Fatima (Anxiety) Flashcards
Anxiety
Anxiety disorders are common mental health problems in modern society.
Global prevalence estimated about 7%.
Anxiety disorders are associated with higher levels of depression, substance abuse, accidental death and suicide.
Failure to diagnose anxiety disorders is associated with overuse of healthcare resources and increased morbidly and mortality.
What is anxiety?
A natural, commonly experienced emotion.
Spectrum of physiological and emotional responses to unpleasant or threatening situations.
- Physiological- activated sympathetic nervous system
- Cognitive component- awareness of being frightened
- Behavioural component- urge to escape
Anxiety that is excessive or interferes with normal functioning is a pathological anxiety disorder.
Can be primary (caused by experiences) and secondary anxiety (caused by drugs and diseases).
Amygdala is the area of the brain responsible for fear.
Risk factors
- Family history
- Life events causing emotional or physical stress
- Individual factors- personality traits/style, learned responses
- Childhood adversity or youthful exposure to stressful life events
Being female, unmarried, social isolation, unemployment or poverty - Co-morbid medical conditions and medications.
Secondary anxiety causes
Neurologic
- CNS neoplasm
- Chronic pain
- Encephalitis
- Parkinson’s disease
Endocrine
- Addison’s disease
- Cushing’s disease
- Hyperthyroidism
Cardiovascular
- Angina
- CCF (congestive cardiac failure)
- MI
Inflammatory
- RA (rheumatoid arthritis)
- SLE (systemic lupus erythematosus)
Gastrointestinal
- Chron’s disease
- IBS
- PUD (peptic ulcer disease)
Metabolic
- Porphyria
Respiratory
- Asthma
- COPD
- Pneumonia
Miscellaneous
- Chronic infection
- HIV
- Malignancy
Some drug use
- CNS stimulants e.g. amphetamine, cocaine, ephedrine
- CNA depressant withdrawal e.g. withdrawal from barbiturates, benzodiazepines, ethanol, opiates
- Other medications e.g. corticosteroids, prednisone, dopamine agonists, amantadine
Anxiety disorders family
This includes
- Generalised anxiety disorder (GAD)
- Panic disorder
- Agoraphobia
- Social anxiety
- Post traumatic stress disorder (PTSD)
- Obsessive compulsive disorder (OCD)
- Body dimorphic disorder
- Health anxiety
- Specific phobias
Generalised anxiety disorder
A chronic or relapsing anxiety disorder involving persistent uncontrollable worry, with physiological symptoms such as disturbed sleep, muscle tension, and difficult sleeping.
Other symptoms include feeling restless, GI symptoms, palpitations, sweating, shaking, trembling, difficulty concentrating.
Symptoms cause distressed have a significant impact on functioning and quality of life.
GAD is the most common anxiety disorder, affecting around 8% of patients that are seen in primary care.
Screening
- GAD-2 questionnaire may be used
- It asks 2 questions- over the past 2 weeks, how often have you been bothered by the following problems; feeling anxious or on edge, and, not being able to stop or control worrying.
For each question, score from 0-3
- 0 = not at all
- 2 = more than half the days
- 3 = nearly every day
A score of 3 or more suggests that further investigation is required.
Psychological therapies for GAD
Self help, group based psychoeducation based on CBT principles, digital CBT, applied relaxation.
Drug therapies for GAD
NICE recommends SSRIs as first line. Drug therapy should be continued for at least one year because of the risk of relapse.
Panic disorder
In panic disorder panic attacks become recurrent but typically happens ‘out of the blue’ without specific stimuli or situations.
Panic attacks that occur in specific or predictable situations are usually referred to as phobias rather than panic disorder.
Panic attacks
- Involves discrete episodes of intense fear. They occur rapidly and usually
peak within 10 mins.
- They are usually accompanied by intense physical symptoms for example,
sweating, trembling, palpitations, shortness of breath, chest pain and light
headedness.
- Panic attacks can appear ‘out of the blue’ or can be triggered by particular
situations.
Frequency and severity of panic attacks in panic disorder varies widely
from many times a day to one or two per month. Nocturnal panic attacks
may happen which can wake the person from sleep.
Panic disorder is sometimes associated with a persistent fear of having
further panic attacks which may cause anticipatory anxiety between panic
attacks. This can lead to marked avoidance behaviour which can cause
marked impairment of functioning.
Around twotwo-thirds of people with panic disorder also develop agoraphobiaagoraphobia, that may involve fear and avoidance of places or situations.
Panic attack is 2-3 times more common in women; the onset age is usually
early 20’s.
Patients with panic disorder are high users of primary care and emergency
services.
CBT is one of the most effective treatment
Breathing exercises and distraction are helpful skills
Benzodiazepines or sedating antihistamines should not be used.
Agoraphobia
Agoraphobia is a fear of being in situations where escape might be
difficult or that help would not be available if things go wrong.
When individuals with agoraphobia are in stressful conditions they experience symptoms of panic attacks.
A person with agoraphobia may be scared of open/public spaces such as
visiting a shopping centre, travelling on a public transport. They try to
avoid situations that may cause anxiety (avoidance behaviour). For e.g.
shopping online rather that visiting a shopping centre.
Symptoms of agoraphobia
Divided into 3 categories
- behavioural
- cognitive
- physical
Behavioural
- avoiding situations that could lead to panic attacks e.g. crowded places
Cognitive
- fear that a panic attack will make the person feel embarrassed in front of other people
- fear of being left along in the house
- feeling that they cannot function or survive without the help of others
Physical
- feeling hot and sweaty
- rapid heartbeat
- rapid breathing
- chest pain
Treatment of agoraphobia
Lifestyle changes and self help techniques e.g. regular exercise, creative visualisation
Guided self help- support of a therapist
CBT
