environment they are in
3 - feeling unreal and detached, separated from people, as through by a pane of glass
4 - separated from the environment

A
  • depersonalisation = 3 - feeling unreal and detached, separated from people, as through by a pane of glass
  • derealisation = 4 - separated from the environment
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15
Q

An acute stress reaction occurs when symptoms develop due to a particularly stressful event. The symptoms develop quickly but do not usually last long. The events are usually very severe and an acute stress reaction typically occurs after an unexpected life crisis. Following an acute stress reaction patients can have a normal physiological response, however, they can also develop an adjustment disorder, what is this?

1 - an gradual and prolonger excessive response to a stressor lasting <6 months
2 - separation from family, friends and/or the environment they are in
3 - feeling unreal and detached, separated from people, as through by a pane of glass
4 - separated from the environment

A

1 - an gradual and prolonger excessive response to a stressor lasting <6 months
- >6 months it becomes a different disorder)
- occurs following an acute or ongoing stressor, no stressor means no adjustment disorder

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16
Q

What is post traumatic stress disorder?

A
  • response to exceptionally threatening or catastrophic event
  • patients experience or witness an event
  • involved actual or threatened death or serious injury …. or threat to physical integrity of self or others
  • response involved is intense fear, helplessness or horror
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17
Q

Post traumatic stress disorder is a response to exceptionally threatening or catastrophic event. Patients experience or witness an event that involves actual threat of death or serious injury …. or threat to physical integrity of self or others. The response involves intense fear, helplessness or horror. How long must a patient present with symptoms prior to a diagnosis?

1 - 1 week
2 - >1 month
3 - >6 months
4 - >12 months

A

2 - >1 month

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18
Q

What are some key features of PTSD?

A
  • increased arousal
  • dissociative symptoms (depersonalisation and derealisation)
  • hyper-vigilance (startle easily)
  • re-experiencing symptoms (flashbacks/nightmares)
  • avoiding reminders of the stressful event
  • maladaptive coping strategies (alcohol/drugs)
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19
Q

In PTSD, how soon can symptoms present?

1 - within days of the event
2 - within weeks of the event
3 - within 6 months of the event
4 - >12 months from the event

A

1 - within days of the event

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20
Q

In PTSD, what % of patients recover and what % of patients become chronic?

1 - 10% recover and 10% become chronic
2 - 30% recover and 10% become chronic
3 - 30% become chronic and recover
4 - 10% recover and 40% become chronic

A

3 - 30% become chronic and recover
- 30% recover within 3 months, but most in a year
- 30% become chronic

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21
Q

What is anxiety?

A
  • bodies natural response to stress
  • feeling of fear or apprehension about what’s to come
  • stressor may not actually be present though
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22
Q

When we think about anxiety, what are psychological responses?

A
  • fearful anticipation
  • irritability
  • restlessness
  • poor concentration
  • worry
23
Q

When we think about anxiety, what are autonomic responses?

A
  • fight or flight response
  • cardiac, respiratory, GIT and/or micturition
24
Q

When we think about anxiety, what happens to muscle tension?

A

body prepares for fight or flight
- tremors
- headaches
- aching muscles

25
Q

When we think about anxiety, what happens to respiration?

A
  • hyperventilation
  • dizziness, tingling of hands and feet, breathlessness
26
Q

When we think about anxiety, what happens to sleep?

A
  • lack of sleep
  • night terrors
  • insomnia
27
Q

What is agoraphobia?

1 - fear of spiders
2 - fear of being unable to escape
3 - fear of small spaces
4 - fear of open spaces

A

2 - fear of being unable to escape
- agora = place of meeting and phobia = fear
- fear of being in situations where escape might be difficult

28
Q

What is a generalised anxiety disorder?

A
  • patients feel anxious most of the time
  • not restrictive to a specific stressor or stimulus
29
Q

Generalised anxiety disorder is where patients feel anxious most of the time that is not restricted to a specific stressor or stimulus. How long does this last prior to a diagnosis?

1 - 1 week
2 - >1 month
3 - >6 months
4 - >12 months

A

3 - >6 months

30
Q

Generalised anxiety disorder is where patients feel anxious most of the time that is not restricted to a specific stressor or stimulus, that needs to last >6 months before being diagnosed. What is one of the key emotions patients experience?

1 - happiness
2 - sadness
3 - mental tired
4 - worry

A

4 - worry

31
Q

Generalised anxiety disorder is where patients feel anxious most of the time that is not restricted to a specific stressor or stimulus, that needs to last >6 months before being diagnosed, with the key emotion being worry. This group of patients are at an increased risk of developing other what?

1 - psychiatric conditions (depression, phobias, panic)
2 - metabolic disorders
3 - dementia
4 - CVD

A

1 - psychiatric conditions (depression, phobias, panic)

32
Q

Generalised anxiety disorder is where patients feel anxious most of the time that is not restricted to a specific stressor or stimulus, that needs to last >6 months before being diagnosed. We must be careful to ensure the diagnosis is correct. What are some common differential diagnoses?

A
  • depressive illness
  • schizophrenia
  • dementia
  • substance misuse
  • physical illness
33
Q

Generalised anxiety disorder is where patients feel anxious most of the time that is not restricted to a specific stressor or stimulus, that needs to last >6 months before being diagnosed. We must be careful to ensure the diagnosis is correct. Are men or women at an increased risk of developing this?

A
  • females (2:1 ratio)
  • generally occurs in adulthood (but broad age)
  • more common in poorer areas
34
Q

Generalised anxiety disorder is where patients feel anxious most of the time that is not restricted to a specific stressor or stimulus, that needs to last >6 months before being diagnosed. What are the 5 most common aetiologies of generalised anxiety disorder?

A
  • stressful events (trigger the initial anxiety)
  • genetics (1st degree relatives)
  • early life experiences
  • cognitive theories (coping styles or lack of, lack of self control)
  • neurobiological mechanisms
35
Q

What is panic disorder?

1 - form of anxiety
2 - form of delirium
3 - form of dementia
4 - form of psychosis

A

1 - form of anxiety
- patients regularly have sudden attacks of panic or fear
- attacks of panic do not occur with an associated phobia and are non-specific

36
Q

Are panic attacks sudden and dangerous?

A
  • occur suddenly and lasts a few minutes
  • severe, unpleasant and overwhelming, but generally relieve themselves
37
Q

What is the major difference between anxiety and anxiety experienced during a panic attacks?

1 - anxiety is more severe than anxiety in a panic attack as it is not-specific
2 - anxiety in a panic attack is more severe than anxiety

A

2 - anxiety in a panic attack is more severe than anxiety

38
Q

The reactions to panic attacks are more severe than general anxiety. What do panic attacks do to breathing?

A
  • cause hyperventilation (rapid shallow breathing)
  • reduces CO2 in the blood
  • causes dizziness, tingling, weakness, breathlessness
39
Q

Panic attacks are a form of anxiety, where patients regularly have sudden attacks of panic or fear that are not associated with a phobia and the symptoms are more severe than anxiety. What are the 3 biggest risk factors for developing panic attacks?

A

1 = genetics
2 = participating in an events that act as trigger
3 = traumatic life events

40
Q

What is a phobia?

A
  • an overwhelming and debilitating fear of an object, place, situation, feeling or animal in response to that stimulus
  • more pronounced than fears
41
Q

Specific phobias generally occur when?

1 - from birth
2 - childhood
3 - puberty
4 - adulthood

A

2 - childhood
- then continue into adulthood

42
Q

In patients with phobia, they have an unrealistic response to a specific stimulus, which can be anything, including specific locations or venues. Why is this important clinically?

A
  • patients may fear coming into a hospital
  • patients anticipate the phobia and experience huge anxiety
43
Q

Blood injury phobias are a serious problem. There is said to be a biphasic (means 2 responses) anxiety reaction in patients, what is this?

1 - 2 consecutive stimulations of the sympathetic system
2 - 2 consecutive stimulations of the para-sympathetic system
3 - stimulation of the sympathetic and then para-sympathetic system
4 - stimulation of the para-sympathetic and then sympathetic system

A

3 - stimulation of the sympathetic and then para-sympathetic system
- initial reaction = sympathetic arousal (tachycardia)
- second reaction = parasympathetic arousal (fainting)

44
Q

How is classical conditioning associated with developing phobias?

A
  • experience an encounter with a specific event or object
  • patient attends hospital and has bad reaction to medication
  • patient will then associate coming into hospital with similar responses
45
Q

How does the “Biological preparedness” hypothesis contribute to phobias?

1 - following an initial fear of something that persists and develops into a phobia
2 - developing a phobia from birth
3 - developing a phobia based on survival and what we should be scared of

A

3 - developing a phobia based on survival and what we should be scared of
- we know we should run from bears and lions

46
Q

What is social anxiety disorder, also known as social phobia?

A
  • inappropriate levels of anxiety during social events
  • social interaction (chatting to someone)
  • being watched (eating)
  • performing in front of others
47
Q

Social anxiety disorder, also known as social phobia is an inappropriate levels of anxiety during social events, such as:

  • social interaction (chatting to someone)
  • being watched (eating)
  • performing in front of other

What can this lead to?

A
  • people avoiding social interactions that trigger anxiety
  • avoidance is the patients coping strategy
48
Q

Social anxiety disorder, also known as social phobia is an inappropriate levels of anxiety during social events. If a patient has to come out and mix with people in a social event, how can these patients present?

A
  • severe anxiety
  • panic attacks
49
Q

What is Obsessive compulsive disorder?

A
  • a person has obsessive thoughts
  • a person has compulsive behaviours
50
Q

Obsessive compulsive disorder is when a person has obsessive thoughts and compulsive behaviours. What other psychiatric disorders are these patients likely to have?

A
  • anxiety
  • depression
  • depersonalisation (isolate from others)
51
Q

What are obsessions and compulsions?

1 - obsessions = behaviours and compulsions = thoughts (doubts, impulses, rumination’s)
2 - obsessions = thoughts (doubts, impulses, rumination’s) and compulsions = behaviours

A

2 - obsessions = thoughts (doubts, impulses, rumination’s) and compulsions = behaviours

52
Q

When does obsessive compulsory disorder become a disorder and not just a compulsion?

1 - when present for >6 months
2 - when it interferes with life and function
3 - when present for >2 years

A

2 - when it interferes with life and function

53
Q

What are some of the main themes that patients obsess over?

A
  • dirt/contamination
  • aggression
  • orderliness
  • illness
  • sex
  • religion
54
Q

Are compulsions (actions) in isolation from obsessions (thoughts)?

A
  • no
  • obsessions lead to compulsions

NSB! (53 decks)

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