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Psychiatry > Generalised anxiety, panics and phobias > Flashcards

Generalised anxiety, panics and phobias Flashcards

1
Q

Describe some of the physical symptoms of anxiety?

A
  • 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)
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2
Q

Describe some of the cognitive symptoms of anxiety?

A
  • 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
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3
Q

Why does everyone have anxiety and fear?

A

-genetically ingrained function of neurological system wih adaptive evolutionary significance

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4
Q

What do co-ordinated neural systems do during periods of anxiety/fear?

A

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)

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5
Q

What is the stress response?

A

exposure to stress = instantaneous and concurrent biological response
- assess danger and organise appropriate response

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6
Q

Describe the role of the amygdala in the stress response? How is this then modified?

A

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)

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7
Q

Describe the role of cortisol in the stress response

A

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

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8
Q

What constitutes anxiery disorder?

A

-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

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9
Q

what are the five different classifications of anxiety disorder?

A
  • generalised anxiety disorder
  • panic disorder
  • specific phobia
  • agoraphobia
  • social phobia
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10
Q

What is generalised anxiety disorder?

A

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

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11
Q

describe symptoms of generalised anxiety disorder

A

dominant symptoms variable:

  • persistent nervousness/trembling
  • muscular tensions
  • sweating
  • lightheadedness
  • palpitations
  • dizziness
  • epigastric discomfort
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12
Q

What is the classification for generalised anxiety disorder?

A 
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)
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13
Q

What is the lifetime prevalence/age onset/F:M ratio of generalised anxiety disorder?
Is there usually co-morbid psychiatric disorders?

A

Lifetime prevalence - 9%
Age onset - 20-40yrs
F:M - 2:1
90% have comorbid psychiatric disorders

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14
Q

Where do patients with generalised anxiety disorder usually present?

A

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
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15
Q

What is the prognosis for generalised anxiety disorder?

A

-chronic and fluctuating course

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16
Q

Describe the biology of panic attacks

A
  • 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)
17
Q

What is panic disorder?

A

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)

18
Q

What are the symptoms of panic disorder?

A

-sudden onset palpitations
-chest pain
-choking sensation
-dizziness
-depersonalisation
-derealisation
-secondary fear of dying/losing control/going mad
(may occur +/- agoraphobia)

19
Q

what is the lifetime prevalence and age onset of panic disorder? is there comorbidities associated with it?

A

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

20
Q

what is the prognosis for panic disorder?

A
  • chronic waxing and waning

- 10 year follow up: 1/3 unchanged or worse, 1/3 modest improvement, 1/3 better (well)

21
Q

Describe clinical features of phobias in general?

A
  • fear recognised as irrational

- typified by avoidance and anticipatory anxiety

22
Q

what is the general age of onset of agorophobia and social/specific phobias?

A

Typically early onset

  • agoraphobia: 50% presented by 20yrs old, 75% by early 30’s
  • social/specific: 75% by early adolescence/early 20’s
23
Q

What is agorophobia?

A

Fears of leaving home/entering shops or crowds or public places/travelling alone in trains, buses or planes

24
Q

Describe the clinical features of agoraphobia

A

-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
-

25
Q

What is specific phobia (AKA simple phobia)?

A

marked and persistent fear, excessive and unreasonable, cued by presence or anticipation of specific object/situation e.g. flying

26
Q

describe the clinical features associated with specific phobia

A

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
27
Q

What is social phobia?

A

persistant fear of 1+ social/performance situations where the person is exposed to unfamiliar people or possible scrutiny by others

28
Q

Describe the clinical features of social phobia

A
  • 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)
29
Q

Describe the anxiety symptoms experienced in social phobia

A
  • blushing/shaking
  • fear of vomiting
  • urgency/fear of micturition/defeacation
30
Q

What is social phobia linked to which can be identified in toddlers or preschool children?

A

-behavioral inhibition (react to novel situations by withdrawal and avoidance to safety)

31
Q

Describe the pathophysiology suggested in social phobia

A

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)

Psychiatry (26 decks)

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