Generalised anxiety, panics and phobias Flashcards
Describe some of the physical symptoms of anxiety?
- sweats/hot flushes/cold chills
- trembling/shaking
- muscle tensions/aches/pains
- numbness/tingling
- dizzy/unsteady/faint/lightheaded
- dry mouth
- feeling of choking
- globus/difficulty swallowing
- difficulty breathing
- chest pain/discomfort
- palpitations/pounding heart/tachycardia
- nausea/abdominal distress (churning stomach)
Describe some of the cognitive symptoms of anxiety?
- fear of losing control/’going crazy’/dying
- feeling ‘keyed up’/on edge/mentally tense
- derealisation
- depersonalisation
- hypervigilance
- metaworry
- health anxiety
- beliefs about importance of worry
- preferance for order/routine
Why does everyone have anxiety and fear?
-genetically ingrained function of neurological system wih adaptive evolutionary significance
What do co-ordinated neural systems do during periods of anxiety/fear?
They orchestrate perceptual, physiological and behavioral responses that promote survival
-emotion arises from neural processes that cause organism to freeze(distant or inescapable threat) or flee (threat nearby and escapable)
What is the stress response?
exposure to stress = instantaneous and concurrent biological response
- assess danger and organise appropriate response
Describe the role of the amygdala in the stress response? How is this then modified?
The amygdala acts as an emotional filter and assesses whether sensory material from the thalamus requires a stress or fear response
This is modified later by later-received cortically process signals
= series of responses to stressor before stimulation of the adrenal gland to release cortisol
(act first, think later)
Describe the role of cortisol in the stress response
acute stress = dose dependant increase in catecholamines and cortisol
-cortisol acts to mediate and shut down the stress response through negative feedback, acts on the pituatary/hypothalamus/hippocampus/amygdala (sites responsible for cortisol release)
= acute stress thereforre increases cortisol levels
What constitutes anxiery disorder?
-anxiety more extreme than normal (extent)
-Anxiety occurs in situations that shouldn’t provoke anxiety (context)
=significant distress and impairment of social/occupational/other functioning
what are the five different classifications of anxiety disorder?
- generalised anxiety disorder
- panic disorder
- specific phobia
- agoraphobia
- social phobia
What is generalised anxiety disorder?
Anxiety is generalised and persistent but not associated with any particular environment circumstance (free floating)
-it’s not due to substance misuse or any medical condition e.g hyperthyroid
describe symptoms of generalised anxiety disorder
dominant symptoms variable:
- persistent nervousness/trembling
- muscular tensions
- sweating
- lightheadedness
- palpitations
- dizziness
- epigastric discomfort
What is the classification for generalised anxiety disorder?
NEEDS TO BE: -long lasting (most days for 6mths+) -uncontrollable -causing significant distress/impairing functioning ASSOC. WITH: -restlessness -on edge -keyed up -easily fatigued -mind going blank -difficulty concentrating -irritability -muscle tension -sleep disturbance (difficulty falling/remaining asleep and unsatisfying sleep)
What is the lifetime prevalence/age onset/F:M ratio of generalised anxiety disorder?
Is there usually co-morbid psychiatric disorders?
Lifetime prevalence - 9%
Age onset - 20-40yrs
F:M - 2:1
90% have comorbid psychiatric disorders
Where do patients with generalised anxiety disorder usually present?
Primary/general care settings
- assoc. with disability/functional disorders/overutilisation health services and resources
- often diagnosis of exclusion with unnecessary medical ix and delay in treatment
What is the prognosis for generalised anxiety disorder?
-chronic and fluctuating course
Describe the biology of panic attacks
- Can be triggered in an individual susceptable by infusions of lactate or by re-breathing air
- no altered physiological activity, more a change in perception?
- PET shows an increase in the metabolism at the anterior lobe of temporal lobe (parahippocampal gyrus)
What is panic disorder?
recurrent attacks of severe anxiety (panic) not restricted to any particular situation or circumstance and are therefore unpredictable
(Not due to substance misuse/use or medical condition or better accounted for by a mental disorder e.g. depression)
What are the symptoms of panic disorder?
-sudden onset palpitations
-chest pain
-choking sensation
-dizziness
-depersonalisation
-derealisation
-secondary fear of dying/losing control/going mad
(may occur +/- agoraphobia)
what is the lifetime prevalence and age onset of panic disorder? is there comorbidities associated with it?
lifetime prevalence 2-3% (higher in cardio clinic) (50-60% also agorophobic)
onset late adolescents to mid 30’s
comorbid with other mental disorders (anxiety disorders/depression) and drug and alcohol abuse
what is the prognosis for panic disorder?
- chronic waxing and waning
- 10 year follow up: 1/3 unchanged or worse, 1/3 modest improvement, 1/3 better (well)
Describe clinical features of phobias in general?
- fear recognised as irrational
- typified by avoidance and anticipatory anxiety
what is the general age of onset of agorophobia and social/specific phobias?
Typically early onset
- agoraphobia: 50% presented by 20yrs old, 75% by early 30’s
- social/specific: 75% by early adolescence/early 20’s
What is agorophobia?
Fears of leaving home/entering shops or crowds or public places/travelling alone in trains, buses or planes
Describe the clinical features of agoraphobia
-avoidance of situation is prominent
-some avoid phobic situation and therefore never experience any anxiety/experience little anxiety
-may be primary disorder secondary to other pathology e.g. panic disorder/depression
-
What is specific phobia (AKA simple phobia)?
marked and persistent fear, excessive and unreasonable, cued by presence or anticipation of specific object/situation e.g. flying
describe the clinical features associated with specific phobia
exposure to phobic stimulus provokes immediate anxiety response akin to panic attack
- patient knows fear is excessive/unreasonable
- normal functioning is impaired (avoidance/anxious anticipation/distress)
- phobia is avoided or endured with intense anxiety/stress
What is social phobia?
persistant fear of 1+ social/performance situations where the person is exposed to unfamiliar people or possible scrutiny by others
Describe the clinical features of social phobia
- fear of doing something humiliating
- occurs in relatively small social settings
- exposure to feared situation provokes anxiety which could = panic attack
- (this can all result in bad school performance/school refusal/bad employment hx)
Describe the anxiety symptoms experienced in social phobia
- blushing/shaking
- fear of vomiting
- urgency/fear of micturition/defeacation
What is social phobia linked to which can be identified in toddlers or preschool children?
-behavioral inhibition (react to novel situations by withdrawal and avoidance to safety)
Describe the pathophysiology suggested in social phobia
increase in the activation of the amygdala bilaterally, and an increase in regional cerebral blood flow to the amygdala that normalises on successful treatment (pharmacological or psychological)
