Fear, anxiety disorders and treatment Flashcards

1
Q

Functionality of Fear

A

Fear as a natural human reaction with basic survival function
- prepares organism for fight, flight or freeze

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2
Q

Components of anxiety

A

affective (Fear, Panic, Shame…),
cognitive,
physiological (incr. heart rate, sweating, shortness of breath..),
behavioural (flight, fight, freeze, avoidance…

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3
Q

Anxiety is referred to as pathological when…

A

… the arousal sytem is hypersensitive and responds to only minor stimuli
… there is extreme anxiety in the absence of actual danger
… intensity, duration, and/ or frequency of anxiety become distressful and chronic

–> leading to severe interference in a person‘s well-being and everyday functioning

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4
Q

List the “Classical” anxiety disorders

A
  • Agoraphobia
  • Panic disorder
  • Social phobia
  • Specific phobia
  • Generalized anxiety disorder

(some classification systems add OCD, adjustment disorder, PTSD,…)

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5
Q

What is agoraphobia?

A

Anxiety in situations or places, e. g. public transport, lifts, shopping malls, crowds, cinema, airplane, long journeys or distances from home, where it is difficult to escape and / or to get help.

+ Avoidance and/ or safety behavior,
dependence on accompanying persons

+ Agoraphobia without (F40.00) or with
panic disorder (F40.01)

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6
Q

What is “Panic disorder”?

A
  • Recurrent and unpredictable panic attacks:
    — Sudden onset and rapid increase of anxiety
    — Symptoms related to the autonomic nervous system (palpitations, chest pain, shortness of breath, sweating, tremor, dizziness, feelings of unreality etc. …)
  • Secondary fear of dying, losing control, or going mad
  • Anticipatory anxiety with impairment of functioning and behavior change for at least 1 month
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7
Q

What is social phobia?

A

= Fear of scrutiny by other people in social situations, e. g. speaking, eating, drinking in public or just being in contact with other people,
with the …

… fear to embarrass him- or herself, being critisized or humiliated, particularly by the presence of anxiety symptoms (e. g. blushing,
sweating, tremor … )

  • Avoidance and/ or safety behavior (e. g. talking fast during a meeting, breathing techniques etc. … )
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8
Q

Characterize the diagnosis “Specific Phobia” [F40.2 (ICD-10)]

A

= Exaggerated fear restricted to specific situations or objects

  • Avoidance and/ or safety behavior
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9
Q

Examples of specific phobia [F40.2 (ICD-10)]

A
  • Subtypes:
  • Animal phobias (Ophidiophobia - Snakes)
  • Natural environment phobias (Aquaphobia - Water)
  • Blood-injection-injury phobias
  • Situational phobias
  • Other phobias (e. g. clowns, vomiting etc. … )
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10
Q

Characterize “Generalized anxiety disorder [F41.1 (ICD-10)]”

A

= Exaggerated anxiety and worries that are generalized to many different topics of everyday life („free-floating“) for at least 6 months and > 50% of time per day

  • Difficulty to control or stop the worrying
  • Multiple physiological complaints such as muscular tensions, trembling, sweating, etc.…
  • Concentration problems, nervousness, insomnia, irritability
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11
Q

What model did the lecture discuss for the pathogenesis of anxiety disorders?

A

Diathesis-Stress-Model

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12
Q

What are the two main components of the Diathesis-Stress-Model?

A

Neurobiology (“predisposition”) and learning history

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13
Q

HPA Axis

A

Hypothalamus produces CRH (Corticotropin-releasing hormone)
–> Pituitary gland: ACTH (Adrenocorticotropic hormone)
–> Adrenal gland: Cortisol

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14
Q

Name 3 Learning theory models

A

Classical conditioning (Pawlow, dog - bell - saliva),

operant conditioning (Skinner, rewards and punishment)

observational learning (Bandura, bobo experiment - observe aggressive/friendly behaviour)

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15
Q

Explain Mowrer’s Two-Factor-Theory

A

!no info on slides, taken from internet and notes!

Phase 1. Classical conditioning
- individual transforms a neutral and innocuous stimulus (an airplane, a spider, an event at work, a crowded supermarket, etc.) into a painful or traumatic stimulus

Phase 2. Operant conditioning
- fear is reinforced by avoidance behaviour
e.g. avoiding train rides after a one-time panic attack on the train

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16
Q

What are functional and structural alterations of the brain related to anxiety disorders? (structure and activity change)

A

Amygdala - increased activity (GAD; panic, social, specific phobia)
ACC - increased (and decreased) (GAD; panic, social, specific phobia)
Insula - increased (panic, social, specific phobia)
Hippocampus - increased (and decreased) (panic, social phobia)
Prefrontal cortex - decreased (and increased) (panic, social phobia)

*sometimes both increased and decreased activity listed on the slide - lecturer pointed out the one that is not bracketed

17
Q

Overview over substances used in treatment of
Panic disorder, GAD and social phobia respectively:

A
18
Q

Summary and Overview Diathesis-Stress-Model

A

Anxiety disorders always result from a complex interaciton of many factors

  • interaction btw. predisposition, (constant) tension and weak/stronger stressors (life events)
19
Q

Treatments for anxiety disorders

A
  • Psychotherapy: Cognitive
    behavioral therapy (CBT)
  • Psychopharmacotherapy:
    Antidepressants
  • Psychoeducation, relaxation,
    exercise/ sport
20
Q

What are “decision parameters” in treatment selection?

A
  • Expectations of patient
  • Diagnosis/ symptomatology
  • Severity
  • Pre-treatment
  • Concomitant illness and medication
  • Availability of therapists
  • Competencies/ ressources of patient
21
Q

What options are there for psychopharmacotherapy?

A
  • alteration of monoaminergic neurotransmission (serotonin and noradrenaline) via …
  • Selective Serotonin Reuptake Inhibitors (SSRI)
  • Selective Serotonin Norepinephrine Reuptake Inhibitors (SSNRI)
  • Tricyclic Antidepressants (TCA)
22
Q

What is the aim of CBT in the treatment of anxiety disorders?

A

= reduction of avoidance and safety behavior to allow for a corrective experience, i. e.:

! Confronting the anxiety provoking stimulus repeatedly without the occurrence of the feared catastrophy!

  • integration of this new and functional experience in the patient‘s everyday life step-by-step
23
Q

Central element of psychotherapy for anxiety disorders?

A

Repeated confrontation/exposure to the most feared situation: exposure therapy
–> emotional learning via “corrective experience” (hapituation –> extinction)

24
Q

How is exposure therapy implemented?

A

combined with preparatory meetings:
- create therapeutic alliance
- psychoeducation
- cognitive strategies

confrontation with feared situation:
- no safety or avoidance behaviour allowed
- Experience of anxiety until it decreases by itself
- repitition

25
Q

Which exposures have a stronger therapeutic learning effect?

A

Exposures with high anxiety experience

26
Q

Further techniques implemented as part of CBT

A

Cognitive therapy
Schema therapy
Experience oriented methods
Biography work
Emotion focused therapy
ACT (Acceptance and commitment therapy)